CVA_Jeff Hall_10.16.13

CITIZEN VOICE AND

ACTION

CORE Group Fall Meeting 2013 – Washington

DC

World Vision’s Approach to Social

Accountability

What is

Citizen Voice and

Action?

What is “Citizen Voice and Action”?

Citizen Voice and Action is a social accountability approach

designed to improve the relationshipbetween communities and

government, in order to improve services,

like health care and education, that impact the daily lives

of children and their families.

How does

Citizen Voice and

Action

work?

“Citizen Voice and Action” in

Practice

CVA Phase One:

“Enabling Citizen Engagement”

“Enabling Citizen Engagement” is an awareness raising phase (up to 1 year). Begin with human rights, but focus on their articulation under local law (“what vaccines should be available at my clinic? “What hours should the doctor work?”)

CVA Phase Two:

The “Community Gathering”

The “Community Gathering” is a series of four participatory meetings that equip communities to monitor service provision at the schools and clinics they use every day

CVA Phase Two:

The “Monitoring Standards”

ProcessIn the “monitoring standards” session, communities, service providers, and civil society visit brick-and-mortar facilities (like clinics and schools) to compare reality against the commitments that government

Sample “Monitoring Standards”

Data

Midwives 1 per RHC None Left in June

ORS Free and available

Available, but with fee

Vaccines for children

Free and available

Free and available

Beds 3 2 1 broken not replaced

Keembe Mushikili RHC

CVA Phase Two:

The Community Scorecard

In the “score cards” session, we invite focus groups (government, service providers, marginalized groups, etc.) to rate facilities against criteria that they themselves generate. Communities use a 5-point “smiley scale” that encourages participation by children and illiterate

Sample “Community Score Card”

results

CVA Phase Two:

The Interface Meeting

The “Interface Meeting” convenes100-200 participants from government, civil society, and the community to review the results of the monitoring exercise and create an action plan to improve services.

CVA Phase Three – How will we

address the issues identified?

Citizen Voice and Action Scale Up –

227 Programmes in 34 countries in

FY13

CVA activity in FY13

RESULTS?

CVA’s Impact on

Child Well-Being

Social Accountability - Impact on

Health Outcomes –

Bjorkman/Svennson 2009J-PAL researchers used Randomized Control Trials to study

the impact of an approach like Citizen Voice and Action at

50 clinics in 9 districts of Uganda:

Quality of Care. After one year, relative to comparison

villages, health facilities in treatment villages:

Experienced a 12-minute reduction in average wait time

Experienced a 13% reduction in absenteeism

Health Outcomes. After one year, relative to the comparison

villages, the treatment villages showed a:

33% drop in under-five mortality

58% increase in use of skilled birth attendants

19% increase in number of patients seeking prenatal care

Results holding after 4 years.Bjorkman, M and Svensson, J, 2009. Power to the People: Evidence from aRandomised Field Experiment on Community Based Monitoring in Uganda.Quarterly Journal of Economics.

Social Accountability - Impact on Education Outcomes – Zeitlin 2011

Oxford University researchers used Randomized Control

Trials to study the impact of the CVA Score Card in100

Ugandan primary schools. After one year, in the schools

using the CVA score card, they found:

• Test scores rose by an average of 9%

• Pupil attendance increased by 8-10%.

• Teacher absenteeism dropped by13%.

• Cost: $1.50/student

• A “standardized” score card had no significant

impact.

Andrew Zeitlin, Management and Motivation in Ugandan

Primary Schools: Impact Evaluation Final Report (2011).

In 13 of the 17 clinics where CVA has been introduced,

staff have increased; 7 of the clinics showed staff

increases of more than 2 staff.

In 3 clinics, the number of women in a month attending

for antenatal services and to give birth more than

doubled.

In 4 clinics, dedicated maternity services were initiated.

In 3 of the clinics, Prevention of Mother to Child

Transmission (PMTCT) services either started or were

expanded.

Communities, clinic staff, and local government officials

attribute the changes to increased advocacy by the

community.

Citizen Voice and Action in Uganda

Citizen Voice and Action in Zambia

4 out of 5 targeted facilities have reported deployment of

additional staff

Community members in 5 sites reported reduced waiting

hours (average reduced from 6 hours to 2 hours).

