The power of participatory monitoring in making the Sustainable Development Goals … · 2017-07-27 · 2 The power of participatory monitoring in making the Sustainable Development

CARE Governance

The power of participatory monitoring in making the Sustainable Development Goals a reality

The power of participatory monitoring in making the Sustainable Development Goals a reality 1

Contents

Executive summary 2

Background 3

Whatisparticipatorymonitoring? 3

CARE’shistorywiththeconcept 3

CARE International’s current engagement with participatory monitoring 5

CSCs–methodologyandapplication 5

Socialmonitoring–methodologyandapplication 9

Outcomes of participatory monitoring 11

Citizenempowerment 11

Improvedrelationsbetweencommunitiesandserviceproviders 11

Improvementsinservice-provideraccountability,responsivenessandeffectiveness 12

Improvementsinserviceavailability 12

Improvementsinserviceaccess 13

Improvementsinserviceutilisation 13

Lessons from participatory monitoring in practice 14

Post-2015 implications: A new approach to the data revolution 15

Towardsadatarevolution 15

Adatarevolutionrequiresachangeoflevels 15

Adatarevolutionrequiresachangeinactorscollectingthedata 16

Adatarevolutionrequiresachangeinthetypeofinformationcollected 16

Towards a model for participatory monitoring of the SDGs 18

Six-step model for participatory monitoring of the SDGs 21

Advantagesofthesix-stepmodel 21

Conclusions 23

References 24

2 The power of participatory monitoring in making the Sustainable Development Goals a reality

Executive summary

BeforegovernmentsaroundtheworldbeginimplementingtheSustainableDevelopmentGoals(SDGs)on1January2016,arobustmonitoringsystemmustbeputinplacetotrackprogressinaconsistentandrigorousmanner.AtCAREInternational,webelievethatthissystemrequiresmorethanjustbettertechnology,moresurveysandgreatergovernmentcapacitiesincollectinginformationandtransparencyinpublishingdata.Thisisonlyonesideoftheequation.Basedonoursuccessfulexperienceswiththeapproachinabroadvarietyofcountries,webelievethatincorporating participatory monitoring into the SDG process can provide much that was lacking in the MDG system.

Participatorymonitoringaddsvalueinthreedistinctways.One,itdevelopsanindigenousaccountabilitymechanismintheformof‘shadowreporting’toprovideoversightofthedataenteringandpassingthroughtheofficialsystem.

Two,itintroducesnew,criticallyimportantcontextualinformationonthequalityofservice-deliveryinputsthathasbeenlackinginpreviousmonitoringsystems.Respondingonlytooutcomesleavesgovernmentsconstantlybehindthecurve;understandingthelinkbetweeninputsandoutcomesgivesbothnationalandinternationalcommunitiesmorerobustoptionsforimprovingservice-deliveryinatimelyfashion.

Three,itlinkslocalcommunitieswithanendeavourthathaslargelybeentheremitoftheinternationalcommunity,therebydeliveringagreatersenseofownershipandpotentiallyshiftingincentivesinapositivedirection.Ifdevelopedfurtherandultimatelyimplemented,participatorymonitoringwillprovideanecessarycomplementtoanyofficialUN/WorldBankmonitoringsystemestablishedforJanuary2016.

Buildingonatwo-tiered approach to measuring progress against the SDGs,thispaperpresentsapotentialsix-stepmodelforeffectivelyincorporatingparticipatorymonitoringintothemonitoringsystemforthepost-2015developmentgoals.WehaveanopportunitynowtocreateamonitoringsystemfortheSDGsthatdelivers the datarequiredfortheinternationalcommunityandchanges the incentives of national governmentstorespondtodomesticaswellasinternationalprioritieswhensettingdevelopmentagendas.Progressonthesecomplementaryobjectiveswillculminateinpotentiallystrongermonitoringsystemsandbetterdevelopmentoutcomesfortheworld’spopulation.


Background

What is participatory monitoring?Participatorymonitoringismuchmorethantheuseofparticipatorytechniqueswithinaconventionalmonitoringandevaluationsetting.Itinvolvessubstantiallyrethinking who initiatesandundertakestheprocess,andwho benefitsfromthefindings(GuijitandGaventa1998).Theconcepthasevolvedoveraseriesofdecadesintomanydifferentforms.

Essentially,however,participatorymonitoringhasfour broad principles:

• Participation–whichmeansopeningupthedesignoftheprocesstoincludethosemostdirectlyaffected,andagreeingtoanalysedatatogether;

• Negotiation–toreachagreementaboutwhatwillbemonitoredorevaluated,howandwhendatawillbecollectedandanalysed,whatthedataactuallymeans,andhowfindingswillbeshared,andactiontaken;

• Learning–whichbecomesthebasisforsubsequentimprovementandcorrectiveaction;

• Flexibility–isessential,sincethenumber,role,andskillsofstakeholders,theexternalenvironment,andotherfactorschangeovertime.

Participatorymonitoringisnowoftensubsumedunderthemoreexpansiveterm‘socialaccountability’.Thisapproachseekstobuildaccountabilitybyrelying on ordinary citizens and/or civil society organisations participatingdirectlyorindirectlywithofficialstoachieveaccountabilitythroughabroadrangeofactionsandmechanisms.Thesecitizen-drivenaccountabilitymeasurescomplementandreinforceconventionalmechanismsofaccountability,suchaspoliticalchecksandbalances,monitoringsystems,administrativerulesandlegalprocedures(WorldBank2004).

CAREbelievesthatparticipatorymonitoringandsocialaccountabilitymechanismsmoregenerallyarecrucialformaking the voices of the most marginalised heard,increasingpublicawarenessofglobaldevelopmentgoals,andbysodoing,generatingcollectiveactionandbottom-updemandsagainstinadequateservice-delivery.Ithasthedual benefit ofallowingbeneficiarycommunitiesthemselvestoassessthequalityofserviceprovisionandprovideaccurateinformationabouttheirownsatisfaction,whilealsoofferingservice-providersanddistrictandnationalofficialstheopportunitytoassesstheperceptionofusersintermsofqualityofservices,totrackoutcomes,andtotakecorrectivemeasurestoimproveperformance.Thiscreatesapotentiallyvirtuous circle of accountability and responsivenessthatcouldbeappliedtothemeasurementofthepost-2015SustainableDevelopmentGoals(SDGs).

CARE’s history with the conceptCAREInternationalhassignificantexperienceworkinginsocialaccountabilitywithcommunitiesandgovernmentofficialsacrosstheglobeinarangeofdifferentcontexts.Togetherwiththesestakeholders,CARE has developed a variety of approaches and models,includingCommunityScoreCards(CSC),adaptedmodelssuchasCommunityHealthScoreBoards(CHSB),andalternativecitizenoversightmechanismsimplementedthroughcommunitymonitors.TheCSCmethodology,developedbyCAREMalawiin2002aspartofahealthservicesproject,wasaninnovativeapproachtofacilitatingaparticipatoryassessmentofhealthserviceprovisionanddevelopingasharedstrategyforitsimprovement.Sinceitsinception,theCSChasbecomeaninternationallyrecognisedprocessforimprovingservicedeliveryandhasbeenacentralcomponentofmanyofCARE’sgovernanceprogrammesacrossarangeofsectorsincountriesthatincludeRwanda,Tanzania,Malawi,EthiopiaandEgypt.

CARE is also a partner in the World Bank’s Global Partnership for Social Accountability (GPSA).InMalawi,CAREisoneoftwoorganisationsthatwereawardedgrantstoaddressteachers’absenteeismandcorruptioninschools,usingmobiletechnology(cellphoneandITplatform)andCommunityScoreCardsasthemeanstoimproveaccountability.InBangladesh,CAREisalsooneofjusttwoorganisationsthatwereawardedgrantstosupportthecapacityofcitizenstoparticipateatthelocallevelinparticipatorybudgetingandtomonitortheuseofdecentralisedgovernmentfunds.


InEgypt,inOctober2010andinpartnershipwiththeWorldBank,CAREorganisedthefirstregionalworkshoponsocialaccountabilityintheArabworld.SinceMarch2012,whentheGPSAwasofficiallylaunchedintheregion,CARE has been managing the ANSA network for the Arab world (Morocco, Tunisia, Egypt, Palestine, Jordan, Lebanon, and Yemen).BeyondtheCSCapproachCAREhasalsousedothermethodsofsocialaccountabilityincontextsasdiverseasNepalandPeru,asdiscussedbelow.

CARE has also supported participatory monitoring efforts in conflict and post-conflict contexts,linkinglocaltonationalandglobal-levelrecovery,peacebuildingandtransitionalgovernanceprocesses.IncontextsasdiverseasAfghanistan,Burundi,Sierra LeoneandYemen,CAREhasundertakenresearchandsupportedcivilsocietyengagementwiththeUNPeacebuildingCommission’sStrategicPeacebuildingFrameworks,MutualAccountabilityFrameworksandtheNewDealonPeacebuildingandStatebuilding.1

1. ConsolidatingthePeace?ViewsfromSierraLeoneandBurundiontheUNPeacebuildingCommission(2007);WomenandTransitioninAfghanistan(2012);ArabSpringorArabAutumn?Women’spoliticalparticipationintheuprisingsandbeyond:Implicationsforinternationaldonorpolicy(2013);AidReform:Addressingsituationsofconflictandstatefragility(2008).


