In total 200 participants took part in our study, comprising childcare managers and parents (see Table 1) in the methods section. We identified two domains 1) processes of co-creating iSAMs, and 2) self-evaluation of iSAMs as summarised in Table 2
a) Defining accountability to whom and for what
The study participants agreed that this was the first step of the co-creation model. Parents and childcare managers described the importance of the collaborative definition of accountability to whom and accountability for what? The study participants described the importance of accountability to children and to each other as the key actors in childcare centres, for access and utilization of WASH services and products by the children in childcare centres.
“It is key to define accountability, for example, I am accountable to the child and to the parent of the child because they are the reason why I am in this centre.” (Childcare centre manager, Viwandani, F)
“I am accountable and by the way, parents need to be accountable to childcare centre managers and the children as well. It is important to define and agree because some parents think that they are only accountable to their child” (Parent, Korogocho, F).
In addition, parents felt the definition of accountability could enable parents to explore further on “accountability to whom” as such, parents thought they were accountable to not only childcare centre managers and children but also to their neighbours. Childcare centre managers also agreed on the same and described that they were also accountable to the government and local authorities.
“When we define accountability to whom, we get to think further. As parents, we are also accountable to our neighbours. For example, if I do not ensure children have access to water, sanitation and hygiene at the centre, the children might not access, be sick and disturb the neighbours because we share sanitation facilities at home” (Parent, Viwandani, F).
"If we find a good time to define accountability to whom, it becomes an opportunity to think of actors we are accountable to. We are also accountable to the government and other authorities” (Childcare centre manager, Korogocho, F)
There were dynamics in the definition of accountability for what. Male parents described that there was no need to define accountability for what as they thought they would forget, while female parents embraced the need to define the same, as they thought it could catalyse accountability.
“I think it is just ok to define accountability to whom; accountability for what is not necessary… this is because one can easily forget what they subscribed to and what they did not” (Parent, Viwandani, M)
“It is important to define accountability for what so that the centre manager can be keen on what you all agreed” (Parent, Viwandani, F).
b) Action and information on social accountability actions
Study participants described how once accountability for WASH service delivery is defined, there is a need for the key actors (parents and childcare centre managers) to act by ensuring the provision and utilization of WASH amenities by children. Parents described that their roles could include payment of childcare fees to enable childcare managers to purchase WASH amenities, or sometimes parents could purchase WASH amenities for children and deliver them to childcare centres. Parents expressed the willingness to prioritize availing the WASH needs of children in childcare centres, even when they lacked the amenities at their homes so that they could not be interrupted at work to avail the amenities.
“Once the roles are defined, it is important to act by availing water, sanitation and hygiene amenities in childcare centres, payment of a fee for the childcare centre managers to purchase the amenities or by referring well-wishers to the centres” (Parent, Viwandani, F).
“I am ready to forgo having water for instance in my house but ensure that the child has access to clean water and sanitation in the centre. This is because, I do not want to be interrupted by calls on the WASH needs by the centre managers, while I am at work” (Parent, Viwandani, M).
“I usually do not like my children to suffer when they are young. Anything we agree with the centre manager, I just avail; be it a fee or anything agreed. Even if I do not have water at home, I ensure the child has water at the centre because they spend most of their time there” (Parent, Korogocho, M).
Centre managers described the importance of availing WASH services and ensuring that children could utilise the amenities in the childcare centres.
“It is important to avail water, sanitation and hygiene services and products in childcare centres for children to use” (Childcare centre manager, Viwandani, M).
“Childcare managers should always act to ensure children use the water, sanitation and hygiene services and products at the centre. There are times when I train children on the use of the WASH amenities” (Childcare centre manager, Korogocho, M).
Despite the willingness of many parents, study participants described that in some instances, some parents might not avail WASH services due to their inability to oblige to pay the fee or unavailing the WASH amenities and products.
"There are some times when we are not able to avail adequate WASH amenities; more so when parents fail to do their responsibility of paying a fee or availing facilities at the centre" (Childcare centre manager, Korogocho, F).
“Some parents are not able to avail WASH facilities or products in childcare centres and could not pay the fee. They affect the ability of childcare centre managers to provide the amenities in the centres” (Parent, Viwandani, F).
c) Judging and assessing performance
Judging and assessing performance/action was thought to be key for continued provision and utilisation of WASH amenities. As such, during action/performance, participants agreed on the importance of assessing the progress of action/performance.
“We should monitor how children use WASH facilities and be present to give guidance when needed” (Childcare centre manager, Korogocho, M).
The assessment could potentially happen in many forms through visits to a childcare centre
“It is always good to assess performance. While taking my child to school, I confirm if the centre has potty/toilet facilities and drinking water” (Parent, Korogocho, F)
“I find it important to visit my child in the centre at least once in a month to confirm if the child is being attended to and could utilise available water, sanitation and hygiene facilities” (Parent, Viwandani, F).
“I sent her older sister to go and check if the child could access water and sanitation facilities at the centre” (Parent, Korogocho, M).
Some parents, most of whom were male, were committed to other duties and did not visit the childcare centres. As such, the parents would do an assessment of WASH amenities and service delivery digitally hence, the need for the iSAMs process as a support to effective social accountability.
“I usually ask the parents who take children to the centre on my behalf to find out about the status of WASH in the centre, where possible I ask them to take the photo of WASH facilities and share with me” (Parent, Korogocho, M).
