Sara Gullo|Anne Sebert Kuhlmann|Christine Galavotti|Thumbiko Msiska|C. Nathan Marti|Philip A. Hastings
Creating spaces for dialogue: a cluster-randomized evaluation of CARE’s Community Score Card on health governance outcomes
CARE USA|Saint Louis University|CARE USA|Christian Health Association of Malawi
social accountability interventions cares community score card show promise improving sexual reproductive maternal health outcomes key component intervention creation spaces community members healthcare workers district officials safely interact collaborate improve healthrelated outcomes evaluate interventions effect governance constructs power sharing equity central theory changewe randomly assigned ten matched pairs communities intervention control arms administering endline surveys women arm given birth last 12 months fortysix governance items reduced factor analysis eight underlying scales evaluated interventions impact constructs using local average treatment effect estimatesamong interventionarea women reported community meeting evaluated influence governance constructs healthrelated outcomes home visit community health worker modern family planning satisfaction health services significantly greater proportion interventionarea women compared control reported existence community groups provide facilitate negotiated space community members healthcare workers p 003 several governance constructs positively associated healthrelated outcomes active participation intervention also positively associated several governance constructscares community score card facilitated creation claiming effective inclusive negotiated spaces community members healthcare workers could vocalize service delivery issues prioritize actions improvement argue reliable measurement governance concepts power sharing equity quality negotiated space collective efficacy mutual responsibility enhance ability evaluate social accountability interventions understand processes affect change