CARE International’s current engagement with participatory monitoring

ThispaperdrawsuponCARE’sexperiencewithtwo specific forms of participatory monitoring: Community Score Cards and social monitoring.Whilebroadlysimilarintheory,theyinvolvedifferentmethodologiesforachievingtheirobjectivesandleadtodifferentexperiencesofimplementation.

CSCs – methodology and applicationTheCommunityScoreCardisacitizen-drivenaccountabilitymechanismthatbringstogetherserviceusers,serviceprovidersandlocalauthorities,firsttoidentifytheunderlyingobstaclestoeffectiveservicedelivery(expressedinindicators),thentoscoretheservicesagainsttheidentifiedindicators,andfinallytogenerateandimplementacommunityactionplantoaddressidentifiedproblemsandissues.TheCSCisaflexibleprocessthatcanbeadaptedtoanyservice-deliverysectorandcontext.

TheCSCshouldformpartofanongoingassessmentprocess,andiscommonlyrepeatedonabiannualbasis.Itcanformpartofagovernmentinstitution’smonitoringandevaluationsystem;forexample,healthassistantsatahealthcentrecanleadaCSCprocessinwhichvariousgroupsaregivenanopportunitytodiscussthequality(availability,accessanduse)ofhealthcentreservices.Thehealthcentrecanthenusetheinformationtoidentifygapsandimproveserviceswherenecessary.

Giventhewiderangeofcontextswithinwhichitisused,theCSCprocessvariesaccordingtowhatisappropriatewithindifferentsettingsasameansoffacilitatinggoodgovernanceandimprovedservicedelivery.Broadlyspeaking,however,theCSC application consists of five phases(seediagramonpage8):

1. PREPARATORY WORK AND PLANNINGThiscanincludeidentificationandtrainingoffacilitatingstaff,communityresearch,introductoryengagementwiththecommunity,anddevelopment.Atthisstage,itisbesttoidentifythesectoralandgeographicalscopeoftheCSCprocesstomakeefficientuseofresources.CSC’sbroadapplicabilityisitsstrengthbutiftheprocessisnotsufficientlyfocused,itwilldiluteitseffectiveness.InRwanda,forinstance,CAREhaslimiteditsapplicationoftheCSCtowater and sanitation, infrastructure, and agriculture sectors.

2. COMMUNITY SCORING OF PERFORMANCE BY COMMUNITY MEMBERS AND SERVICE PROVIDERSInthisphase,facilitatorsshoulddividetheparticipants into focus groupsanddevelopperformanceindicatorsandascoringsystem.AgreeingtheissuesisacriticalphaseintheCSCprocess.CARE’sexperiencesuggeststhatquestionssuchas,“Howarethingsgoingwiththisservice?Whatareyourmainconcernswiththisservice?Whatdoesnotworkwell?”areeffectiveatdrawingoutparticipantengagement.

Havingestablishedthemainissues,thefacilitatorsreconveneandcompareissuesacrossfocusgroupstodeterminethecommonareasofconcern.Forthese,indicatorsarecreatedinordertomeasureprogress.Theseindicatorsarethenpresentedtothecommunityandscoringcommences.Wherescoresforcertainindicatorsareratedpoorly,communitymembersareencouragedtoofferpotentialsolutionsforimprovementthatcanbepassedontoserviceproviders.Thisisbothan empowering step and a practical one in generating grassroots solutions to grassroots problems.

PUBLIC POLICY INFORMATION, MONITORING AND ADVOCACY (PPIMA) PROGRAMME – RWANDA

AnexternalevaluationofthePPIMAprogrammeinRwandaarguedthatthechoicetofocusengagementquitenarrowlyonkeyserviceswasastrategicasset.TheCSCprocessbuilds the citizens’ relationship with the state, and not just the capacity of a narrow band of civil society organisations.Ensuringthatcitizensunderstandtheir


3. SELF-EVALUATION BY SERVICE PROVIDERSAservice-providerScoreCardcanbeconductedaftertheCommunityScoreCardhasbeencompletedoritcanbeconductedconcurrently.Theprocessfortheprovidersisessentiallythesameasthatfortheusers.Thepace,however,forgeneratingissuesofconcernandindicatorswithserviceprovidersisoftenmuchquickerbecauseoftheliteracylevelsofserviceproviders.Theindicatorsgeneratedbytheprovidersareusuallysimilartothoseofthecommunitybecausetheserviceprovidersoftenidentifythesameissuesbutfromadifferentangle.ItisimportanttoexplainclearlytotheserviceprovidersthattheScoreCardprocessisnot to point fingers at individuals but to improve service-delivery problems.Thisrequiresashiftorchangeinattitudeofthestafftobeopen-mindedandcriticalthinkerswhiletakingpartinthescoringprocess.

EXAMPLES OF INDICATORS FROM CARE CSCsWater and Sanitation

Accesstocleanwater #ofhouseholdswithtapwater Citizenshaveaccesstocleananddrinkablewater

Qualityofsourceofwater Existenceandapplicationofsafetyandsecurityprotocolsforeachofthewater

sources

Villagesareconnectedtoasourceofwaterwithsafenetworksupplyto

households

InfrastructureAccesstoelectricity #ofhouseholdsatcelllevelconnected

toasourceofelectricity–ratio#of…Citizens’accesstoelectricity

Availabilityofmarketplaces/spaces #ofdevelopedandorganisedmarketplacesatvillage/celllevel–ratio#of

marketspervillage

Farmersandcash-cropmiddle-menhaveaccesstoorganisedandstructured

marketplaces

Farming – agriculture + livestockSizeoffarminglandforcashcrops #offarmers’householdswithownership

orleaseofarablelandsengagedincash-cropfarming–ratioacresofarableland

allocatedtocash-cropproductionperhousehold

Typeandqualityoffacilitiesfordistributionoffertilisersandinputs

#ofsellingpointsforfertiliserswithinthevicinityandeasyreachforfarmers–organisedcooperativesthateaseaccess

tofertilisersandextensionservices

Citizenhaverights,andaresupportedtoorganiseincooperativestobetteraccess

fertilisersandimprovedinputs

righttoinformationandwheretogainaccesstoitmeanstheyarelesslikelytobecomedependentonoutsideorganisations,makingtheinterventionmoresustainable.TheCSCprocesswasjudgedtohavethefollowing strengths in the Rwandan statebuilding context:

• Itisbasedonevidence,akeyadvantageinanenvironmentwhereanavowedaimistomakepolicy-makingasevidence-basedaspossible;

• Itprovidesafulcrum for engagement inwhichcitizenshaveachancetoexpressopinionscollectively,clarifyingandgainingconfidenceintheirpositionbeforeengaginggovernmentactors;

• Itavoids a potentially sterile debatebetweenCSOsandgovernmentactorsinwhichthelatterdisputethelegitimacyoftheformer.

Source: Delta Partnership, PPIMA Mid-term Review, October 2011


4. INTERFACE MEETING BETWEEN SERVICE USERS AND PROVIDERS, AND ACTION PLANNING Theinterfacemeetingiswheretheserviceusersandprovidersshare and discuss their scores and the reasons for the scores.Thisisalsowherea joint action plan will be developed.Theinterfacemeetingbringsserviceusers,serviceprovidersandotherinterested/relevantpartiestogether.Itisimportantthatkeydecision-makers(chiefs,group/villageheadmen,districtofficials,ministryofficials,localpoliticians,etc)arepresenttoensureinstantfeedbackontheissuesandresponsibilitytotakeissuesandtheplanofactionforward.

Theinterfacemeetingmightbecomeconfrontationalifnothandledcarefullyandcorrectly.Communityparticipantsshouldalwaysberemindedthatthis is not a finger-pointing exerciseandshouldbeencouragedtothinkaboutservicesandnottohaveunrealisticdemandsonservice-deliverystaff,whoveryoftenfacesignificantchallengesinfulfillingtheirmandates.

5. POST-IMPLEMENTATION ACTIVITIESItisimportanttorecognisethattheScore Card process does not stop immediately after generating a first round of scores and joint action plan.Follow-upstepsarerequiredtojointlyensureimplementationofplansandcollectivelymonitortheoutcomes.RepeatedcyclesoftheScoreCardareneededtoinstitutionalisethepractice–theinformationcollectedneedstobeusedonasustainedbasis,ie,tobefedbackintotheserviceproviderscurrentdecision-makingprocessesaswellasitsM&Esystem.TheScoreCardprocessgeneratesissueswhichcanbeusedinadvocacyeffortstoraiseawarenessoftheproblemsandpushforsolutions.Theseadvocacyeffortscanalsohelpintegratethesolutionsintolocalpoliciesandsystemsforthesustainabilityofresults.

WhiletheCSCprocessisnotasolutiontoallproblemsinthedevelopmentoflocalandcommunityservice-delivery,itdoesofferaccesstoawealthofcommunityknowledgeandinformationimportantinserviceplanningandmonitoring.Theprocessallowsdifferentsocialgroupstobeaware of each other’s problemsregardingaccessandenjoymentofgovernmentservices.Boththeoutputsandtheprocessitselfareidealforevidence-based advocacy.TheCSCprocessempowers service users and service providers to start discussing issuesaffectingservice-delivery,workingfromthebottomtothetopthroughsectoralstructurestoeffectchange.

