Mobile not an accountability ‘silver bullet’
Making All Voices Count Research Spotlight
“If you build it, they *might* come”: Contrary to the pop-culture refrain, building (or in this case, developing or rolling out) a mobile tool is not sufficient to enact change.
Case in point: Practitioners in civic tech talk about the benefits that flow from mHealth innovations and information and communication technological (ICT) interventions as a “given” — that they will drive improvements in health systems, and support citizen engagement and service provision accountability.
But there is little systematic research here to back this up. In fact, the findings of a new Making All Voices Count (MAVC) report — by Tabitha Hrynick and Linda Waldman — found that strong stakeholder relationships with “government actors” are just as critical to success in mHealth accountability as the tech intervention itself.
The authors address the gap in the research literature through their study of the accountability models of seven mHealth initiatives in developing countries.
Why you should care
The report found that incorporating mobile interventions in your accountability model is not a sufficient condition for encouraging engagement or driving changes to the levels of service delivery. Simply put: mobile isn’t the silver bullet solution we so often suggest it is. Civic tech projects and organisations — both in and outside of mHealth — will find the recommendations provided by the report illuminating, and can use the key findings to maximise their own engagement and feedback strategies.
The gist of it
All the organisations assessed in the review use mobile tools — tablets and mobile phones — to capture information on health services. Five of the seven used the tech tools to source feedback from citizens and shared this information with the public health institutions. They found that the tech tools aided the efficiency of the information capturing and feedback process.
According to the researchers, the seven organisations shared two common, well-founded, assumptions: that encouraging citizen engagement and amplifying users’ voices can bolster accountability, and that information gathering is a critical step towards improving service provision. But the authors note two more, less immediately evident, assumptions shared by the organisations reviewed: Firstly, the assumption that citizens would use the technology provided, and, secondly, that the public officials who were responsible for these services would respond to this feedback to improve services. It is in these latter assumptions that the research found that potential missteps lie.
The report delves into these and other barriers to accountability, and highlights the complex combination of conditions required for the greatest chance of a successful feedback loop within accountability projects. , Primarily, programme examples with existing, well-established and maintained public stakeholder relationships were most likely to succeed on those terms.
Report summary
This report (pdf, 1.3MB), by Tabitha Hrynick and Linda Waldman, explores the successes and challenges of the ICT-supported accountability programmes of seven mHealth initiatives, specifically OurHealth, eThekwini WACs, and Thuthuzela Voices (all in South Africa); Mobile Mapping for Women’s Health (Tanzania); Text2Speak (Nigeria); SMS Gateway, and Citizen Journalism for Quality Governance of Universal Health Insurance Scheme (both Indonesia).
Through a mixed methods approach (combining narrative information sourced through interviews with quantitative information from project reports), the research reveals the conditions that promoted both engagement and accountability within the programmes.
The learnings are relevant to civic tech initiatives beyond health: The researchers found that mobile accountability tools do in fact speed up the collection and analysis of the required information. But this is countered by elements like slow app or tool development, and personnel changes in public stakeholder positions.
On the latter point, the authors write: “Changes in government staffing (locally or nationally) also meant that some projects lost the crucial link with sympathetic and influential individuals who were willing to listen to and amplify citizen voices within government and policy circles, and take action when necessary.”
What was done
The researchers conducted a series of semi-structured interviews with representatives of the organisations who were identified as “having the most experience relevant to [the] enquiry”. These interviews focused on the interviewees’ self-assessment: both how they had imagined the interventions to affect accountability, and “how this played out in practice”. Interview time was also give to help understand the broader context of each project, the design and implementation of interventions, and stakeholder collaboration successes and challenges.
The researchers also incorporated information and insight from the documentation (proposals, progress and final reports) on these projects held by funding partner Making All Voices Count.
What happened?
Through this mixed methods approach, as well as a nuanced literature review of the existing debates and discussions about this subject, the researchers provide a rich and insightful picture of the mHealth for accountability space. They caution that their aim was not to determine whether projects where ultimately successes or failures. Instead, they worked towards providing a better understanding of project design and implementation, and how this can promote or hinder outcomes.
What did the researchers learn?
The research report shines a spotlight on several common road bumps experienced both in mHealth specifically, and in civic tech more generally. In the early phases of developing the mHealth intervention, the interviewees reported experiencing delays that set their overall timelines back. This was “due to having to adapt to realities on the ground or because of tensions and misunderstanding with private technical partners”. This is in line with the findings of another MAVC report, and reiterates the importance of strategic tool choice and project planning.
Other key findings include:
- Strategic partnerships bolster uptake and accountability: “Engaging existing community-level groups or forums is more likely to lead to success in uptake of ICTs for improving health services and strengthening accountability.”
- A network of relevant stakeholders increases input and overcomes the “negative feedback” factor: “Other stakeholders (e.g. health workers) must be involved to maximise impact and sustainability and to allay any fears about consequences of negative feedback.”
- Working collaboratively with decision-makers achieves more than an antagonistic or “call out” stance: “Unless those in positions of power to change things (locally and / or nationally) are allies in the process, efforts are unlikely to meet with success.”
- Match online opportunities to offline ones: “Offline spaces can strongly complement online innovations to leverage individual citizens’ feedback and translate that feedback into action to improve services.”
The authors also note, rather worryingly, that “the services that required the most attention … were the ones least likely to be addressed. This illustrates how highly unfavourable feedback can pose barriers to accountability.”
For the full details, you can access the research report here.
Publication: “ICT-facilitated accountability and engagement in health systems: a review of Making All Voices Count mHealth for accountability projects”
· Authors: Tabitha Hrynick, Linda Waldman
· Download (PDF, 1.3MB): https://opendocs.ids.ac.uk/opendocs/bitstream/item/14034/RReport_ICTfacilitated_Online_final.pdf
