Sexual, Reproductive, Maternal Health andGovernance

What is Governance in SRMH programming?

Governance is the exercise of power in the management of public affairs. It is a dynamic, political process through which decisions are made, conflicts are resolved and diverse interests are negotiated. The process can draw its authority from formal written rules, as well as from informal processes such as unwritten cultural norms. CARE defines good governance as the effective, participatory, transparent, equitable and accountable management of public affairs guided by agreed upon procedures and principles, to achieve the goals of poverty reduction and increasing social justice. States operating with good governance are accountable (taking responsibility for actions) and transparent (providing relevant and timely information to the public), and they supply inclusive spaces where citizens can participate in decision-making that directly impacts their lives.

Governance approaches in CARE's SRMH programs aim to allow for communities to sustainably improve the performance, accountability and responsiveness of their health systems, leading to improvements in quality, coverage, and equity of health services. CARE’s approach to governance in SRMH draws upon the Governance Programming Framework, cultivating 1) empowered citizens; 2) effective, responsive, and accountable health providers and government officials; and 3) expanded, inclusive, effective spaces for negotiation between power-holders and citizens. Change needs to take place and be sustained in all three domains in order to strengthen health systems and ensure they are responsive and effective.

Guidance to Governance Work

CARE International UK's Guide to Governance Programming will help practitioners conceptualize,
plan, monitor and evaluate governance strategies, programs and projects - in any sector.
The guide includes three components:
Governance Programming Framework

Context Analysis

Monitoring & Evaluation

Approaches & Tools

Community Score Card - a citizen-driven accountability measure for the assessment, planning, monitoring and evaluation of service delivery.

Social Accountability - social accountability interventions engage
citizens for achieving better governance and service delivery outcomes through two components: 1) providing citizens information about rights, service delivery standards, and service performance, and 2) helping them to use this information to take action.

Citizen Surveillance - an approach that builds the capacity of national and regional civil society networks to act as citizen monitors to oversee the quality of maternal and child healthcare provision and advocate for the improvement of policies and programs.

Women's VOICES and Health Worker VOICES - two survey tools for evaluating the impact of social accountability approaches, like the Community Score Card (CSC), on governance processes and outcomes.

CARE's Experience with Governance in Health

Malawi: Maternal Health Project (MHAP)

Malawi Case Study: Local Initiatives for Health (LIFH)

Malawi Case Study: Supporting and Mitigating Impact of HIV/AIDS for Livelihood Enhancement (SMIHLE)

Malawi: The Sustainability of the Community Score Card and its Effects in Dowa

Cambodia: Using social accountability to strengthen health systems

Nepal: Practice of Community Score Board Forward Accountability

Nepal: Linking Governance and Empowerment to Improved Maternal and Newborn Health Services

Peru Case Study: Participatory Voices

Rwanda Case Study: Public Policy Information, Monitoring and Advocacy project (CSC tool)

Ethiopia Case Study: Springboard Project

Ethiopia Case Study: Getting Ahead Project (GAP)

Tanzania Case Study: Getting Ahead Project (GAP)

Tanzania Case Study: Health Equity

CARE's Evidence Generation

Click here for external evidence resources