COMMUNITY SCORE CARDS IN TANZANIA

“Theprocessinfluencedtheimprovementofhealthservicesinourcommunitiesbecausecommunitymembersnowknowthehealthcentresaretheirpropertyanditistheirresponsibilitytomonitortheirperformance.”–GovernmentRepresentative

ParticipantsintheCSCprocessinTanzaniaremarkedonitsabilitytocutthroughthe‘bureaucracy’oftraditionalgovernmentsystemsandprovidealmostimmediateandreal-timefeedbackloopsbetweenserviceusersandpublicserviceproviders.Theprocesselucidatedtheinherentchallengeofmakingdecisionsaboutpublicserviceprovisionagainstabackdropoflimitedresourcesandresourceconstraints.Throughthisprocess,participantsrealisedthevalueofanalysisandevidenceinsettingprioritiesfordecision-making.Resultingactionplanswererootedinsystematicanalysesofwhichservicesrequireimmediateattentionandalignwithcommunityneedsandpreferences.

Source: CARE, The Community Score Card in Tanzania, 2011


COMMUNITY SCORE CARD TOOLKIT 11

PHASE III: CONDUCTING THE SCORE CARD WITH SERVICE PROVIDERS

• Conduct general assessment of health service provision – what are the barriers to delivery of quality health services?

• Develop indicators for quality health service provision

• Complete Score Card by scoring against each indicator

• Identify priority health issues

• Generate suggestions for improvement

PHASE II: CONDUCTING THE SCORE CARD WITH THE COMMUNITY

COMMUNITY SCORE CARD:• Community level assessment of priority issues in one village

– what are the barriers to delivery of quality services• Develop indicators for assessing priority issues• Complete the Score Card by scoring against each

indicator and giving reason for the scores• Generate suggestions for improvement

= complete community Score Card for the village

CLUSTER CONSOLIDATION MEETING:• Feedback from process • Consolidate scores for each indicator to come up with

representative score for entire village• Consolidate community priority issues and suggestions

for improvement

= complete (consolidated) Score Card for the cluster

PHASE IV: INTERFACE MEETING AND ACTION PlANNING

INTERFACE MEETING:• Community at large, community leaders, committee members,

health center staff, district officials and process facilitators• Communities and health center staff present their findings

from the Score Cards• Communities and health center staff present identified

priority health issues• Prioritize the issues together (in a negotiated way)

ACTION PLANNING:• Develop detailed action plan from the prioritized issues –

agreed/negotiated action plan• Agree on responsibilities for activities in the action plan

and set time frames for the activities (appropriate people take appropriate responsibility – community members, community leaders, health center staff, government staff and community committees and process facilitators

PHASE V: ACTION PlAN IMPlEMENTATION AND M&E

• Execute action plan • Monitor and evaluate actions • Repeat cycles to ensure institutionalization

PHASE I: PlANNING AND PREPARATION

coMMUnItY score card process dIagraM

Repe

at C

yCle

The structure of this diagram has been modified from the original version to better reflect and align with the phases outlined in this toolkit.Note that Phase II and III can be conducted concurrently.Source: CARE Malawi, The Community Score Card (CSC): A generic guide for implementing CARE’s CSC process to improve

quality of services, 2013


Social monitoring – methodology and application CAREhasalsopilotedthemonitoringofhealthservicesintheremote Peruvian highlandsthroughcommunityhealthmonitors(vigilantes)whichallowedcitizenstovoicetheirconcerns,holdservice-providerstoaccount,andpromoteconstructivedialoguetoimprovethequalityofservices.Monitorshavebeenchosen,trainedanddeployedtovisithealthcentresthroughoutthetargetedareas,assessingthequalityoftheservicesprovided.Thisinformationisfedintoaseriesofdialogueswithgovernmentofficialsandhealthadministratorsandpractitioners,highlightingthestrengthsandweaknessesofvariousfacilities’performance.CARE’sdecade-longexperiencewithPeruviancommunityhealthmonitors’oversightofmaternalandinfanthealthserviceshasbeenhailedasanexample of best practice by the UN Commission for Information and Accountability for Women’s and Children’s HealthinSeptember2012.

InPeru,themethodologyconsistedoffour broad phases(seediagramonnextpage):

1. PLANNING AND OPERATIONFromtheoutset,CAREPerupartneredwithForoSalud(thecountry’slargestcivilsocietyhealthnetwork)andthegovernmentOmbudsman’sOffice.Together,theydefinedwhattrainingwasrequiredformonitorsandthesupportthatpublicagenciesrequired.Rolesandresponsibilitiesforeachbodywerealsodefinedinthemonitoringprocess.

2. MONITORING VISITS TO HEALTH FACILITIESTwoprovinceswerechosen,AzángaroandMelgar,wheretherewereextremelyhighratesofpoverty,maternalandchildmortalityandahistoryofusercomplaintsregardingthetreatmentofpoorindigenouswomeninhealthfacilities.Theprojectmadeanopencallforparticipantsthroughtheradio.Ratherthanstartingfromscratch,CAREreachedouttohealthpromotersinthedepartmentofPunowhichformedpartofForoSaludandlocalwomen’sorganisations,astheyhadpreviouslyreceivedsometraininginreproductivehealthandfamilyplanning.Monitorswerechosenbasedontheirtimeavailability,proximitytohealthfacilities,knowledge,interestandlevelofcommitment.Monitorswerethenshownhowbesttointroducethemselvesandaddresspatientsandserviceproviders,andweregivenanIDandaccreditationbythegovernmentOmbudsman.

3. DIALOGUE WITH SERVICE PROVIDERS AND COMMITMENTThemonitorsvisitedhealthcentresinpairsandgenerallycarriedouttwotothreevisitsperweek,eachroughlyfivehourslong.Theydiscussedissueswithfemalepatientsintheirnativelanguageabouthowtheyweretreated,howlongtheyhadtowaittobeattended,whetherpersonnelcompliedwithworkingschedulesandwhethertheywereprovidedwithinformationintheirownlanguage.Themonitorsdocumentedthisinformationinaregisterandtheyproducedregularreportsincludingbothpositiveandnegativefindings.ThesewereanalysedmonthlywiththeregionalOmbudsman’sOffice,CAREPeruandForoSaludmembers.Attheendofthevisit,monitorsaskedthestaffwhowerepresenttosignamonitoringformasproofoftheirvisitandtohelpcorroborateorchallengetheirfindings.

EARNING RESPECT AS A SOCIAL MONITOR – PERU

Atotalof150womenweretrainedandaccreditedtomonitorhealthfacilitiesandservices.Themajorityofmonitorswerepreviouslycommunityleaderswhohadcompletedeitherprimaryorsecondaryeducationandhadsomepriortraininginsexualandreproductivehealthrightsandfamilyplanning.Quechuawastheirnativelanguage,butmostunderstoodSpanish.Sometimesgettinginthedoorofthelocalhealthfacilitymeantgettingrespect:

“WhenIwenttothedoctoratthehospital,hesaid:‘Whatisallthisaboutmonitoring?Weworkhardhere.Wouldyoulikemetocometomonitoryouathome?’Itoldhim,‘Excuseme,doctor,wearehealth-carepromotersandhavebeentrainedbytheOmbudsmanandForoSaludinmonitoring.Weknowourrights.Youcannotgotomonitormyhouse,becauseitisprivate,butIcancometomonitorthehospital,becauseitisapublicinstitution,itisstate-run.Andherearemycredentials.’‘OK,comerightin...,’hetoldme.”

Source: CARE, Social monitoring to defend maternal health rights in Peru, forthcoming


4. MONITORING COMMITMENTS AND PLANNING NEXT STEPSEverythreetofourmonths,monitorsmetwithCAREPeru,ForoSaludfacilitators,theOmbudsman’sOfficeandtheDepartmentalOfficerforIntegralHealthInsurance(ODESIS)todiscussandanalysefindingsfromthemonthlyreportsandtoidentifytrendsofgoodandbadpracticesandperformanceatthevisitedfacilities.Basedonthisinformation,a‘dialogueagenda’wasproposedforameetingwiththedirectorsofhealthmicro-networks,provincialhospitals,theheadsofthehealthestablishmentsandtheirteams.Inthesemeetingsthemonitorsexpressedtheirconcernsandissuesthatneededtobeaddressedlocally.

FROM LOCAL TO NATIONAL – ADVOCACY IN PERU

“Changedoesnothappenovernight.Ithinkthatsomedoctors,nursesandmidwiveshavebeguntounderstandwhywearedoingthisvolunteerwork...Littlebylittle,theywillseethattheirworkalsoimprovesthisway.”–SocialMonitor

Oneofthegreatestachievementsofthisparticipatorymonitoringmodelininfluencingpolicyisthefactthatit has become a national reference point for the issue of citizen monitoring of the quality of health-care services.DuringavisittoAzángaroinMay2008,theMinisterofHealthmetthemonitorsandsawtheirworkinperson.Asaresult,andduetothetechnicalassistanceactivitiesofCAREPerunationally,the first Ministerial Resolution was issuedinrecognitionandsupportoftheCitizenHealthMonitoringCommittees(R.M.422-2008/MINSA,DA133-2008-MINSA/DEST-V01).

Sincethen,CAREPeruhascontinuedwiththeactivitiesofpolicy/advocacyandtechnicalassistancetotheMinistryofHealth.Togetherwithothercooperationagencies,andonthebasisoftheexperienceinPuno,inJanuary2011theNational Policy Guidelines for the Promotion of Citizen Health Monitoring(R.M.040-2011/MINSA,14January2011)werepromulgated.