"In many cases, I ask my neighbour who constantly visits the centre to take the photos of the facilities and share them during her visits" (Parent, Viwandani, M).
Judgement and assessment could also be done through reports
“I have to report to parents when they fail to meet what we agreed on regarding provision of WASH services… sometimes through a written note or phone calls” (Childcare centre manager, Viwandani, F).
“As parents, we ask children to report on access to WASH facilities while at the centre. Although very young children could not report effectively” (Parent, Korogocho, F).
d) Learning and adapting informal social accountability mechanisms
Study participants described how the assessment/judgement step should lead to learning and adapting of informal social accountability mechanisms that included informal interactions, shared understanding, rewards, sanctions, norms and values among others.
“If a centre manager is doing well, it is important to reward them as parents. The rewards could be in form of availing free water or paying extra money for their good task so that they could use the money to buy more WASH amenities… the reward could be adapted over time to always be effective” (Parent, Korogocho, F).
“For parents who are not compliant with what we agreed, it is good to communicate with them and encourage and train them to pay in instalments for their children to access WASH facilities. However, when they cannot improve in their compliance, we do not allow them to bring their children to the centre” (Childcare centre manager, Viwandani, F).
a) Improved understanding of childcare centres and building trust for WASH service delivery
Respondents mentioned that the discussions during the co-creation process resulted in new insights and awareness regarding childcare centre operations, challenges, values and WASH service delivery.
“One thing I take with me is that the childcare manager is investing in these matters {accountability for WASH service provision). It is valuable to see that there is an ongoing concern. They take these matters seriously and engage with parents. So, it feels good." (Parent, Viwandani, F).
Increased learning about accountability for WASH was mentioned, in that working with the researchers contributed to a more profound understanding of different aspects of social accountability and its relationship to WASH service delivery. The respondents described that, even though the concept of social accountability was not new to them, it was somewhat difficult to grasp and fully understand its practical meaning. The concept was operationalized and applied in their local context which then contributed to their greater understanding of the issues in focus. One participant whose views represented those of the majority described this in terms of getting a new, mutual and practical language.
“So, the centre has gotten a lot out of this co-creation work. We as individuals have got a language, we had never used the word accountability before, but I have done so now. Yes, so we have learned and gotten a lot out of this, the language seems practical to us” (Childcare centre manager, Korogocho, F).
b) Enhance inclusion, ownership and enable a satisfying co-creation process
Study participants acknowledged how the co-creation process was mutual and both parents and centre managers shared responsibilities. The participants noted that there was a great engagement of all during the workshop, a good grounding in the concepts, and informative with a great diversity in the participants. As such, the respondents expressed that they were satisfied with the balanced responsibilities and ownership throughout the whole process.
“We have tried to take responsibility and we have felt a sense of inclusion and ownership in the process, therefore, we are satisfied with the entire process, we deliberated a lot” (Childcare centre manager, Viwandani, F).
Many respondents expressed satisfaction with the collaboration in the overall co-creation structure as there were representatives of different primary actors. The participants perceived the co-creation process as straightforward, and a helpful tool to identify outcomes and processes. Some respondents desired to try the model for other service delivery challenges other than WASH.
“We do not have everyone involved but as representatives, it becomes easier for us to convince others. I will convince other parents. Childcare managers who are here will also convince their colleagues to apply the process to WASH service delivery and other services” (Parent, Viwandani, M).
Time, date and other plans of conducting FGDs and workshops were participants-led, as such, respondents expressed satisfaction in the process. Several respondents also expressed contentment with being listened to and said that they had the opportunity to have their voices heard.
"We were allowed to choose the best time to attend the session and we committed to the sessions. I think the researchers listened to us like never before. Which was helpful to all of us” (Childcare centre manager, Viwandani, F).
3. Negative self-evaluation of the co-creation process
Study participants identified various challenges to effective co-creation. These challenges were around timing and organisation. Further, the participants described how it could be challenging to consistently have committed local contributors and committed leaders.
“Amount of time that goes into the co-creation process can be challenging… the entire steps consumes a lot of time” (Parent, Viwandani, M).
“Time is very precious and challenging while engaging childcare managers and working parents… more so those who seemed informative and able to convince others because they are busy” (Childcare centre manager, Korogocho, F).
“I needed to be at a community forum but I had to give an apology so that I could join this meeting” (Childcare centre manager, Viwandani, F).
“Lots of people usually want to contribute liberally, but I do feel it needs some strong leadership from all actors involved” (Parent, Korogocho, M).
A final challenge was a need to ensure effective co-creation and positive outcomes, with limited resources and planning, while taking cognisant of social, structural and economic challenges of the local context in the informal settlements. As such, most parents and childcare centre owners who were underprivileged compared to the ones who were privileged raised this concern. For instance, some parents reported a lack of finance to purchase WASH facilities for their children. Several of the childcare centre owners and parents were positive but pointed out a lack of consistent commitment by some actors to perform their roles.
“One challenge is the lack of consistent commitment of partners and stakeholders to do the needful that will promote co-creation” (Childcare centre manager, Korogocho, F).
“The co-creation process was good but sometimes; we have inadequate resources and cannot afford to purchase potties, soap, water or buckets for hand washing” (Parent, Viwandani, F).