Social Accountability at the Service Delivery Level · Social Accountability at the Service Delivery Level Kristin Savard, White Ribbon Alliance Enhancing capacity of civil society,

Social Accountability at the Service Delivery Level

Kristin Savard, White Ribbon Alliance Enhancing capacity of civil society, parliamentarians and the media for budget analysis and advocacy for women’s and children’s health Nairobi, Kenya August 29, 2013

The broad range of actions and mechanisms that citizens can use to hold the state to account, as well as actions on the part of government, civil society, media and other actors that promote or facilitate these efforts.

Social Accountability

Benefits of Social Accountability

1) Contributes to improving public services and policies by narrowing the gap between the vision/policy & the reality

2) Empowers women by creating a space where they are asked to contribute their experiences and point of view & where they are informed of entitlements

3) Enables ongoing advocacy to formulate policies, monitor implementation because it’s rooted in the understanding that policy change is not a one-off activity

Government Function

SA Mechanisms & Tools

Policies & Plans Local issue forms Deliberative polling

Budgets & Expenditures

Participatory budget formulation Public expenditure tracking surveys

Delivery of Goods & Services

Public hearings Verbal Autopsy Community Scorecards

Public Oversight CSO oversight committees

SA Mechanisms & Tools

Public Hearings

Community Checklists

Verbal Autopsies

“The verbal autopsy conducted by WRA-Orissa is not only an eye opener to all of us, but it helps in identifying gaps that need to be addressed properly so that the lives of mothers can be saved.”

- Dr. Seba Mohapatra Former Director of Health Services

Orissa

Verbal Autopsy Process

1. Gather information on maternal deaths from the health institution

2. Form a team 3. Conduct interviews 4. Document findings 5. Advocate

Elements Central to WRAI’s SA

1. Generating Demand for rights and better services via information and mobilization

2. Leveraging Intermediaries to support the demands of women via dialogue and engagement

3. Sensitizing Leaders & Providers on the needs of women through external and internal levers via negotiation

Challenges

• Buy-In: fear of exposing vulnerabilities; ‘fact-finding’ not ‘fault-finding’, need assurance of positive outcomes.

• Demystifying government procedures, policies, programs, rights and entitlements

• Status of Women: women asserting their rights in a society where historically they have had extremely limited access to decision making

• Gathering Evidence: Who has the information and how can you get it?

Recommendations

• Identify key stakeholders (intermediaries, leaders, citizen groups) and engage them early in the planning of SA initiatives

• Pursue maternal health SA efforts in tandem with more systemic efforts to empower women and ameliorate gender power dynamics

• Highlight achievements as well as gaps in progress and delivery of commitments

• Remember that SA isn’t a one-off activity and develop a long term plan

Raising Her Voice to Demand Improved Maternal Health Service Delivery

A short term pilot by WRA Uganda and Akina Mama wa Afrika (AMwA) the coordinating agency of Women First Coalition to contribute towards the popularization and domestication of the Maputo Protocol

Focus on Article 14 2a and 2b: Health and Reproductive Rights States Parties shall ensure that the right to health of women, including sexual and reproductive health is respected and promoted

Who was involved?

WRA Uganda piloted the initiative in Mityana district working with:

WRA district members Women Community members Community and district leaders Area members of Parliament District Health Team (DHO, Health Center

Managers, Health Unit Management Committees & Village Health Teams etc)

Health CSOs in health sector-AMREF, Marie Stopes,

PNFP health service providers

Approach

1. Awareness and Information dissemination on:

Right to Respectful Maternity Care

Family Planning Maternal health service

entitlements at each level of healthcare

This was aimed at stimulating demand for rights and better service availability

2. Forming & training a community based advocacy and monitoring group

Approach

3. Health facilities assessment by community members on availability of maternal health service provision using a check list

Approach

4. Analysis of data and prioritization of findings

Approach

Key findings at Kyamusisi HC III • No electricity- At night

midwives deliver using candles or cell phones or mothers are asked to buy kerosene/paraffin for the lamp

• No running water • No Clinical Officers • No resuscitation device • No delivery set • No sterilizer/Autoclave • No blankets at the unit

• No security guard, making it risky for health workers to receive clients at night

• Non functional blood pressure machine

• 1 delivery bed • 8 health workers out of

recommended 19 at HC III (two midwives-one on study leave, the other was also Ag. In-charge)

• Inadequate and untimely provision of essential medicines

5. Dialogue and engagement with leaders and health care providers to support the demands of

women and acting on them

Results

Two clinical Officers recruited

A Lab Technician recruited The district provided funds

in the budget to provide solar power to the facility

15 blankets were provided A delivery set was

provided A bulb for resuscitation

was acquired