Source: CARE, Social monitoring to defend maternal health rights in Peru, forthcoming


Outcomes of participatory monitoring

Thisreportreflectstwo sets of research findings of CARE’s work: joint research by the UK Overseas Development Institute (ODI) and CARE of CSC useinfourAfricancountriesandCARE’s internal evaluationsofitssocialmonitoringworkinthesecountries,Peru,andNepal.Wehaveclassifiedtheoutcomesaccordingtosix broad categories,threeofwhichrelatetospecificservice-deliveryimprovements(availability,access,andutilisation)andthreetomoreintangiblegovernanceoutcomes(citizenempowerment,accountability,responsivenessandeffectivenessofserviceproviders;andimprovedrelationsbetweenserviceprovidersandusers).

Citizen empowermentCitizensbecomebetterinformedabouttheirrightsandentitlements,aswellastheresponsibilitiesthatlocalauthoritiesandserviceprovidershavetowardsthem.

• InTanzania,communityvolunteersandserviceprovidersindicatedthatinsomeareas,serviceuserswerenowbetterinformedabouttheirrights,nationalstandardsandinitiatives,andthattheywerenowmoreassertiveandwillingtocriticiseandengagewithauthoritiesandserviceproviders.Itwasalsoemphasisedthatcommunitieswerenowmorewillingandabletoengagewithparticipatoryopportunitiespresentedbynationalinitiatives.CAREstaffnotedthatcommunitieswhichhadoriginallybeenhappywithonlytwohealthworkersperfacilitychangedtheirattitudeswhentheyrealisedtheyshouldhaveseven.

• InEthiopia,theCSCprocessactedasaconveningvenueforsolvingwhatwasidentifiedasessentiallyalocalcollective-actionproblemintermsofcitizensfailingtodemandaccountabilityforbetterservices.Interviewsconductedthroughtheresearchhighlightedthatcommunitiesnowhaveagreatersenseofownershipandareassuminggreaterresponsibilityoverserviceprovision,whereasbeforetheyreportedlybelievedthegovernmentheldthefullresponsibilityforprovision.

• InRwanda,survivorsofgender-basedviolence(GBV)werepreviouslyencouragedbyotherwomentoremainsilent,includingthoseontheNationalWomen’sCouncilwhowereostensiblyresponsibleforsupportingGBVvictims.Respondentsclaimthatthis‘cultureofsilence’hasnowbeenchallengedlocally,largelyduetothetrainingthatcommunitymembershavereceivedonwomen’srightsandGBVthroughtheCSCprocess.

• InruralPeru,usersofhealthcentreswheresocialmonitoringwasintroducedhaveafour times higher awareness ofcomplaintmechanismsandsubmitcomplaintstwiceasoften.Thishasdrivenbothariseinexpectationsandanimprovementinthequalityofservices.

Improved relations between communities and service providersImprovedrelationsalsoresultinincreasedmutualunderstandingbetweenthetwogroups.

• InTanzania,theprovisionofinformationtothecommunityaboutnationalstandardsforhealthservicesrevealedinmanyplacesthathealthfacilitieswereunder-staffedandunder-equipped,fosteringanunderstandingofthedifficultcircumstancesunderwhichtheirstaffwereworking.

• InMalawi,theCSCprocessbroughttheissueofcommunity/serviceproviderrelationsoutintotheopen,andencouragedgreatermutualunderstandingbetweencommunitymembersandhealthworkers.Anecdotalevidencesuggeststhathealthworkers,inparticular,arerealisingtheimpactsoftheirbehaviour,whichiscontributingtochangesinthatbehaviour.

• InPeru,thesocialmonitoringprocesshascontributedtogreaterrespectandculturalsensitivityinservicedelivery.Therehasbeenadeclineinthenumberofepisodesofdisrespecttohealth-careusers,withovernineoutoftenusersfeelingthattheattitudeofpersonnelhadimproved.


Improvements in service-provider accountability, responsiveness and effectiveness ThisisachievedespeciallythroughtheCSCprocess.

• InMalawi,arangeofexamplesofcorruptpracticeswasreportedlybroughttolightaspartoftheCSCprocess,includingwhereaPrimaryEducationAdvisorhadtriedtoextortfundsfromtheparentsofstandard-8classpupils.ThroughtheScoreCards,thecommunityexerciseditsabilitytochallengeandstopthispractice.

• AlsoinMalawi,aschoolinDowa,throughtheCSCprocess,identifiedsignificantgapsintermsoflowlevelsofgirls’enrolment.Furtherinvestigationhighlightedanumberofcontributingfactors,includingpoorfacilities,butalsoaninactiveanddysfunctionalSchoolManagementCommittee(SMC).Asaresult,theSMCwasreplacedandissuesofgirls’enrolmentandparticipationwerereportedtohavebeengivenmuchcloserattention.

• InTanzania,atonelocaldispensary,anagreementwasmadebetweenhealth-serviceworkersandtheleadersofitssixsurroundingvillagestocreateanout-of-hoursservice.Thiswouldbefreeforpregnantwomenbutallothersattendingoutsidenormalhourswouldpayafee.Thisprovided an incentive for health workers to attend during these hours and was cheaper for patients than the cost of transportation to other health facilities.

• InEthiopia,itwasnotedininterviewsthatpriortotheCSCprocess,theWereda(district)hadonlyafewactiveWASHCOs(ruralwaterandsanitationcommittees),withtherestlargelyinactive.TheCSCprocessbothclarifiedthedutiesoftheWASHCOtothewidercommunityandcreatedanadditionallineofoversightthroughtheCSCfacilitators,whichallowedclosermonitoringfromthegovernment’sWaterOffice.WASHCOsweregivenspecifictaskstoperformasaresultoftheinterfacemeetings,whichwerethendirectlyfollowedup.Brokeringbetweendifferentactorsalsoseemstohaveplayedarolehere,withbothCAREandtheWeredaadministrationprovidingadditionaltrainingonmanagementandmaintenanceduties.InterviewsindicatedthatWASHCOs had become significantly more active following the CSC process.

Improvements in service availabilityThisisduetoalterationsinresourceallocationinordertoimprovetheavailabilityofservices.

• InRwanda,threehealthcentreswithinahospital’scatchmentareaweresharingoneambulance,creatingaccessproblemsforthemostdistantcentrelocatednearly30kmfromthehospital.FollowingtheCSCprocess,anambulance was relocated to this health centre, greatly reducing the waiting times for pregnant women in the area.

• AlsoinRwanda,acommonthemewhicharoseintheCSCprocessinRusengewasthelackofexperiencedmedicalstaff,particularlydoctorsanddentists,atthesectorlevel.Thecommunitycomplainedthatnursesatthehealthcentreswereunabletoprovidethenecessarymedicaltreatmentandthatthelongdistancebetweenthehealthcentreandthehospitalmeantthattheywereunabletoconsultwithadoctor.Inaddition,thelackofadentistmeantthatthecommunitymemberswereforcedtousetheservicesofanunqualifiedvillagedentist.Asthiswasnotanissuewhichcouldbeaddressedlocally,thehealthstaffraisedtheseissuesatthemonthlydistricthealthcoordinationmeeting.Asaresult,thedecisionwasmadetosendadoctorfromthehospitaltothehealthcentretoundertakesupervisionvisitstwiceamonth.Althoughthedecisiontookseveralmonthstoimplement,doctors’ supervision visits have now been sustained for two years.Likewise,adentistnowalsovisitsthehealthcentreonceaweek.

• InTanzania,theCSCprocessresultedinseveralrecordedinstancesofadditional health workers being deployed to health centres in villages where this was prioritised in the CSC process.Inmostcases,thesewerehealthworkerswhohadbeennewlyhiredtothedistrict,asopposedtobeingre-assignedfromelsewhereinthedistrict.Forinstance,anadditionalnursewasdeployedtotheBusisidispensary;fouradditionalstaffweredeployedtotheIgogwedispensary;andadditionalqualifiedstaffweredeployedtotheIgaladispensary.ThiswascoupledwithvariousexamplesofdistrictofficialschannellingadditionalresourcestohealthcentresanddispensariestovillagesinvolvedintheCSCprocess,suchasadditionalbedsprovidedtohealthfacilities(Busisi,Igala)andadditionalbirthkitsdisbursed.

• InPeru,monitors’effortsinparticipatorybudgetsimprovedmaternalhealthservicesbysuccessfullyadvocatingforthe construction of birthing houses where women can stay before delivery.


Improvements in service access Thiscanbeachievedthroughneworrenovatedserviceinfrastructure.

• InEthiopia,theCSCprocessresultedinabrokeredagreementamongstakeholderstobuild a new water point,outsideoftheAnnualPlanoftheWaterOffice.Thecommunitycontributedconstructionmaterialsandpartofthefinancing,thedistrictwaterofficecontributedtheremainderoffundsneededandoversawtheconstruction,andCAREEthiopiacontributedindustrialmaterials.

• InMalawi,theCSCprocesshighlightedissuesofgapsinaccessibilitytofacilitiesandpoorhealthawarenessandengagementwithincommunities.Thesubsequentactionplanallowedforthecommunitytomobiliseandbuild a new house for the health worker,whichwillalsoinclude a village clinic.

• InTanzania,theserviceinfrastructureimprovedinanumberofinstancesthroughthelocalcommunityprovidingthebulkofthelabourandthedistrictadministrationprovidingthematerialsandcontents.Theresultsweretheconstructionandrenovationofhealth centres,theprovisionofstaff housing,andtheprovisionofuserconveniencessuchastoilets.

