Using Feedback to Improve Accountability in Global Environmental Health and Engineering.

Engineered environmental health interventions and services in low-income and resource-limited settings-such as water supply and treatment, sanitation, and cleaner household energy services-have had a less than expected record of sustainability and have sometimes not delivered on their potential to improve health. These interventions require both effectively functioning technologies as well as supporting financial, political, and human resource systems, and may depend on user behaviors as well as professionalized service delivery to reduce harmful exposures. In this perspective, we propose that the application of smarter, more actionable monitoring and decision support systems and aligned financial incentives can enhance accountability between donors, implementers, service providers, governments, and the people who are the intended beneficiaries of development programming. Made possible in part by new measurement techniques, including emerging sensor technologies, rapid impact evaluation, citizen science, and performance-based contracting, such systems have the potential to propel the development of solutions that can work over the long-term, allowing the benefits of environmental health improvements to be sustained in settings where they are most critical by improving trust and mutual accountability among stakeholders.