The Community of Milopa, in Lufwanyama District,

successfully pressured for the construction of a new

clinic by 2015.

Construction of clinic has resumed in Chibombo District.

# of deliveries at health centres increased by 64% in

Lufwanyama District between 2011-12.

Chibombo recorded an upward movement of 3% in

under-5 immunization between 2011 and 2012.

Governments, communities, and service providers

attribute improvements to increased engagement

between citizens and government

“Vertical” Citizen Voice and Action:

Linking communities to policy

influence

• Uganda: Practitioners used data from CVA to

demonstrate inadequate clinic staffing on MNCH.

• Result: Coalition work ultimately persuaded

parliament to forgo drastic cuts in health budget.

Prime Minister committed to hire of 6100 new

health workers.

• Armenia: Practitioners and coalition partners used

CVA data to identify problems in MoH pay structure

that were discouraging doctor visits to poor rural

areas.

Result: Policy-level reform of pay structure of

doctors.

• Peru: Practitioners created new departmental CSO

“Vertical” Citizen Voice and Action:

Linking communities to policy

influence

Now for something

completely different

1. Each person will be given one voucher.

2. You can invest your voucher in one of 2

accounts (a “private” or “group” account).

3. These accounts pay returns in points in different

ways.

4. Your investment is anonymous. You cannot

discuss your investment choice with other

participants.

Playing the Investment Banker

If you invest your voucher in the Private Account you will

earn:

(A) a fixed return of XX points; PLUS

(B) 1 point for every voucher that the other participants

have decided to invest in the Group Account.

If you invest your voucher in the Group Account you will

earn 1 point for every voucher that you and the other

participants have invested in the Group Account.

Playing the Investment Banker

Instructions:

Instructions:

1. Write your name on your voucher.

2. Write “Private” or “Group” on your voucher to indicate

where you will invest.

3. Pass your voucher to our broker.

Your investment is anonymous. You may not indicate

your choice to any other investor or plan your investment.

Playing the Investment Banker

1. Why did you invest as you did?

2. What if the stakes had been higher? Would higher

stakes have changed your investment behavior?

3. Do you think it would have changed the outcome if

you had had a chance to discuss with your fellow

investors prior to investing?

Playing the Investment Banker

1. Why did you invest as you did?

2. What if the stakes had been higher? Would higher

stakes have changed your investment behavior?

3. Do you think it would have changed the outcome if

you had had a chance to discuss with your fellow

investors prior to investing?

Playing the Investment Banker

Voluntary Contribution Mechanism

game – why does it matter?

Propensity to invest

in the group bank

correlates with other

measures of group

cohesion and ability

to solve collective

action problems.

• Over the course of an academic year, 30 schools

used the score card, 40 schools served as a control

group.

• At the end of the year, researchers from Oxford and

Makerere University played the “Voluntary

Contribution Mechanism” game with the School

Management Committee from each school.

• “Group” bank pays 1,000Ushs for every participant

who invested in the first bank.

• “Private” bank pays 6,000Ushs, plus 1,000Ushs for

every participant who invested in the group bank.

Field Experiment results from

“Voluntary Contribution Mechanism”

game:

• Participants who had participated in the score card

exercise during the school year were 16% more

likely to invest in the group bank.

• These schools also exhibited a 9% increase in test

scores, and drops in student and teacher

absenteeism by 10% and 13%, respectively.

• World Vision and Johns Hopkins SPH have

extended this study to 16 sites in four countries to

examine how CVA contributes to collective action for

health outcomes.

Field Experiment results from

“Voluntary Contribution Mechanism”

game:

“I have more confidence and knowledge to speak at the District and I have the support of the community members and the community health clinic…. At first they didn’t have the confidence to speak. (But) the community have more courage to speak up in community meetings. The women also speak. They have more ‘fight’.”

Yoseph Marianus, village head of Flore Island

Collective Action among

communities: strengthening local

leadership

Jeff Hall

Director, Local Advocacy

World Vision International

[email protected]

tinyurl.com/citizenvoiceandaction

Thanks!