Reviewer’ s report
Title: Implementing social accountability for contraceptive services: Lessons from Uganda
Version: 0Date: 27 Jul 2020
Reviewer's report:
This article constitutes an interesting contribution to the programmatic research on contraceptive
provision by introducing a community lens, using the concept of social accountability, to theusually individualized (or couple-based) approach to family planning decision-making. Theintervention described in the paper offer a good reminder that those decisions, and contraceptiveknowledge, perception and use in general do not exist in a vacuum, nor are they limited to clients -providers interaction.In addition, the qualitative research methods are presented in great details and support a thick, richanalysis of the considerable amount of data available to support the results.
Some additional revisions would further clarify and strengthen this paper.*While the authors give a general definition of "social accountability", it seems necessary to
introduce how it was specifically operationalized in the two interventions used to support thepaper's finding.*In addition, social accountability efforts are usually more geared towards improving quality ofcare for health services. Here the authors seem to suggest that it would also increase contraceptiveuptake and even continuation, which would indeed be a remarkable achievement. It would beworth detailing the mechanism behind this increased social accountability increased FP use
relationship, perhaps by briefly presenting the main findings from some of the cited references?
Another welcome addition would be clarifying how while social accountability improves access tohealth services in other field, it may or may not work that way for contraceptive services?*Could the author clarify who is held accountable in those two interventions and how it influencesFP services use? The stated definition of social accountability implies that the public is holdingproviders accountable for the services they provide, but the interventions described here seem tofocus more on community transparency, sharing and acceptance around FP?*In other words, how are the intervention described here part of a "social accountability" effortrather than Behavior Change Communication?*For the "Case Study A", we couldn't find a clear definition / presentation of the "scorecard" andthe intervention described seems to be a slightly modified version of "community dialogues". It'dbe fine if both interventions are community dialogues, but if A and B are indeed different, thenthose differences need to be more clearly detailed and contrasted.*It might be useful to detail any reported instances of competition between the various communitygroups in the limitation section. Participatory approaches are notoriously not egalitarian as moreprivileged participants (because they're endowed with more social capital to begin with) canconfiscate the participatory mechanisms to serve their own interests and agenda, while the morevulnerable are further marginalized (e.g. in the case of FP, if older, married women are the most
vocal participants, the contraceptive need of youth and adolescents could be obfuscated by the
dominant discourse). This is worth discussing here as the authors admit that they selected more
socially privileged individuals to participate in the community dialogues.*Finally, the programmatic lessons in sustainability for that type of intervention are worthdeveloping. The authors touch up them as they indicate that the groups somewhat fizzled out afterthe money to support their meetings ran out. To what extend then are the observed results theproduct of the "social accountability" and associated practice, vs. a simple "pilot project effect"that cannot be durably integrated in FP programs?Some minor suggested edits:
p.7, l.18-19"Data collectors were post-graduate students and had at least an undergraduate
qualification, […]" Clarify for readers unfamiliar with the Ugandan education system.
p. 7, l. 27"Interviews were one hour long" Add missing wordp.15, l.15"improvements in improved" Repetition is a bit awkward, edit if possible.
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(default)
Is the study design appropriate to answer the research question (including the use of appropriate
controls), and are the conclusions supported by the evidence presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?YesIs the use of statistics and treatment of uncertainties appropriate?NoIs the presentation of the work clear?YesAre the images in this manuscript (including electrophoretic gels and blots) free from apparent
manipulation?
Yes