Broadening understanding of accountability ecosystems in sexual and reproductive health and rights: A systematic review

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Study Justification:
– Accountability for sexual and reproductive health and rights is receiving global attention.
– However, there is a lack of focus on accountability mechanisms at the national and sub-national levels.
– This systematic review aims to fill this gap by examining accountability strategies in the field of sexual and reproductive health and rights.
Highlights:
– The review analyzed 40 peer-reviewed articles from 41 low- and middle-income countries.
– Accountability was discussed in five health areas: maternal, neonatal and child health services, HIV services, gender-based violence, and access to reproductive health care.
– Three main groupings of accountability strategies were identified: performance, social, and legal accountability.
– The review identified a complex ‘accountability ecosystem’ with multiple actors and interactions across different levels.
– The publications provide limited insight into the connections between accountability strategies and contextual conditions for successful implementation.
Recommendations:
– Obtain a more nuanced understanding of the underpinnings of successful accountability approaches at national and sub-national levels.
– Further research is needed to explore the connections between accountability strategies and contextual conditions.
– Strengthen the evidence base for accountability initiatives in sexual and reproductive health and rights.
Key Role Players:
– Researchers and academics in the field of sexual and reproductive health and rights.
– Policy makers and government officials responsible for implementing accountability mechanisms.
– Non-governmental organizations and civil society organizations working in the field of sexual and reproductive health and rights.
– Health care providers and professionals involved in delivering sexual and reproductive health services.
Cost Items for Planning Recommendations:
– Research funding for further studies and data collection.
– Capacity-building and training programs for policy makers and government officials.
– Resources for knowledge dissemination and awareness campaigns.
– Support for non-governmental organizations and civil society organizations to implement accountability initiatives.
– Investments in health care infrastructure and service delivery to support accountability mechanisms.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a systematic review that followed a well-defined protocol and used a meta-interpretation approach for analysis. The review included a large number of articles and covered multiple disciplines. However, the abstract does not provide specific details about the inclusion and exclusion criteria, the search strategies used, or the quality appraisal process. To improve the strength of the evidence, the abstract could include more information about these aspects, as well as the specific findings and conclusions of the review.

Background Accountability for ensuring sexual and reproductive health and rights is increasingly receiving global attention. Less attention has been paid to accountability mechanisms for sexual and reproductive health and rights at national and sub-national level, the focus of this systematic review. Methods We searched for peer-reviewed literature using accountability, sexual and reproductive health, human rights and accountability instrument search terms across three electronic databases, covering public health, social sciences and legal studies. The search yielded 1906 articles, 40 of which met the inclusion and exclusion criteria (articles on low and middle-income countries in English, Spanish, French and Portuguese published from 1994 and October 2016) defined by a peer reviewed protocol. Results Studies were analyzed thematically and through frequencies where appropriate. They were drawn from 41 low- and middle-income countries, with just over half of the publications from the public health literature, 13 from legal studies and the remaining six from social science literature. Accountability was discussed in five health areas: maternal, neonatal and child health services, HIV services, gender-based violence, lesbian/gay/bisexual/transgender access and access to reproductive health care in general. We identified three main groupings of accountability strategies: performance, social and legal accountability. Conclusion The review identified an increasing trend in the publication of accountability initiatives in Sexual and Reproductive Health and Rights (SRHR). The review points towards a complex ‘accountability ecosystem’ with multiple actors with a range of roles, responsibilities and interactions across levels from the transnational to the local. These accountability strategies are not mutually exclusive, but they do change the terms of engagement between the actors involved. The publications provide little insight on the connections between these accountability strategies and on the contextual conditions for the successful implementation of the accountability interventions. Obtaining a more nuanced understanding of various underpinnings of a successful approach to accountability at national and sub national levels is essential.

