We assess the impact of a transparency and accountability program designed to improve maternal and newborn health (MNH) outcomes in Indonesia and Tanzania. Co-designed with local partner organizations to be community-led and non-prescriptive, the program sought to encourage community participation to address local barriers in access to high quality care for pregnant women and infants. We evaluate the impact of this program through randomized controlled trials (RCTs), involving 100 treatment and 100 control communities in each country. We find that on average, this program did not have a statistically significant impact on the use or content of maternal and newborn health services, nor on perceptions of civic efficacy or civic participation among recent mothers in the communities where it was offered. These findings hold in both countries and in a set of prespecified subgroups. To identify reasons for the lack of impacts, we use a mixed-method approach combining interviews, observations, surveys, focus groups, and ethnographic studies that together provide an in-depth assessment of the complex causal paths linking participation in the program to improvements in MNH outcomes. Although participation in program meetings was substantial and sustained in most communities, and most attempted at least some of what they had planned, only a minority achieved tangible improvements, and fewer still saw more than one such success. In our assessment, the main explanation for the lack of impact is that few communities were able to traverse the complex causal paths from planning actions to accomplishing tangible improvements in their access to quality health care.

我们评估了旨在改善印度尼西亚和坦桑尼亚产妇和新生儿健康（MNH）结果的透明度和责任制计划的影响。该计划与当地合作伙伴组织共同设计，以社区为主导且非强制性的，旨在鼓励社区参与，以解决当地阻碍孕妇和婴儿获得高质量护理的障碍。我们通过随机对照试验（RCT）评估该计划的影响，该试验涉及每个国家的100个治疗和100个对照社区。我们发现，平均而言，该计划对产妇和新生儿保健服务的使用或内容没有统计上的显着影响，也没有对提供该计划的社区中的最近母亲的公民功效或公民参与的观念产生统计上的影响。这些发现在两个国家和一组预先指定的亚组中均适用。为了确定缺乏影响的原因，我们采用混合方法，将访谈，观察，调查，焦点小组和人种学研究相结合，共同深入分析将计划参与与改善之间联系的复杂因果路径。 MNH结果。尽管在大多数社区中参加计划会议的人数很多且持续不断，并且大多数人至少尝试了他们计划中的某些计划，但只有少数人取得了明显的进步，只有很少的人看到了如此成功。在我们的评估中