The project studied accountability regimes in Brazil and Mozambique's health systems to understand how to strengthen accountability and deliver better healthcare for poor and marginalized groups. Case studies in Sao Paulo and Alto Rio Negro, Brazil and Maputo, Zambezia Province in Mozambique explored the political and institutional conditions under which accountability regimes are most effective in reducing health inequities. The project engaged experts and policymakers to share learning on upholding commitments to universal healthcare made over 30 years ago in both countries, and the ongoing challenges of operationalizing inclusive health systems.

1. The Accountability Politics of Reducing Health Inequities: Learning from Brazil and Mozambique
Unequal Voices
PI: Alex Shankland (IDS)
Co-leading: Vera Schattan Coelho (Cebrap – Brazil), Denise Namburete (N’Weti - Mozambique), Gerry Bloom (IDS)
Unequal Voices created a new set of evidences on the politics of accountability for health equity via multi-level case studies in health systems in
Brazil and Mozambique, exploring how multiple accountability regimes (electoral politics, public sector administration and social accountability)
can be strengthened to deliver better health services for poor and marginalised.
What can the megalopolis of Sao Paulo and the indigenous health district of Alto Rio Negro, in Brazil, and the capital Maputo and the Zambezia
Province, in Mozambique, say about what combinations of accountability regimes work best under which political and institutional conditions for
reducing health inequities?
✓ Brazil and Mozambique: Historical political commitment to universal health coverage more than 30 years ago. Advances and set-backs in
planning, managing and operationalising health systems in highly unequal settings that can be useful to the growing universal health
coverage movement
✓ National compacts: when, why and how universal health coverage became politically significant and the challenges to sustain the
promises and operationalise inclusive health systems
✓ Politics of accountability: understanding the conditions under which the promises of bridging the health inequalities gap work or fail to
deliver on health equality
Views from Mozambique
✓ Dis-functional decentralisation in Maputo and Quilemane: blurred accountability lines
✓ Donor’s Babel Tower: Donor (des) harmonisation and little mutual accountability
✓ Whose voice? Moving beyond the gift-model and putting citizens at the centre
Views from Brazil
✓ Increasing national and health sovereignty: government and civil society taking responsibility for expanding access to health coverage
✓ Sao Paulo: Political competition and the virtuous combination of pro-poor social mobilisation and management tools
✓ Rio Negro Special Indigenous Health District: The limits of the gift-model and mismatch between levels/spaces of/for accountability and
governance
Making knowledge works for accountability for universal health coverage
✓ Engaging an international network of experts in accountability and health to support the project
✓ Bridging knowledges and expertise: political scientists, anthropologists, public health experts, citizens and civil society organisations
✓ Critically engaging with local and national policy-makers and health managers in Brazil and Mozambique
✓ Creating spaces for mutual learning and effective collaboration across research and policy communities in the Global South Global South
Links:
IDS Bulletin “Accountability for Health Equity: Galvanising a Movement for Universal Health Coverage’: https://www.ids.ac.uk/news/accountability-for-health-equity-galvanising-a-movement-
for-universal-health-coverage/ https://www.youtube.com/watch?v=Ez6IOQIj_cs
UHC2030 IDS Webinar on Accountability for Health Equity May 2018 - https://www.youtube.com/watch?v=hRfuiyhkjOw
Video “Holding a Health System to Account: Voices from Mozambique (A Documentary)” - http://bulletin.ids.ac.uk/idsbo/article/view/2962/Online%20article
Contact: Denise Namburete (d.namburete@nweti.org.mz) or Laura Trajber Waisbich (laura.waisbich@gmail.com)