• InRwanda,therewerenumerousexamplesofwheretheCSCprocesswasabletobringaboutimprovementsininfrastructure,withinputfromalllevels(local,districtandnational)andacrossavarietyofsectors(health,education,roads,water,etc).Inoneinstance,followingarequestbythehealthcentrewhosecatchmentareasincluded‘administrativecells’whichweretwohoursawaybyroad,thedistricthealthauthorities approved the building of a new health post,whichwasupandrunningabouteightmonthsafterwards.Inseveralvillages,theCSCprocessidentifiedaccesstowaterasbeingparticularlyproblematicforthelocalcommunity.Inonevillage,followingtheCSCprocess,thelocalsectorleadersnegotiatedtheinstallation of a water pipelinewithtechnicalassistance.Thepipelinetookayeartobuildwiththecommunitycontributingtoitsconstructionthroughcommunityworks(knownasumuganda).Finally,duringaninterfacemeeting,onevillagenotedthatthelackofnurseryfacilitieswasproblematicbecauseitwasplacingaburdenontheoldermembersofthecommunity.Inthiscase,anagreementwasreachedtouseexistingfundstosupportthebuilding of two new nurserieswhicharenowstaffedbycommunitymembers.

Improvements in service utilisation Qualityofservicesimprovestosuchanextentthatutilisationbythecommunitygrows.

• InPeru,greaterconfidenceinthequalityofcarehastranslatedintoincreaseddemandforservices.CARE’squantitativeassessmentfoundan increase in:pre-andpost-natalcontrols;women’saccesstolaboratoryexams;institutionalbirthdelivery;andtheproportionofwomenaffiliatedwithSIS(healthinsurancescheme).Quantitativedataalsoshowedincreased access to the culturally-appropriate ‘vertical birth delivery’ –from194in2008to437in2009inAzángaroProvince.

• InRwanda,theCSCprocesshasbeen beneficial to highly marginalised people by increasing their utilisation of facilities.Beforehandtheyhadbeensilentanddidn’tusethehealthcentrefacilities(forexampletogivebirth).SinceinstitutingtheCSCprocesstheynowcomeingreaternumbers:threegavebirthinonecentreonlyinNovember2013usingtheirstatehealthinsurancecards.Othershavestartedusingfamilyplanningmethods,andsomehaveevensubmittedcomplaints.Inoneexampleofthis,acommunitymembercametothehealthcentre’sinsuranceofficetopickupherhealthinsurancecard,paidforbythestate.Shedidn’thaveaphotowithher,however,sothehealthinsuranceofficerrefusedtoserveher.Asthecommunitymemberwassick,shewenttothehealthcentredirectortocomplain,feelingthatitdiscouragedpeoplefromattendingthehealthcentre.Thedirectoroverruledherstaffandinsistedtheygiveherthecard.Thehealthcentretreatedherfirstandthenshereturnedwithaphotoafterwards.


Lessons from participatory monitoring in practiceCARE’sexperiencewithparticipatorymonitoringandotherformsofsocialaccountabilityhasyieldeda number of lessons highly relevant to the post-2015 consultation:

PARTICIPATORY MONITORING IS DIVERSE AND ADAPTABLE TO CONTEXT Theconceptofparticipatorymonitoringisnotmonolithic.Itcoversabroadarrayofmethodologiesthat,whilesharingacommonfocusontheprimacyofcitizensandtheirvoices,canadapttothecontextinwhichmonitoringistakingplaceand,moreimportantly,tothecontentbeingmonitored.

COLLABORATION IS CRUCIALTheCAREethosplacesspecificemphasisonparticipatorymonitoringbeingcollaborativeprocesses.Thismeansselectingpartnersandapproachesthatmaximisecooperationandunderstandingthroughdialogueandjointaction,andavoidconfrontationbetweencommunitiesandserviceproviders.Evenininstancesofcorruptionandservicefailure,itisimportanttorecognisethattheserelationshipsmustendurebeyondthelifeoftheCSCprocessandcannotfunctioninanatmosphereofopenhostility.

PARTICIPATORY MONITORING MUST BECOME MORE STRATEGICArecentanalysisofsocialaccountabilityhassuggestedthatapproachesthataretacticallyoriented(engagingonlyatonelevelononeissue)arelesssuccessfulthanthosethataremorestrategic(workingatmultiplelevelswithmanypartnerstoachievechange)(Fox2014).CARE’sexperiencesupportsthiscontention;ourCSCapproachhasevolvedtobecomemorestrategicoveritsdecadeinuse,basedonourlearningfrompreviousprojects.

LOCAL-LEVEL INFORMATION ADDS CRUCIAL TEXTURE TO GENERIC ‘OUTCOME INDICATORS’WhileindicatorslikethoseoftheMillenniumDevelopmentGoals(MDGs)andnationaldevelopmentplanscancapturesignificantquantitiesofdataandexplainsignificantdatatrends,theyoftenmissthe‘granularity’thatlocal-leveldatacanprovide.Specifically,participatorymonitoringdeliversdataonthe quality of servicesoverandabovethequantityofservicesprovided.Thisisafundamentalissueinexplaininginconsistenciesbetweenseeminglycomplementaryindicators.Ifprimaryschoolenrolmentsareupbutliteracylevelsarestagnant,localleveldataanswersthediscrepancyinwhateverformittakes.Whilethisdoeslittletohelpaggregateprogress,itisessentialforpolicyplanning.

CONTEXTUAL ANALYSIS IS FUNDAMENTALTobecomestrategic,it’scrucialfirsttounderstandthecontextinwhichoneisworkinginordereffectivelytotieprogrammeinterventionsintoexistingaccountabilitymechanisms,torespondtokeyinterestgroups,andtoadaptthemodelformaximumeffectiveness.Thismeansspendingthetimeinadvancetoanalysethepoliticaleconomyoftheenvironmentinwhichonewillbeworking.

PROCESS MATTERS WHEN IT COMES TO DATA COLLECTION AND SERVICE-DELIVERYDataisclearlycrucialintheworld’sfighttoeradicatepovertyanddeliverbasicservicestoall.Inensuringthatdataiscollectedandservicesdelivered,however,itisimportanttotakeintoconsiderationtheprocessbywhichitisaccomplishedaswellasthesuccessofthefinaloutcome.Thechronicissuesthatafflictmanydevelopingcountriesmustbeaddressed,butitshouldnotbe‘byanymeansnecessary’.CARE’sexperiencewithparticipatorymonitoringsuggeststhattheprocesscanhaveatangibleimpactontheultimateoutcomeofaprojectorpolicy.Involvingcommunitiesnotonlyempowersthem,italsogivesallparticipatinganincentiveinseeingtheprocessachieveresults.Futuredevelopmentgoalscannotbeisolatedindicatorsviewedasthesolepreserveoftheinternationalcommunityandnationalstatisticsoffices;theyaretooimportantforthatandrequireaprocessthatreflectsallthosewhohaveastakeintheirachievement.

PARTICIPATORY MONITORING SHOULD COMPLEMENT AND INFORM EXISTING ACCOUNTABILITY MECHANISMSThegainsobservedthusfarhavebeenlargelyatthelocallevel,withafewnotableexceptionslikeRwandaandPeru.Forparticipatorymonitoringtobescaledupeffectivelyandmakesubstantialimpactatnationallevel(‘verticalintegration’),socialaccountabilitymechanismsshouldtapintoindigenousaccountabilitysystemsandfeedthecollecteddataintogovernmentperformance-assessmentmechanisms.Itisnotsufficienttogenerateinformationonly;serviceprovidersandpublicauthoritiesmustbeableandwillingtouseandactuponthatinformation.Inotherwords,top-downaccountabilitymechanismsneedtobeaccompaniedbybottom-upmechanismstogeneratetransformativeprocesses.


Post-2015 implications: A new approach to the data revolution

ThenewframeworkforsustainabledevelopmentwillbeadoptedinSeptember2015,tocontinue,andhopefullyaccelerate,theprocessbegunwiththeMillenniumDevelopmentGoals,whichexpireattheendofthatyear.TherehasbeenwidespreaddeterminationthatthenewSDGframeworkmusteliminatethegapsinmeasuringtheMDGs.Thismeansthatarobustmonitoringsystemmustbeputinplacetotrackprogressinaconsistentandrigorousmanner,beforegovernmentsaroundtheworldbegintoimplementthenewSDGframeworkon1January2016.

Towards a data revolution ExperiencefrommonitoringtheMDGsrevealedthatofficialstatisticsinmanydevelopingcountriesarewoefullyinadequateandunreliable.Inresponsetothisfailure,theUNHighLevelPanelonpost-2015developmentgoalshascalledfora‘datarevolution’toimprovetrackingofeconomicandsocialindicatorsinAfricaandtherestofthedevelopingworld(UnitedNations2013).Theagendaemergingfromdiscussionsaboutthedatarevolutionhastendedbebasedontheassumptionthatadditionalfundingandimprovedtechnologywillsolvetheproblem.Thishasledtoafocusonexpansionofsurveydata-collectionefforts,andgreatertransparencyofdatafromnationalgovernments.

Indeed,sincetheadoptionoftheMDGsin2000,itisarguedthatthedevelopingworldhasmadesomeheadwayinimprovingitsdatacollectionandreportingsystems.Thesesystemsneverthelessremaincharacterisedbyunder-funding,relianceondonorsupport,particularlyforhouseholdsurveys,andveryweakadministrativedatasystems.Insomecountries,thebasicdemographicinformationneededtounderpinkeyindicatorsremainsoutofdate,andfundingformajoractivities,suchaspopulationcensuses,continuestobedifficulttoobtain.Datafromnationalstatisticalsystemsandhouseholdsurveysareoftenincompleteandofpoorquality.Becausethedataoftencomewithtoogreatatimedelay,theMDGindicatorshaveneitherbeenusefulforplanningnorformeasurementandaccountabilitypurposes.

