International Women’s Day 2025 is a timely reminder of the ongoing struggle for gender equality and women’s rights globally. This year’s theme, ‘Accelerate Action’, calls for better efforts to address systemic barriers and promote accountability in all sectors. To do this, it is vital to understand the role of power dynamics in shaping accountability and development outcomes.
At Itad, we are committed to advancing gender equality, disability inclusion and social inclusion (GEDSI) through the power of evidence. We accompany our clients to understand and address such dynamics, leading to more effective and sustainable interventions.
Lessons from the field of sexual and reproductive health rights
Accountability in sexual and reproductive health rights (SRHR) is intrinsically linked to power dynamics, as it involves holding stakeholders (governments, donors, and healthcare providers) responsible for their commitments to equitable and accessible healthcare services, products and rights. Furthermore, SRHR encompass fundamental human rights central to bodily autonomy, gender equality, and wellbeing. Thus, understanding power dynamics is essential for impactful programming that promotes GEDSI and empowers women and girls, whilst involving men and boys at different levels.
Last year, alongside my work as an Itad consultant, I completed a Master’s Degree in Governance, Development and Public Policy. My research explored Mozambique’s SRHR landscape and provided a comprehensive analysis of what strategies and how power shape accountability at different levels. Although power and accountability are dependent on the context in which they unfold, my research offers insights that are useful for any actors involved in enhancing accountability and access to SRHR. Below I outline some of the highlights, including different forms of power, examples of success and implications for organisations working to advance the SRHR and GEDSI agendas .
Different forms of power and their impacts
Power is manifested through different forms which can overlap or happen in parallel. Power can be visible, hidden and invisible. Each of these forms of power can exist in closed, invited or contested spaces and at different levels including local, national and global.
- Visible power is the observable use of structures, rules, and procedures to make decisions and maintain control. At the national level in Mozambique, visible power is evident in the Ministry of Health’s control over financial resources and the implementation of health policies. However, the centralisation of power in decision-making in the health sector, usually concentrated in a handful of individuals in control of planning, management and regulation, limits autonomy of local governments and other organisations often leading to inequitable resource distribution. The consequences of power concentration are evident in rural areas facing significant health infrastructure and services deficits. Women, girls, ethnic minorities and people with disabilities are amongst the most affected populations.
- Hidden power involves the control of agendas and the exclusion of critical voices. Corruption and patronage networks usually happen in closed spaces and divert resources from public health priorities, undermining public trust and exacerbating inequities. In Mozambique, the dominance of political elites and the incomplete decentralisation process has further weaken accountability mechanisms.
- Invisible power relates to internalised norms and beliefs that perpetuate inequality. This form of power is likely to happen across all levels and spaces. In Mozambique patriarchal attitudes and cultural stigmas around SRHR limit women’s autonomy and access to health services. Traditional beliefs and societal expectations often restrict women and girls’ decision-making power, particularly in rural areas where traditional beliefs and restricted access to education prevail.
Examples of success from civil society organisations
Prominent civil society organisations (CSOs) in Mozambique have exemplified how strategic approaches can enhance accountability and improve SRHR outcomes by addressing power dynamics at multiple levels through community engagement, policy advocacy and monitoring and evaluation.
- Through community engagement CSOs utilised Community Score Cards (CSCs) to bridge gaps between service providers and users, fostering transparency and dialogue. This ‘bottom-up’ approach involves communities in identifying issues and voicing their concerns and supporting the planning and monitoring of health programmes. A case study carried out by N’Weti, a prominent CSO in Mozambique showed that the CSC tool led to greater awareness of rights, better relationships with service providers and revitalised health unit Co-management Committees. This example highlights how certain CSO’s interventions can empower individuals to demand programmes that deliver better health services and respond to local needs. Combined with local level interventions, at the national level, policy advocacy promoted by CSOs within government ministries has shown efficiency in shaping policies and frameworks that enhanced SRHR accountability. Their advocacy efforts have influenced the National Health Sector Strategic Plan and resource allocation to community health systems, including for SRHR services, thus contributing for gender equality and better disability and social inclusion.
- CSOs’ monitoring and evaluation supports Mozambique’s Ministry of Health’s real-time data collection initiative, leveraging digital tools for transparent data sharing and evidence-based decision-making. This ensures that interventions are responsive to local needs and adaptable to changing contexts. Alignment between evidence and advocacy underscores CSOs’ strategic vision and their commitment to addressing systemic barriers to SRHR accountability.
Implications for the wider development sector
Understanding the interplay of power dimensions and their impact on accountability is crucial for our clients, including foundations, governments, and multilateral organisations. The following four takeaways demonstrate how strategies that enhanced accountability in SRHR, based on my research in Mozambique, can inform action and programming to accelerate gender equality, disability, and social inclusion.
- Designing inclusive interventions is essential to promote GEDSI. Recognising the influence of visible, hidden, and invisible power can strengthen interventions that address systemic barriers and promote GEDSI. Involving communities in decision-making processes is more likely to lead to effective and sustainable outcomes.
- Promoting transparency and accountability requires the right mechanisms to address corruption and ensuring visible resource allocation. Supporting initiatives that enhance data collection and evidence-based decision-making can improve accountability and service delivery.
- Challenging cultural norms and addressing invisible power involves confronting beliefs that perpetuate inequality. Programmes that promote GEDSI, dialogue, contest structural violence against minorities and empower women to make informed decisions about their lives and health are essential for achieving gender parity.
- Forming strategic partnerships, especially at the local level by collaborating with local CSOs and organisations, can enhance the effectiveness of interventions by utilising their understanding of local contexts and power dynamics. These collaborations can amplify efforts to promote accountability and improve women’s empowerment outcomes, thereby advancing GEDSI.
In conclusion, understanding how different power dynamics affect accountability in SRHR is crucial not only for advancing equitable healthcare access but also for catalysing gender equality, disability inclusion, and social inclusion. By recognising and addressing the different forms of power—visible, hidden, and invisible—organisations can design more effective and inclusive interventions. Insights from Mozambique highlight the importance of community engagement, strategic partnerships, and evidence-based advocacy in promoting accountability and improving SRHR and GEDSI outcomes. These strategies underscore not only the urgency of empowering women and girls but also the need to involve men and boys, ensuring a holistic approach to achieving equitable and accessible SRHR. As we continue to work towards these goals, it is essential to recognise the value of evidence, learning, and strategic thinking in addressing power dynamics and leveraging them to create sustainable, impactful change.
