mothers, leaders). The facilitators mobilized the village members by cooperating with village council representatives in the catchment area. Invited participants were asked to spread the word about the meeting and, in the end, a large number of uninvited participants from other villages who had found out about the event also attended the meeting. A typical village meeting was attended by more than 150 participants per day.

In the community meeting, the facilitators used a variety of methods, including maps, venn diagrams, role-play, and focus group discussions, to disseminate the information in the report cards in a participatory, or interactive, way.<sup>15</sup> Information on patients’rights and entitlements was also discussed.<sup>16</sup> As the objective was not only to inform but to encourage people to participate in developing a shared view on how to improve service delivery and monitor the provider, the facilitators structured the discussions through a series of questions on the various elements of accountability in the primary health sector (who is accountable to whom?; what is a particular actor accountable for?; how can these actors account for their actions?; and how are these elements re‡ected in the report card ...ndings?). At the end of the meeting, the community’s suggestions for improvements (and how to reach them without additional resources) were summarized in an action plan. The action plan contained information on health issues/services that had been identi...ed as the most important to address; how these issues could be addressed and how the community could monitor improvements (or lack thereof). An abbreviated version of one such action plan is depicted in the appendix. While the issues raised in the action plans di¤ered across communities, a common set of concerns included high rates of absenteeism, long waiting-time, weak attention of health sta¤, and di¤erential treatment. After the meeting, participants were given posters and copies of the report card to bring back to their villages and share with their village members.

The health facility sta¤ meeting was a one-day (afternoon) meeting held at the health facility with all sta¤ present. In this meeting, the facilitators contrasted the information on service provision as reported by the provider with the ...ndings from the household survey. The meeting enabled the providers to review and analyze their performance, and compare their performance with other health clinics in the district and across the country.

An interface meeting with participants (chosen by people that attended the community meeting) from villages in the catchment area and the health facility sta¤ followed the community and health facility meetings. Based on the action plan developed in the community meeting and the discussions from the health facility meeting, the interface 15See the appendix for a more detailed description of the various methods used during the meetings. 16Information on patients’ rights and entitlements was based on the Yellow Star program. In 2000, the MoH developed a quality of care strategy called the Yellow Star Program with the aim of improving and maintaining basic standards of care at government and NGO health facilities. The rationale behind this strategy was the general consensus that the quality of health services had been a major deterrent to service utilization. The Yellow Star Program lists a set of basic standards of quality. The standards fall into six categories: Infrastructure and Equipment; Management systems; Infection prevention: Information: Education and Communication; Clinical skills; and Client services.

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