ArecentreportfromtheCentreforGlobalDevelopment(CGD)findsthattheproblemsaremoredeeplyrooted.SurveyingdatasetsfromseveralAfricancountries,theauthorsfound“therearesignificantinaccuraciesinthedatabeingpublishedbynationalandinternationalagencies.Theseinaccuraciesappeartobedueinparttoperverseincentivescreatedbyconnectingdatatofinancialincentiveswithoutchecksandbalances,andtocompetingprioritiesanddifferentialfundingassociatedwithdonorsupport.”(SandefurandGlassman2014)

Thereiscertainlyastrongargumentthatamuch greater investment in building national statistical capacities and strengthening quality and standardswillberequiredfortheSDGindicatorstofulfiltheirpotential.TheCGDreportnotablyassertsthat“statisticalagenciesintheregion,particularlythoseinAnglophoneAfrica,lackfunctionalindependence,failtoattractandretainhigh-qualitystaff,dependonexternalfundersforthemajorityoftheirspendingandexperiencesignificantvolatilityandunpredictabilityintheiryear-to-yearbudgets.Plansareoftendivorcedfrombudgetrealities,thusforcingNSOs[NationalStatisticsOffices]toprioritise‘payingcustomers’ratherthannationalprioritiesandcorestatisticalactivitiesasarticulatedincountrydevelopmentplans.”(ibid)

CAREbelievesthatadatarevolutionrequiresmorethanjustbettertechnology,moregovernmentsurveysandmoregovernmenttransparencyinpublishingdata.Thisisonlyonesideoftheequation.Wewouldarguethata real data revolution that will contribute to the achievement of the SDGs and to tracking service-delivery outcomes requires three elements: 1) a change in levels; 2) a change in actors (citizen-generated information); 3) a change in the type of information collected.

A data revolution requires a change of levelsTheSustainableDevelopmentSolutionsNetwork(SDSN)assertsinitsrecentreportthat“inadditiontonational-levelreportingofSDGindicators,datashouldalsobecollectedandreportedsub-nationally(egforcitiesandstates/provinces).Ideally,thescheduleforsub-nationalreportingwouldtracktheinternationalscheduleforharmonisedcountryreporting.”(SDSN2014)


Inallcountries,thereisafrequentdisconnectionbetweeninternational,national,andlocalpriorities.Effectiveservicedeliveryistheresultofeffective governance at all these different levels,soitiscrucialtoensurethattheyareinterlinked–alignmentfromthetopdownandfromthebottomupwillhelpclosethe‘implementationgap’betweenwhatisproposedgloballyandwhatisachievedlocally.Without vertical integration, there will be a disconnection between what we claim we want to achieve at both global and country levels and what is actually implemented, ultimately undermining the effectiveness of the post-2015 framework. CARE believes thatparticipatory monitoring from the local level is the current missing piece in the existing proposals for tracking progress against the post-2015 SDGs.

Thisrequiresamajor,concertedpushtoensurethatthelocalleveliseffectivelyincludedinthedesign,implementationandparticularlythemonitoringofthepost-2015framework.Local governance is the first point of contact between citizens and the state. Institutional performance at the local level will determine both if and how the SDGs are achieved.Indeed,itisatthelocallevelwherewecanengagewiththeprocessofservicedelivery,goingbeyondsimplymeasuringanoutcome,tounderstandingwhy and howthatoutcomecameabout.Iftheincentivesoflocalandnationalgovernmentsaretobeshiftedawayfromdonorprioritiestolocally-relevantreform,itwillhavetooccuratprocess-level,learningwhatworksandwhatdoesn’t,andmakingcorrectiveadjustmentsalongtheway.

Building participatory monitoring into the SDG process can provide the link to local processes that was lacking in the MDG system, giving an internationally-led mechanism local relevance and ownership.

A data revolution requires a change in actors collecting the dataThesameSDSNreportarguesthat“therevolutionininformationandcommunicationtechnologiesandthegrowingroleofcivilsocietyorganisationsandbusinessesofferunprecedentedopportunitiesforcomplementingmetricsanddata.”(ibid)

Firstandforemost,theSDGs should include citizens’ (service users’) perspectives on public services. So, we need to produce citizen-generated data to complement official data.

Secondly,theaforementionedinaccuraciesdiscoveredinofficialstatisticsalsopointtoaneedforgreater citizen scrutiny and government accountability for this data.Citizensandcivilsocietyorganisations(CSOs),existingandnew,shouldthusbesupportedtogeneratedatatoverifyorchallengethefindingspresentedbystateauthorities.

Building participatory monitoring into the post-2015 SDG implementation process can mobilise new actors to voice their views on the quality of service provision and corroborate or contest data from official statistics.

A data revolution requires a change in the type of information collectedForthedatarevolutiontowork,wenotonlyneedtoputemphasisonnewlevelsandnewactors,wealsoneedtogeneratenewinformation.Officialdatacanonlytellhalfthestory.Wemustalsocheckwhetherthatdataiscredible,whetheritistherightdata,andindeedwhetheritisallthedatayouneed.Citizen-generated data through social monitoring can help to tell the whole story.

CAREproposesthatofficialstatisticsderivedfromsurveysshouldbecomplemented by a citizen-generated ‘shadow reporting’ system.TrainingcitizensandCSOstocarryoutshadowreportsisahighlyeffectivewaytodeterminethecredibilityofnational-levelofficialdatabeingreportedbyserviceprovidersandlineministries,andwhetherornotitactuallyreflectstherealityatthelocallevel.Community Score Cards and citizen oversight mechanisms such as that employed in Peru would allow the post-2015 accountability system to confirm the accuracy of certain statistics against local data trends.

Secondly,asocialmonitoringapproachandmethodologyallowscitizens to produce locally validated information and feedback on the actual quality of services.Thiswouldhelptorealignincentivesaroundthequalityofservicesasmuchasthebasicoutcomethoseservicesprovide.Governmentswouldberequiredtoreportaccurate‘headline’humandevelopmentindicatorsiftheunderlyingservice-provisiondatawerebothavailableandcontradictorytoofficialstatistics.Iftheadage‘whatgetsmeasured,getsdone’holds,thentheincorporationofparticipatorymonitoringintothepost-2015SDGimplementationisessentialtoensurethatthenationalgovernmentsandtheinternationalcommunitystartgettingthequalityofservicesright.


CARE views the post-2015 process as an opportunity to improve not just the quality of data but also the kind of data collected and the process by which it is gathered. By adopting a more participatory and inclusive approach to the data revolution, the SDGs can contribute to citizen empowerment.Fortunately,thepost-2015agendaalreadyidentifiestheneedtoencourage“meaningfulcivilsocietyparticipationviaarights-drivenframework”.Participatorymonitoringcanfacilitatethisbyfosteringactiveparticipationfromthegroundup.

Byprovidingamechanismfordirectdialoguebetweenserviceprovidersandthecommunity,participatorymonitoringalsocreatesopportunitiestoreduceinequalityandsocialexclusion,empoweringthepublictovoicetheiropinionanddemandimprovedservice-delivery.Participatorymonitoringalsocreatesincentivesforparticipants on both sidestodrivetheaccountabilityandtransparencyagendaforward,buildingfromlocaloriginstocatalysebroadertransformativechange.

Whatisrequiredisamodelforincorporatingparticipatorymonitoringintoexistingproposedsystemsformeasuring,monitoringandtrackingtheeffectivenessofthedeliveryofSDGs.Basedonourexperiencesinsocialaccountability,wehavedevelopedanindicativemodel.Thisispresentedinthefollowingsection.


Towards a model for participatory monitoring of the SDGs

ThestartingpointforourmodelisthattheSustainable Development Goals agreed in the post-2015 framework must be measured and monitored at all levelsfromthestartwithastandardmethodology.Likewise,accountability mechanisms to measure the performance of governments need to start at the sub-national level.Thismeansgoingbeyonddiscussionsabouthowtostrengthennationalstatisticsofficesandthequalityofquantitativedataatnationallevel.Whilevital,focusingonlyonthisleveloftheprocessignoresthecritical importance of data on service-delivery quality and performance at the local level.Thisiswheretheimpactofservice-deliveryoutcomesisfeltandwhereinformationiscurrentlyleastavailable.Community Score Cards and similar approaches generate easily comparable data that can be assessed against agreed standards across levels and countries.

CAREproposesatwo-tiered approach for participatory monitoring(seediagramonnextpage)inwhichprocesseslikeCommunityScoreCardsandcitizenoversightmechanismsprovidenecessaryaccountability over outcome level indicators in the form of shadow reportingwhilealsoprovidingnew data on the quality of service-delivery inputs at the local level,feedingintonational level policy-making and international mechanisms for learning and analysis.

Ourtwo-tieredapproachbuildsontheproposaloftheSDSNtocreatetwosetsofindicatorsforthepost-2015SDGs.Itsreportproposesthat“thefirstsetconsistsofCoreIndicatorsthatwouldbeapplicabletoeverycountryandwouldtrackthemostessentialdimensionsofthetargets.Thesecondsetconsistsof‘Tier2’indicatorsthatwouldtrackissuesthatmaybeapplicabletosomecountriesonlyorthatmaygivecountriesgreaterscopeinapplyingcomplexconceptstotheirspecificneeds.”(SDSN2014)Weconsiderthisanovelandpertinentapproachbutonethatrequiresfurtherdevelopment.

