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Negotiated Spaces for Women's Health

Negotiated Spaces for Women’s Health includes 53 items measuring women’s and health workers’ perceptions regarding equity and quality of negotiated spaces. The social accountability measure evaluates CARE’s Community Score Card approach to creating effective and inclusive environments for women and health workers to interact. The items measure mutual responsibility through five aspects: level of citizen and health worker participation in negotiated spaces over the course of six months, mutual responsibility and collective efficacy, accountability and joint monitoring, participation in collective action, and the quality and equity of negotiated spaces.

Categories

Geographies Tested: Malawi

Populations Included: Female, Male

Age Range: Adolescents, Adults

Items:

ASKED ONLY OF WOMEN:

Mutual responsibility for & support of services
Who could have the most impact on…
1. …making sure that women are treated with respect by health workers?
2. …making sure that pregnant women have transportation to the hospital during emergencies?
3. …increasing the number of days a health worker visits your community?
4. …making sure the poorest and most vulnerable women and children in the community receive care?
5. …getting funding to improve health services in this community?

Response Options:
Community members together with health providers & district government officials - 2
Community members alone - 1
Health providers & district government officials, or higher level government officials & institutions (like the national government) - 1
No group is likely to have an impact - 0

Participation in negotiated spaces
6. In the past 6 months, have there been meetings between the community, health providers, and government representatives?
7. Were any of these meetings part of the Community Score Card process?
8. Was your Village Health Committee part of any of these meetings?
9. Did any other formal groups or committees participate in these meetings?

Response Options:
Yes - 1
No - 0
Don’t Know - 8

Joint monitoring & accountability for services
10. Problems or issues with health services were discussed.
11. Plans for improving health services were made.

Response Options:
Yes - 1
No - 0
Don’t Know - 8

Transparency (of negotiated spaces)
12. Information about health services was shared.
13. Community members voiced their concerns about health services.
14. Information on health services is widely available in this community.

Response Options:
Yes - 1
No - 0
Don’t Know - 8

Equity (of negotiated spaces)
15. Health issues of concern to the most vulnerable and marginalized groups were discussed.
16. Did at least half of the community attend these meetings?
17. Were at least half of those from the community who attended these meetings women and girls?

Response Options:
Yes - 1
No - 0
Don’t Know - 8

Quality (of negotiated spaces)
In the past 6 months, have meetings between health workers, district government authorities and the community been…
18. …well run?
19. …inclusive of broad participation from the community?
20. …focused on important issues?

Response Options:
Yes - 1
No - 0
Don’t Know - 8

ASKED ONLY OF HEALTH WORKERS:

Mutual responsibility for & support of service
Who is most likely to have an impact on…
21. …increasing the availability of health services in this community?
22. …improving working conditions for health workers like yourself?
23. …reducing wait times at the health facility?
24. …increasing the availability of equipment & supplies?
25. …increasing funding for improvements in health services?
26. …making sure that pregnant women in the community have transportation to the hospital during emergencies?
27. …making sure staff at the health facility are friendly and treat women well?
28. …making sure health workers keep patients’ information private?
29. …making sure the poorest & most vulnerable women & children in the community receive care?
30. …increasing the availability of skilled birth attendants at the health facility?
31. …increasing the number of women who go to the health facility to deliver their babies?

Response Options:
Community members together with health providers & district government officials - 2
Community members alone - 1
Health providers & district government officials, or higher level government officials & institutions (like the national government) - 1
No group is likely to have an impact - 0

Collective efficacy
32. How sure are you that health workers in this area/health facility AND community members can work together to improve health services for women & children?

Response Options:
5-point Likert scale
Completely sure - 5
Not at all sure - 1

Participation in negotiated spaces
Do you belong to a…
33. …Village Health Committee?
34. …Village AIDS Committee?
35. …Village Action Committee?
36. …Village Development Committee?
37. …Area Development Committee?
38. …Area Executive Committee?
39. …Maternal & Newborn Health Committee?
40. …Any other committees?

Response Options:
Yes - 1
No - 0
Don’t Exist - 7

Participation in health committee
In the past 6 months, have you met with…
41. …the Village Health Committee to discuss and work on health issues?
42. …the Health Centre Committee to discuss and work on health issues?

Response Options:
Yes - 1
No - 0

Participation in collective action
43. In the past 6 months, have you and other health providers in this health catchment area worked together with community members to improve health services?

Response Options:
Yes - 1
No - 0

Joint monitoring & accountability for services
44. Problems or issues with health services were discussed?
45. Plans for improving health services were made?

Response Options:
Yes - 1
No - 0
Don’t Know - 8

Transparency (of negotiated spaces)
46. Information about health services was shared?
47. Community members voiced their concerns about health services?

Response Options:
Yes - 1
No - 0
Don’t Know - 8

Equity (of negotiated spaces)
48. Health issues of concern to the most vulnerable and marginalized groups were discussed?
49. Did at least half of the community attend these meetings?
50. Were at least half of those from the community who attended these meetings women and girls?

Response Options:
Yes - 1
No - 0
Don’t Know - 8

Quality (of negotiated spaces)
In the past 6 months, have meetings between health workers, district government authorities and the community been…
51. …well run?
52. …inclusive of broad participation from the community?
53. …focused on important issues?

Response Options:
Yes - 1
No - 0
Don’t Know - 8

Scoring Procedures

FOR WOMEN’S MEASURES:
Mutual responsibility for & support of services: Item scores summed and divided by number of items.

Participation in negotiated spaces: Not available.

Joint monitoring & accountability for services: Not available

Transparency (of negotiated spaces: Not available

Equity (of negotiated spaces): Not available

Quality (of negotiated spaces): Not available

FOR HEALTH WORKERS’ MEASURES:
Mutual responsibility for & support of services:Item scores summed and divided by number of items.

Collective efficacy: The item is scored individually

Participation in negotiated spaces: Score is based on a sum of all yes responses

Participation in health committee: Score is based on a sum of all yes responses .

Participation in collective action: The item is scored individually

Joint monitoring & accountability for services: Not available

Transparency (of negotiated spaces): Not available

Equity (of negotiated spaces): Not available

Quality (of negotiated spaces): Not available

Original Citation

Sebert Kuhlmann, A. K., Gullo, S., Galavotti, C., Grant, C., Cavatore, M., & 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. Development Policy Review, 35(2), 289-311. https://doi.org/https://doi.org/10.1111/dpr.12209

Psychometric Score

Citation Frequency

Ease of Use Score

Formative Research

Qualitative Research

Existing Literature/Theoretical Framework

Field Expert Input

Cognitive Interviews / Pilot Testing

Reliability

Internal

Test-retest

Interrater

Validity

Content

Face

Criterion (gold-standard)

Construct

Ease of Use

Readability

Scoring Clarity

Length

KEY