• Carolyn Blake, Nii Ankonu Annorbah-Sarpei, Claire Bailey, Yakubu Ismaila, Sylvia Deganus, Samuel Bosomprah, Francesco Galli, and Sarah Clark.
• Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland. Electronic address: carolyn.blake@unibas.ch.
• Int J Gynaecol Obstet. 2016 Dec 1; 135 (3): 372-379.

BackgroundWith the limited availability of quality emergency obstetric and newborn care (EmONC) in Ghana, and a lack of dialogue on the issue at district level, the Evidence for Action (E4A) program (2011-2015) initiated a pilot intervention using a social accountability approach in two regions of Ghana.ObjectiveUsing scorecards to assess and improve maternal and newborn health services, the intervention study evaluated the effectiveness of engaging multiple, health and non-health sector stakeholders at district level to improve the enabling environment for quality EmONC.MethodsThe quantitative study component comprised two rounds of assessments in 37 health facilities. The qualitative component is based on an independent prospective policy study.ResultsResults show a marked growth in a culture of accountability, with heightened levels of community participation, transparency, and improved clarity of lines of accountability among decision-makers. The breadth and type of quality of care improvements were dependent on the strength of community and government engagement in the process, especially in regard to more complex systemic changes.ConclusionEngaging a broad network of stakeholders to support MNH services has great potential if implemented in ways that are context-appropriate and that build around full collaboration with government and civil society stakeholders.Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

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