In the SDSN model, the Tier 1 indicators most closely match the existing MDG indicators.Theyaredesignedtocapturehumandevelopmentoutcomes;arenationallyfocused;andrelyuponstatisticsanddatafromnationalstatisticsofficesandotherofficialsources.Asaddressedabove,thereareseveralpersistentchallengestomonitoringtheseindicatorseffectively.However,existing participatory monitoring approaches are not best placed to capture this level of data.Rather,weenvisionaroleforthesecommunity-drivenprocessesinprovidingcontexttotheserather‘abstract’statisticsandinreinforcing a nationally-focused accountability mechanismtooffsetthedominanceoftheinternationalsystem.

While data gathered from participatory monitoring would not feed directly into the SDGs, the evidence could be anchored to the Tier 1 indicators.Forexample,highlevelindicatorssuchasaccesstohealth-careorhealthexpenditurescanbelinkedwithindicatorsonthequalityofcaresuchasthefollowing:theavailabilityofaccessibleinformationonmaternalandchildhealth(iepublishedinlocallanguages);thereceptionofhealth-careusersatthefacility(respectforusers’culturalcustoms/useoflanguage);reportsofunder-the-tablepaymentsfordrugsthatshouldbefree.

LINKING TIER 1 INDICATORS WITH PARTICIPATORY MONITORING

ProposedTier1indicator:Neonatal, infant, and under-five mortality rates

Underlyingdataavailableforparticipatorymonitoring:

• Whetherhealthcentresarefullyandconsistentlyequippedandsuppliedtoprovideabasicpackageofservices

• Whetherthestaffingofhealthprofessionalsintheareaisproportionatetothepopulation

• Whetherchildrenandtheirparentshaveaccesstoaffordableessentialdrugsandcommoditiesonasustainablebasis

Source: SDSN 2014


Responsibility for Data Collection

ForTier1indicators,nationalstatisticsofficesandtheinternationalcommunityleadaprincipallytop-downprocessofgatheringinformationthroughimprovedhouseholdsurveysandotherstatisticaltools

Participatorymonitoringprovideslittledirectinputbut‘shadows’officialdataasaformofaccountabilitymechanism

Responsibility for Data Collection

ForTier2indicators,nationallevelactorsfunctionasaggregatorsandaudienceforinformationdata

Participatorymonitoringtakestheleadoncollectingdataatthistier,mobilisingalongcivilsocietyplatformsonasectoralorgeographicbasis.Dataonservicedeliverywillbefedintotheofficialsystematdistrictlevelfollowedupthechaintoensurestronglinkagesandtofacilitatepolicyresponsiveness

Tier 1 Indicators

Source:internationalcommunity,deliveredtop-down

Informationcollected:outcomeleveldataonservicedelivery,capturingtheimpactonpeople’slives

Tier 2 Indicators

Source:mixed,fromconsultationbetweencommunitiesanddistrict

andnationalgovernment,alignedatnationalleveltoaidcomparison

Informationcollected:inputleveldataonservicedelivery,capturingpeople’s

experiencewithservicedeliverytocontextualiseTier1data


The Tier 2 indicators as proposed by the SDSN remain somewhat less well-defined.Designedtobenationalinscopebutaddressingissuesthatmaybespecifictoindividualcountries,theyhavegood potential, if developed, to be more ambitious in their coverage.First,theprocessbywhichtheyaredevelopedshouldbeexpanded.Whileacertainnumberofindicatorsmayneedtobedirectedfromthetopdown,CAREbelievesthatthemajorityofthemshouldbeformulatedthroughopenconsultationbetweencommunities,districtofficesandnationalministries.Thisisnecessarytoensuretheyreflectthespecificneedsofthecountryand,importantly,theyprovidethedatanecessaryforpolicychangestobeeffectedwherenecessary.Locally-identified indicators would then need to be adapted at the national level to allow for comparisons and aggregation across different areas and to enable more strategic interventions across districts.Thisisanimportantissuefordiscussionandcollaboration,onethatcouldbeinitiatedthroughanapproachliketheCSCprocess.

Second,thekind of information these Tier 2 indicators aim to measure should be broadened to include data on the quality of service delivery at the ‘input’ level rather than remaining at the ‘outcome’ level.Atthelocalandcommunitylevel,theCommunityScoreCardandsocialmonitoringapproachesofferunequalledaccesstoservice-deliverydatathatcaninformpolicy-makingandcontributetotheSDGindicators.Thedatagatheredwouldspeaktothequality of services delivered and enable officials to enforce existing standards across governance processes.Theinformationcollectedwouldbedistributed to district authorities and sectoral working groups at district leveltaskedwithimprovingserviceperformance,before being aggregated up to the national level to ‘shadow’ official statistics.

UnderCARE’smodel,acommunityprocessmanagedthroughlocalandnationalCSOscouldprovideregularandconsistentfeedbackontheperformanceofavailableservicesandraisequalityissuesthatshouldbeaddressedeitheratdistrictlevelorpassedupthechaintonationaldecision-makers.Issuesthatarefundamentaltothepost-2015SDGframeworkinclude:accesstoservicesintermsofqualityandreach;theuseofservicesintermsofavailabilityandcontinuityofservice;relationsbetweenserviceusersandprovidersintermsofresponsivenesstocitizenneedsandconcerns;andtheeffectivenessoffacilitiesandstaffing.Theprocesseswouldberepeatedonaquarterlyorsemi-annualbasis.

Linking Tier 1 indicators with participatory monitoringProposed Tier 1 indicator: Neonatal, infant, and under-five mortality rates

Underlying data available for participatory monitoring:

Whether health centres are fully and consistently equipped and supplied to provide a basic package of services Whether the staffing of health professionals in the area is proportionate to the population Whether children and their parents have access to affordable essential drugs and commodities on a sustainable basis

Source: SDSN 2014

EXAMPLES OF TIER 2 INDICATORS WITH POTENTIAL FOR PARTICIPATORY MONITORINGWaterandSanitation:

• Thelevelofintegratedwatermanagementinacommunity

• Sanitationandhygienelevelswithinpublicfacilities

Education:

• Qualityandavailabilityofteachingandmanagement

• Qualityandreliabilityoftheschoolinfrastructureandservices

Source: SDSN 2014


Six-step model for participatory monitoring of the SDGs

CAREenvisionsasix-stepmodelforparticipatorymonitoringinconjunctionwiththeSDGs.DrawinguponthesuccessoftheCSCandsocialmonitoringprocesses,thesixstepsarepresentedbelow.

STEP 1: PREPARATION AND TRAINING OF LOCAL FACILITATORS AND COMMUNITY AGENTSThefirstcommonstepinoursocialmonitoringmodelshouldbetoselectcommunitymembersandcivilsocietyorganisationrepresentatives.Theseactorswillbetrainedinsocialmonitoringmethodologiestobecomelocalfacilitatorsforthecommunityscoringprocess.Thesesameactors(orotherlocalrepresentatives)willalsobetrainedascommunity agentstovisitgovernmentfacilitiesorprojectsandtointerviewlocalserviceusersregardingthequalityofpublicservices.

STEP 2: COMMUNITY VALIDATION OF INDICATORS AND SCORING UsingTier1indicatorsasananchor,communitymemberswillbefacilitated(bycommunityfacilitators)toidentifywhichTier2indicatorsaremostimportantfortheircommunitiesandonwhichtheywanttotrackchanges.Inafocusgroup,theseindicatorsarethenrefinedandcommunitymembersareaskedtoscoretheperformanceinthedeliveryofthetargetedpublicservicelinkedtotheSDG.

STEP 3: SERVICE PROVIDERS SCORE ON THESE INDICATORSServiceprovidersaresupportedbycommunityfacilitatorstoscoreontheirownperformanceagainsttheseTier2indicatorsandcertainrelevantquantitativeTier1indicators.

STEP 4: DATA GATHERING ON SERVICE-DELIVERY OUTCOMES BY THE COMMUNITY Communityagentsvisitgovernmentfacilitiesorprojectstoassessthequalityofservicedelivery,interviewingserviceusersand/orusingICT(informationandcommunicationtechnologies)tomonitorimplementationagainstagreedindicators.Theythencompilereportswhicharesharedwithserviceproviders.

STEP 5: INTERFACE MEETINGS BETWEEN SERVICE PROVIDERS, SERVICE USERS AND PUBLIC AUTHORITIES Communityfacilitatorsconveneameetingbetweenserviceproviders,serviceusersandpublicauthorities.Hereeachstakeholdergroupisinvitedtopresenttheirfindings,detailingpositiveandnegativeoutcomes.ServiceproviderswillsharefindingsagainstbothTier1andTier2indicators.Sharingregularupdatesonlocalprogressagainstoutcomes(Tier1indicators)willfurtherpromoteacultureofaccountabilityandintroduceanelementofpublichearingintothemodel.Theseactorsthenjointly agree commitmentstoimproveservice-deliveryoutcomesagainsttheidentifiedindicatorsandgenerate an action plan with clear responsibilities assigned to appropriate actors.

STEP 6: COMMUNITY AGENTS CORROBORATE FINDINGS AND FOLLOW UP ON THE ACTION PLAN Communityagentsvisitfacilitiesorprojectstocheckwhethercommitmentsmadearebeingdeliveredbyserviceproviders,localauthoritiesandcitizens.

Processstartsagain.