The review methodology was initially structured with a realist and multi-disciplinary intent to ask “what works in terms of accountability mechanisms in the field of sexual and reproductive health rights (SRHR) at sub-national and national levels, how, why and in which context?”. The review is based on a protocol that was reviewed by an international expert technical committee. We were guided by a meta-interpretation approach [13], which maintains an interpretive epistemology in its analysis, congruent with primary qualitative research. The guiding principles of meta-interpretation are (1) avoiding predetermined exclusion criteria; (2) a focus on meaning in context; (3) using interpretation as unit for synthesis; (4) an iterative approach to theoretical sampling of the studies, and (5) a transparent audit trail to ensure the integrity of the synthesis. It is suitable for this review because it allows capturing the different dimensions relevant to accountability strategies at national and sub-national levels relevant to SRHR accountability. To capture the accountability strategies across multiple disciplines, we used three search engines: PubMed (health literature), Web of Knowledge (social sciences) and LexisNexis Academic (law). The search terms included combinations of free-text words in TI and /or all fields, depending on the search strategies allowed by the database in question (Table 1 and S1 Table). We refer to the latter for the Boolean operators used for each database search strategy. Options to select languages other than English were limited in the three databases. In LexisNexis Academic, two categories of law reviews were available to cover different languages: (1) UK and European journals and (2) Brazilian, Asian law and French language journals and reviews. The UK/European law journals also include journals on legal traditions from LMIC, e.g. Journal of African Law and the Journal of Asian Law. No specific language or country selection options could be made in PubMed and Web of Science. Each abstract was screened using the inclusion and exclusion criteria presented in Table 2, covering time period, geographic range, language and publication type. The abstracts that met the inclusion criteria (articles on low and middle income countries in English, Spanish, French and Portuguese published from 1994 onwards—the year of the first International Conference on Population and Development was organised publications on low and middle income countries) were then reviewed to assess if they (1) relate to any accountability strategy or mechanism, (2) relate to a SRHR area or (3) a national level judicial or reconciliation mechanism (such as court proceedings of international war tribunals). The latter included studies reviewing jurisprudence from supreme, constitutional or other national and provincial level courts. To verify fidelity to the inclusion criteria, a sample of 20 abstracts per database were checked for inclusion/exclusion by a second senior researcher. Two researchers discussed the papers for which they had a different opinion until a consensus was reached. After the full text review, articles were further excluded based on the exclusion criteria (e.g. articles related to global and regional accountability mechanisms). We present the papers that were included in S2 Table. The review question guided the data extraction. Categories included in the data extraction include: (1) author; (2) SRHR issue; (3) year of publication; (4) number of citations (Google Scholar); (5) year of intervention; (6) original language; (7) funding source; (8) study setting; (9) type of study; (10) accountability type according to the article or as deduced by the researcher; (11) accountability relationship (from whom to whom); (12) accountability strategy and implementation instrument; (13) level at which strategy is supposed to work; (14) purpose (why?); (15) lessons learned; (16) reported outcomes; (17) mechanisms; (18) equity effects; (19) description of the intervention or action; (20) scale of the intervention or action; (21) target population and finally (22) the actors involved in the accountability strategy. Since this review covers several disciplines (public health, social sciences, legal studies) with different disciplinary standards for writing and quality appraisal, it is difficult to apply a single framework to assess quality across the cases. Legal reviews, for instance, apply a critical (post-positivist) paradigm and typically do not provide a methodology section. Other studies included do not neatly distinguish between reporting and interpreting results. To gauge quality across the papers, we applied the principles of data quality appraisal for qualitative research [14] and used “Not applicable (NA)” when criteria were not applicable (see S3 Table). Narrative synthesis [15] was used to summarize results and numerical frequencies per category were calculated, whenever this was applicable. Thematic analysis was used to examine the different categories of accountability strategies that emerged.

