Sara Gullo|Christine Galavotti|Anne Sebert Kuhlmann|Thumbiko Msiska|Phil Hastings|C. Nathan Marti
Effects of a social accountability approach, CARE’s Community Score Card, on reproductive health-related outcomes in Malawi: A cluster-randomized controlled evaluation
CARE USA|CARE USA|Saint Louis University|Christian Health Association of Malawi
social accountability approaches emphasize mutual responsibility accountability community members health care workers local health officials improving health outcomes community increasingly employed lowresource settings evaluated effects social accountability approach cares community score card csc reproductive health outcomes ntcheu district malawi using clusterrandomized control designwe matched 10 pairs communities randomly assigning one pair intervention control arms conducted two independent crosssectional surveys women given birth last 12 months baseline two years postbaseline using differenceindifference local average treatment effect late estimates evaluated effects outcomes including modern contraceptive use antenatal postnatal care service utilization service satisfaction also evaluated changes indicators developed community members service providers intervention areasdid analyses showed significantly greater improvements proportion women receiving home visit pregnancy b 020 p 01 receiving postnatal visit b 006 p 01 overall service satisfaction b 016 p 001 intervention compared control areas late analyses estimated significant effects csc intervention home visits health workers 114 higher intervention compared control b 114 p 001 current use modern contraceptives 57 higher b 057 p 01 13 community providerdeveloped indicators improved 6 showing significant improvementsby facilitating relationship community members health service providers local government officials csc contributed important improvements reproductive healthrelated outcomes csc builds mutual accountability ensures solutions problems locallyrelevant locallysupported feasible implement