Advantages of the six-step modelThismodel’sconsultativefocusanditsinherentrelianceoncommunityinvolvementideallysuitstheproposedTier2indicatorsand,ifinstitutionalisedwithinexistingreportingstructures,couldproduceasignificantshifttowardevidence-basedpolicy,decision-makingandplanning,evenatlocalanddistrictlevels.The lack of reliable information at this level has severely impeded progress on improving service provision, particularly in rural areas. Well-managed and well-coordinated CSCs could provide a compelling option to quickly expand the base for data collection in these marginalised areas while having the positive side-effect of engendering greater cooperation and trust among community members, service providers, and local government officials.

The Tier 2 indicators as proposed by the SDSN remain somewhat less well-defined.Designedtobenationalinscopebutaddressingissuesthatmaybespecifictoindividualcountries,theyhavegood potential, if developed, to be more ambitious in their coverage.First,theprocessbywhichtheyaredevelopedshouldbeexpanded.Whileacertainnumberofindicatorsmayneedtobedirectedfromthetopdown,CAREbelievesthatthemajorityofthemshouldbeformulatedthroughopenconsultationbetweencommunities,districtofficesandnationalministries.Thisisnecessarytoensuretheyreflectthespecificneedsofthecountryand,importantly,theyprovidethedatanecessaryforpolicychangestobeeffectedwherenecessary.Locally-identified indicators would then need to be adapted at the national level to allow for comparisons and aggregation across different areas and to enable more strategic interventions across districts.Thisisanimportantissuefordiscussionandcollaboration,onethatcouldbeinitiatedthroughanapproachliketheCSCprocess.

Second,thekind of information these Tier 2 indicators aim to measure should be broadened to include data on the quality of service delivery at the ‘input’ level rather than remaining at the ‘outcome’ level.Atthelocalandcommunitylevel,theCommunityScoreCardandsocialmonitoringapproachesofferunequalledaccesstoservice-deliverydatathatcaninformpolicy-makingandcontributetotheSDGindicators.Thedatagatheredwouldspeaktothequality of services delivered and enable officials to enforce existing standards across governance processes.Theinformationcollectedwouldbedistributed to district authorities and sectoral working groups at district leveltaskedwithimprovingserviceperformance,before being aggregated up to the national level to ‘shadow’ official statistics.

UnderCARE’smodel,acommunityprocessmanagedthroughlocalandnationalCSOscouldprovideregularandconsistentfeedbackontheperformanceofavailableservicesandraisequalityissuesthatshouldbeaddressedeitheratdistrictlevelorpassedupthechaintonationaldecision-makers.Issuesthatarefundamentaltothepost-2015SDGframeworkinclude:accesstoservicesintermsofqualityandreach;theuseofservicesintermsofavailabilityandcontinuityofservice;relationsbetweenserviceusersandprovidersintermsofresponsivenesstocitizenneedsandconcerns;andtheeffectivenessoffacilitiesandstaffing.Theprocesseswouldberepeatedonaquarterlyorsemi-annualbasis.

Linking Tier 1 indicators with participatory monitoringProposed Tier 1 indicator: Neonatal, infant, and under-five mortality rates

Underlying data available for participatory monitoring:

Whether health centres are fully and consistently equipped and supplied to provide a basic package of services Whether the staffing of health professionals in the area is proportionate to the population Whether children and their parents have access to affordable essential drugs and commodities on a sustainable basis

Source: SDSN 2014


Takenasawhole,CARE’smodelpresentsarobustandvariedsetofoptionsformonitoringtheSDGsatboththenationalandsub-nationallevel.Eachelementcontributessignificantinformationtogovernmentdatacollection,beitatdistrictlevelorthroughnationalministries.Participatory monitoring adds value to the successful implementation of the post-2015 framework in three distinct ways.

One,itdevelopsanindigenous accountability mechanism in the form of ‘shadow reporting’toprovideoversightofthedatapassingthroughtheofficialsystem.

Two,itintroducesnew,critically important contextual information on the quality of service-delivery inputs that has been lacking in previous monitoring systems.Respondingonlytooutcomesleavesgovernmentsconstantly‘behindthecurve’.Understandingandmakingthelinkbetweeninputsandoutcomesgivesbothnationalandinternationalcommunitiesmorerobustoptionsforimprovingservice-deliveryinatimelyfashion.

Three,it links local communities with an activity that has largely been the remit of the international community, delivering a greater sense of ownership and potentially shifting incentives in a positive direction.Ifdevelopedfurtherandultimatelyimplemented,webelieveitwillprovideanecessarycomplementtowhateverofficialUN/WorldBankmonitoringsystemwillbeestablishedforJanuary2016.

Indeed,itisimportanttoreiteratethatCAREInternationaldoesnotseethismodelforparticipatorymonitoringassupersedinganysuchofficialmonitoringsystem.Wewelcomeeffortstoimprovenationalstatisticsofficesandtoincreasethequalityandfrequencyofhouseholdsurveysandcensusesthatprovidethefoundationsofacountry’sdemographicdatabase.Ratherthis model for participatory monitoringisdesignedtocomplementofficialgovernment-ledmonitoring,contributingwhereappropriateto supplement missing data or to ‘triangulate’ (cross-confirm) unverified information.

TheultimateaimoftheSDGsisthattheydeliverbetterlivelihoodsforpeoplelivinginthedevelopingworld.CAREbelievesthatthosepeopleshouldhaveasignificantroleindetermininghowthesuccessorfailureofthesegoalsismeasuredandassessed.


Conclusions

CAREInternational’sexperienceofover10yearsofimplementingparticipatorymonitoringapproachessuchasCommunityScoreCardsandsocialmonitoringhasconvincedusoftheircapacitytocapturerobustandrelevantinformation.Whileparticipatorymonitoringcannotalonesubstituteforrigorousstatisticalsurveysandanalysis,itisanecessarycomplementtoaneffectivemonitoringsystem.Indeed,wewouldarguethatwithoutcitizen-generatedmonitoringdata,anysystemestablishedtomonitorpost-2015sustainabledevelopmentoutcomeswouldbeincomplete.

TheMDGexperiencehasdemonstratedthepitfallsofcreatingasystemwithinsufficientaccountabilityandlocalownership.Facedwithpurelyexternalincentives,theMDGoutcomeshavebecomemoreanexerciseforgovernmentstotickoffindicatorsthantoachievesubstantive,sustainedchange.Inthissense,participatorymonitoringshouldbepositionednotasameansofcollectingTier1SDGoutcomedatabutratherasameansofmeasuringtherealexperienceofservice-deliveryamonglocalpopulations.

Inaddition,social,economic,politicalandenvironmentalcontextsarecrucialtomeasuringdevelopmentoutcomes,butinternationalsystemspredicatedoncross-nationalcomparabilitytendtodilutecomplexityinfavourofconsistencyandreplicability.Participatorymonitoringputslocal,specifictextureintothepost-2015SDGs.Throughstrategicinteractionsacrossmultiplelevelsofgovernance,itcanvalidate,refute,orcontextualiseofficialdata,enrichingthecontentoftheSDGsandultimatelyprovidinglocal,national,andinternationalofficialswithmorereliableandmoreactionableinformationonservice-deliverystandardsinallcountries.

Throughourtwo-tieredmodel,thereisanopportunitytocreateameasurementandmonitoringsystemforthepost-2015SDGframeworkthatbothdeliversthedatarequiredfortheinternationalcommunityandchangestheincentivesofnationalgovernmentstorespondtodomesticaswellasinternationalprioritieswhensettingdevelopmentagendas.Progressonthesecomplementaryobjectiveswillculminateinpotentiallyastrongermonitoringsystemandbettersustainabledevelopmentoutcomesfortheworld’spopulation.


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CAREPeru.2012.SocialmonitoringtodefendmaternalhealthrightsinPeru.

CARETanzania.2011.TheCommunityScoreCardinTanzania.

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Fox,J.2014.“Socialaccountability:Whatdoestheevidencereallysay?”PresentationattheGlobalPartnersForumoftheGlobalPartnershipforSocialAccountability.14May2014.

Guijit,IandGaventa,J.1998.Participatorymonitoringandevaluation:Learningfromchange.IDSPolicyBriefingIssue12.

Gulloetal.2014.EvidencefortheeffectivenessofCARE’sCommunityScoreCard.Unpublished(underreview).

Sandefur,J.andGlassman,A.2014.Thepoliticaleconomyofbaddata:EvidencefromAfricansurveyandadministrativestatistics.CentreforGlobalDevelopmentWorkingPaper373.

SDSN.2014.IndicatorsandamonitoringframeworkforSustainableDevelopmentGoals:LaunchingadatarevolutionfortheSDGs.ReportbytheLeadershipCounciloftheSustainableDevelopmentSolutionsNetwork.26July2014.

UnitedNations.2013.Anewglobalpartnership:Eradicatepovertyandtransformeconomiesthroughsustainabledevelopment.TheReportoftheHigh-LevelPanelofEminentPersonsonthePost-2015DevelopmentAgenda.

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MARCH 2015: CARE INTERNATIONAL

Cover photo: a Community Score Card focus group discussion in Ntcheu District, Malawi. Photo © CARE Malawi Maternal Health Alliance Project.

CARE International UK89AlbertEmbankmentLondonSE17TPUKwww.careinternational.org.ukRegisteredcharitynumber292506

The power of participatory monitoring in making the Sustainable Development Goals … · 2017-07-27 · 2 The power of participatory monitoring in making the Sustainable Development

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