Based on the provided description, it seems that the review is focused on understanding accountability mechanisms in sexual and reproductive health and rights (SRHR) at national and sub-national levels. The review identified three main groupings of accountability strategies: performance, social, and legal accountability. These strategies aim to improve access to maternal health and other SRHR services. However, the review does not specifically mention innovations or recommendations for improving access to maternal health.
AI Innovations Description
The systematic review titled “Broadening understanding of accountability ecosystems in sexual and reproductive health and rights” explores accountability mechanisms for sexual and reproductive health and rights at national and sub-national levels. The review identifies three main groupings of accountability strategies: performance, social, and legal accountability. These strategies aim to improve access to various areas of sexual and reproductive health, including maternal, neonatal and child health services, HIV services, gender-based violence, and access to reproductive health care in general.

The review highlights the need for a more nuanced understanding of the underpinnings of successful accountability approaches at national and sub-national levels. It emphasizes the importance of considering the complex “accountability ecosystem” with multiple actors and their roles, responsibilities, and interactions across different levels.

The review methodology used a realist and multi-disciplinary approach to examine what works in terms of accountability mechanisms in sexual and reproductive health rights. The search for relevant literature was conducted across three databases, covering public health, social sciences, and legal studies. The inclusion criteria focused on articles from low and middle-income countries published in English, Spanish, French, and Portuguese from 1994 to October 2016.

The data extraction process involved categorizing the included articles based on various factors such as author, SRHR issue, year of publication, accountability type, accountability strategy, and reported outcomes. Quality appraisal of the included papers was challenging due to the different disciplinary standards across the disciplines covered in the review.

Overall, the review provides valuable insights into accountability strategies in sexual and reproductive health and rights. It calls for further research to better understand the connections between these strategies and the contextual conditions necessary for their successful implementation.
AI Innovations Methodology
Based on the provided description, it seems that the review is focused on understanding accountability mechanisms for sexual and reproductive health and rights (SRHR) at national and sub-national levels. The review methodology involves a systematic search for peer-reviewed literature using specific search terms across three electronic databases. The search yielded 40 articles that met the inclusion and exclusion criteria. The included studies were analyzed thematically and through frequencies where appropriate. The review identified three main groupings of accountability strategies: performance, social, and legal accountability.

To simulate the impact of recommendations on improving access to maternal health, a methodology could involve the following steps:

1. Identify the specific recommendations: Based on the findings of the review, select the recommendations that are most relevant to improving access to maternal health. These recommendations could be related to accountability mechanisms, interventions, or strategies.

2. Define indicators and data sources: Determine the indicators that can be used to measure the impact of the recommendations on improving access to maternal health. These indicators could include maternal mortality rates, antenatal care coverage, skilled birth attendance, etc. Identify the data sources that provide information on these indicators, such as national health surveys, health facility records, or administrative data.

3. Establish a baseline: Collect data on the selected indicators for a specific time period before implementing the recommendations. This will serve as the baseline against which the impact of the recommendations will be measured.

4. Implement the recommendations: Put the selected recommendations into practice. This could involve implementing accountability mechanisms, interventions, or strategies at national and sub-national levels.

5. Monitor and collect data: Continuously monitor the implementation of the recommendations and collect data on the selected indicators. This can be done through routine data collection systems, surveys, or other data collection methods.

6. Analyze the data: Analyze the collected data to assess the impact of the recommendations on improving access to maternal health. Compare the indicators from the baseline period to the indicators after the implementation of the recommendations. Use statistical methods, such as regression analysis or difference-in-differences analysis, to determine the causal effect of the recommendations on the indicators.

7. Interpret the findings: Interpret the findings of the data analysis to understand the extent to which the recommendations have improved access to maternal health. Identify any challenges or limitations encountered during the implementation of the recommendations.

8. Disseminate the results: Share the findings of the impact assessment with relevant stakeholders, such as policymakers, healthcare providers, and community members. Use the results to inform future decision-making and improve access to maternal health.

It is important to note that the specific methodology for simulating the impact of recommendations on improving access to maternal health may vary depending on the context and available resources. The steps outlined above provide a general framework for conducting such an assessment.

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