Improving maternal health through social accountability: a case study from Orissa, India.

As maternal health specialists accelerate efforts towards Millennium Development Goal Five, attention is focusing on how to best improve service accountability to target communities as a strategy for more effective policy implementation. We present a case study of efforts to improve accountability in Orissa, India, focusing on the role of local women, intermediary groups, health providers and elected politicians. We highlight three drivers of success: (1) the generation of demand for rights and better services, (2) the leverage of intermediaries to legitimise the demands of poor and marginalised women and (3) the sensitisation of leaders and health providers to women's needs. We use the concepts of critical consciousness, social capital and 'receptive social spaces' to outline a social-psychological account of the pathways between accountability and service effectiveness.