Table 2 Suggestions for improving social accountability in maternal health services in local settings

- To reach out to the population about expressing their concerns and complaints, and health providers about being responsive;

- The awareness activities at population level would be done by CHWs mainly during home visits;

- To provide CHWs with a small incentive;

- To improve community recognition of CHWs through an election process in the community;

- To train CHWs for improving their activities;

- The health providers could also get population’s voice through community survey conducted in PBF settings;

- to initiate periodic meetings between CHW, HC members, health providers and decision-makers to share and discuss health issues,

- To encourage the participation of the HZMT Officer in these meetings;

- To work on improving the women’s confidence in CHWs

- To reduce the “cutting” practices sometimes used when writing Health committee’s meeting report.

- To use CHWs for reporting complaints and concerns about health services;

- To reach out to the population about all existing social accountability mechanisms;

- To improve the work of CHWs by an adequate trainings and their choice through community election;

- The training of CHWs would be done by the HMT members in charge of community activities;

- To improve the functioning of health committee;

- To reach out to health providers for improving their responsiveness;

- To document population’s complaints and concerns using a formal system of records;

- To include local authorities and community leaders specifically religious leaders in the process;

- To bring forward complaints and concerns about GRH using CHWs, who could report them during Health committee meeting and through this latter’s report, to HZMT officer.

- To use mechanisms of Community Health Insurance

- To still continue to receive from the population concerns, questions and complaints using home visits;

- To bring them forward to health providers during dialogue meeting and the health committee meeting;

- To make all decision as a group and not individually;

- To sensitize population to report their concerns;

- To ask HMTO to be present in their meeting in order to get complaints and concerns about the GRH;

- To recognize that their number is not optimal given the sunk cost of working without being paid and the difficulty of enlisting local associations to become involved in non-remunerated activities.

- Observed that all accountability is centred on the nurse in- charge, who receives information from the health committee and has to be responsive with his team;

- To organize two meetings, one for the CHWs and their delegates in the health committee and the health committee meeting;

- To transmit decisions of the health committee to the CHWs for closing the loop;

- To organize public meetings putting together the health committee, the health centre providers and the community with the possibility of public questions and answers.

- To invite to these meetings local associations’ representatives and authorities specifically the HZMT officers;

- To collect actively information from the population mainly during home visits and to make a summary in the report;

- To provide some financial incentives to CHWs

- To sensitize the population specifically men on health problems, in order to increase their knowledge, enabling them to express easily their concerns and to monitor health centre activities, in collaboration with community associations (and churches);

- To use CHWs’ networks to report their concerns and complaints;

- To increase the number of CHWs

- To use local associations/groups for informing the population;

- To organize periodically meetings with community leaders, notables, local associations’ representatives, HC members, CHWs and health providers, invited by the health committee to discuss health concerns;

- To improve the health centre supervision by the HZMT.

- To maintain CHWs and to improve their interface activities.

- CHWs collected actively during home visits information from the community and to report them to health providers/The information collected actively by CHWs during home visits to be reported to health providers..

- To set in place a committee to which the population could also report their complaints and concerns. This committee will be composed of some community members coming from villages and CHWs, chosen by the community.

- To organize meetings between this committee and health providers quarterly and a general assembly during which health providers could respond to community concerns.

- This organization has to be preceded by a sensitization of the community.

- To organize periodic meetings putting together community members and health providers in order to allow the population to directly bring forward their grievances about health services to health providers;

- To use CHWs for collecting population’s concerns

- To invite women to participate in these meetings by CHWs through their associations/groups;

- To bring forward complaints and concerns directly to the person in charge of health facilities;

- To use CHWs for reporting complaints and concerns about health services, for avoiding health providers’ reprisals;

- To train CHWs to bring forward their concerns to health providers;

- Health providers have to discuss concerns of the population as a team for improving health services provision.