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Key Findings:

• Although there are some specific challenges to applying an HCD lens to community accountability work, in general, it can be a valuable framework to use in designing and implementing accountability programs. More assessment will be required to fully understand the connection between implementing specific HCD phases and steps and the extent to which doing so increases the success of using community accountability to achieve outcomes.
• Using HCD tools such as activities, games, and interview and discussion guides can facilitate targeted, in-depth investigations of specific topics to guide the development of community accountability programs. Using these tools can help program implementers find the right balance between lengthy and deep examinations of a community and shorter or more circumscribed approaches to identifying MHQoC challenges.
• Rapid prototyping is a central component of HCD that comes from manufacturing practices. This concept is easier to apply when developing and testing specific community accountability tools, such as mobile phone-based apps or electronic applications. However, community accountability rarely involves just one specific product, but usually encompasses a series of processes and products. Thus, implementers must adapt the concept of rapid prototyping for this use case.
• It is important to define and measure success from both a design perspective and a public health perspective. MHQoC strategy grantees have largely recognized this need, tracking both process-oriented measures such as health officials’ responsiveness to accountability measures and outcome measures such as changes in maternal morbidity and mortality.