This is a tool for measuring governance outcomes in reproductive and maternal health programs to evaluate a social accountability approach.
Why is the tool important?
The growing popularity, and promise, of social accountability approaches within the health sector makes fostering good evaluation research to ensure that these approaches actually deliver benefits for women and children particularly important. This multidimensional survey tool was tested in Mali to evaluate maternal and reproductive health social accountability interventions.
Who is the tool for?
The tool is meant for health workers, practitioners and researchers.
Country of focus: Malawi
How can I use the tool?
VOICES is a multidimensional survey tool for studying the types of groups in which women participate (including for collective action purposes); reasons that women do or do not attend/participate in community meetings; to consider the extent to which women feel they would be treated fairly and taken seriously/be influential at community meetings; to consider women's awareness of their legal rights; and to consider women's take-up of public services to which they are entitled.
VOICES is designed to investigate three domains of governance outcomes:
Domain 1: Women and community members empowered—The development of empowerment measures for Women’s VOICES drew upon CARE’s multidimensional quantitative survey tool–Women’s Empowerment-Multidimensional Evaluation of Agency, Social Capital and Relations (WE-MEASR). Scales adapted from WE-MEASR include measures of attitudes and beliefs about gender roles (for example, rejection of intimate partner violence, belief in a woman’s right to refuse sex); household power dynamics (for example, participation in household decision-making, self-efficacy to enact health-promoting behaviors); social cohesion and collective efficacy; and structural and cognitive social capital, including membership of and help from community groups.
New measures include scales to measure women’s knowledge and awareness of health rights, participation in collective action and perception of service quality.
Domain 2: Health workers empowered and responsive—For Health Workers’ VOICES, measures adopted include self-efficacy to improve one’s own performance as well as to improve the quality of health services delivered; social cohesion and collective efficacy; perceptions of service quality and service efficacy; and knowledge and awareness of rights–both patients’ rights and their own rights to supplies and a safe work environment. The tool also includes scales that measure perception of supervisor support and appreciation, as well as work attachment and satisfaction–key components of motivation, retention and performance improvement to health workers.
Domain 3: Expanded, inclusive and effective negotiated spaces—The domain's measures were informed by the GPF’s Monitoring and Evaluation Guidance Note.
When and how was it developed?
Researchers Anne K. Sebert Kuhlmann, Sara Gullo, Christine Galavotti, Carolyn Grant, Maria Cavatore and Samuel Posnock developed the tool in 2017 from theory and past research.
Where can I get the tool? Who can I contact?
Gender in rural institutions and governance: A review of existing tools. CGIAR GENDER Platform working paper 002.
Women’s and Health Workers’ Voices in Open, Inclusive Communities and Effective Spaces (VOICES): Measuring Governance Outcomes in Reproductive and Maternal Health Programmes
Sebert Kuhlmann, A.K., Gullo, S., Galavotti, C., Grant, C., Cavatore, M. and Posnock, S. (2017), Women's and Health Workers’ Voices in Open, Inclusive Communities and Effective Spaces (VOICES): Measuring Governance Outcomes in Reproductive and Maternal Health Programmes. Dev Policy Rev, 35: 289-311. https://doi.org/10.1111/dpr.12209