Validity, digital responsibility, and the community Health workforce in fragile contexts: governance Innovations and health service performance in Somalia

This paper analyzes the relationship between the Marwo Cafimaad community health workforce programme in Somalia and DHIS2-enabled digital accountability mechanisms, in relation to maternal and child health service utilisation, governance responsiveness, and service-level legitimacy. 

This dual-method case study employs a sequential mixed-methods approach that combines routine DHIS2 data (2018 to 2014) with interviews with key informants, focus group discussions, and service-delivery observations. The results of the quantitative findings focus on SBA, DPT3 vaccination, and ANC1, while the qualitative findings look at issues of trust, fairness, responsiveness, and communities’ experiences of health services.

The impact assessment of these service indicators demonstrates gains in the districts receiving both interventions, and three reinforcing mechanisms emerged: culturally aligned female community health workers strengthening trust and acceptability, digital feedback improving responsiveness and resolving issues, and visible accountability encouraging legitimacy at the service level. 

Read more to discover the study’s findings, governance processes, and implications for health service delivery in fragile settings. 

Validity, digital responsibility, and the community Health workforce in fragile contexts: governance Innovations and health service performance in Somalia