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Original research COMMUNITY-LED MONITORING AS ACCOUNTABILITY MECHANISM IN URBAN HEALTH INSTITUTIONS: A MIXED-METHODS CASE STUDY FROM BLANTYRE, MALAWIPages 25-34
Abstract
Community-led monitoring (CLM) is promoted as an institutional accountability mechanism for rights-based HIV services, yet facility-level evidence from urban settings is scarce. This convergent parallel mixed-methods study at two urban facilities in Blantyre, Malawi combined a client survey (n=250), key informant interviews (n=12) and three focus group discussions (n=15). Awareness of CLM was moderate (56.0%) but participation lower (40.2%), with involvement rated 2.78/5, placing CLM at the consultative rung of Arnstein's ladder. Awareness was the only robust predictor of participation (adjusted odds ratio 5.02, 95% CI 2.38–10.6). Notably, 46% of participants monitored services without recognising the term “CLM”. CLM strengthened communication more than institutional responsiveness; accountability mechanisms existed but functioned informally, and the two facilities differed on none of nine indicators (all p>0.12). Urban CLM is a real but under-institutionalized practice: formalising existing monitoring through low-cost documentation, scheduled feedback and independent complaint channels is the decisive governance lever.
Keywords:
Community-led monitoring, institutional accountability, citizen participation, HIV service delivery, health governance, Malawi.
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Misheck Dickson Banda, 
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