Using evidence to strengthen accountability for health financing in Sierra Leone.

In 2012, the government of Sierra Leone cut the national budget allocation to the health sector. Civil society organizations planned a nationwide health budget advocacy campaign, coinciding with the 2012 general elections, to hold future leaders to account on financing for women's and children's health. As part of the campaign, Evidence for Action produced district health budget tracking scorecards. The scorecards presented Ministry of Finance data on the allocation and disbursement of health funds in each district. The data were communicated using simple, non-technical language so that citizens could understand the key messages and take action. A total of 5600 scorecards were shared at district electoral forums attended by political candidates, community members, and health activists. Since the election, the proportion of the total government budget allocated to health increased from 7.4% in 2012 to 11.2% in 2014. However, transforming politicians' commitments and pledges into implementation has been challenging, confirming that accountability is a long-term process.

Using evidence to drive action: a "revolution in accountability" to implement quality care for better maternal and newborn health in Africa.

Introducing evidence-based accountability mechanisms at national and subnational levels into maternal newborn health programs can accelerate reductions in maternal and newborn mortality. Clearly packaged evidence has the potential to catalyze change, if it is communicated not only to the public but also to key policymakers. Evidence for Action (E4A) is a DFID-funded program that contributes to global efforts toward improving accountability in maternal and neonatal health. It uses evidence to drive action and accountability to improve maternal and newborn survival in six African countries: Ethiopia, Ghana, Malawi, Nigeria, Sierra Leone, and Tanzania. This paper introduces the E4A program, the rationale that underpins the program design, and presents initial findings on how information and data currently feed into accountability and implementation across the six E4A countries.

Using scorecards to achieve facility improvements for maternal and newborn health.

The Government of Sierra Leone launched the Free Health Care Initiative in 2010, which contributed to increased use of facility based maternity services. However, emergency obstetric and neonatal care (EmONC) facilities were few and were inadequately equipped to meet the increased demand. To ensure provision of EmONC in some priority facilities, the Ministry of Health and Sanitation undertook regular facility assessments. With the use of assessment tools and scorecards it is possible to make improvements to the services provided in the period after assessment. The exercise shows that evidence that is shared with providers in visually engaging formats can help decision-making for facility based improvements.