Citizen feedback in a fragile setting: social accountability interventions in the primary healthcare sector in Sierra Leone

Abstract

Fragile and conflict-affected states are frequently characterised by their inability to fulfil three core governance functions: provision of security, effective delivery of basic public goods and services, and managing political participation and accountability. This article explores the utility of social accountability interventions in fragile environments. Successful social accountability interventions can lead to joint examinations of public service standards by service-users and providers, resulting in collaborative improvement efforts. The few available studies of such interventions implemented in fragile or conflict-affected states show reasons for optimism as well as challenges. This article advocates the continued use of social accountability methods in fragile settings and provides examples of social accountability interventions in the health sector in Sierra Leone. The study suggests that social accountability can improve interaction between citizens and public service providers. Successful social accountability interventions can also lead to better quality and more accessible public services, which, in turn, can enhance state legitimacy.

Keywords: Sierra Leone; basic public services; citizen feedback; fragile states; governance; health; risk assessment; social accountability.