Since 2016, USAID has supported the Government of Nepal in improving quality of health service delivery and hygiene across 181 healthcare facilities in mountainous and hilly remote areas of Karnali and Lumbini provinces. The USAID Health and Hygiene (Swachchhata) Activity (2016-2024), supported healthcare facilities in rural and urban areas of Dolpa, Salyan, Jajarkot, Rukum West, Rukum East, Dailekh and Surkhet. HHA prioritized increased accountability of stakeholders in the following areas:
The brief highlights three forms of accountability—social, performance, and financial —addressing both effective approaches to improve accountability and challenges HHA faced. While this learning brief distinguishes the three forms of accountability to provide a more in-depth analysis, in reality, a holistic approach to strengthening systems-level WASH in healthcare is required to achieve and sustain quality health care services. Determining the right mix of accountability mechanisms makes for more effective and efficient interventions.