Planning tools and concepts can be used to develop a framework for your action, create stakeholder awareness on the right to food and the right to information in your context and may considerably improve the planning and implementation of your actions.
Those tools and concepts include:. An Analysis framework on the Right to Food provides you with a rights-based framework for categorizing and analyzing state obligations, services, and programs in your context. The Advocacy Canvas is a comprehensive analysis and planning tool for advocacy campaigns, that enables you to develop campaigns in a clear, collaborative, and effective manner. Multi-Actor Partnerships propose and describe the advocacy process in which partners from civil society, the private sector, and the state progress together towards an advocacy goal.
Applying the Right to Information looks at how citizens and development actors can demand and utilize information on state programs and move towards a more pro-active application of the Right to information by states.
In many countries, the RTI is one of the most important framework legislation to improve the implementation of existing state services and programs. Campaign tools , which are used to address policymakers — the long route in the governance triangle - and influence policymaking and the implementation of policies.
Among the many campaign tools, we selected two processes, which become more and more relevant in our work. Online advocacy in the form of slacktivism, or pay forward have become more and more powerful in mobilizing people and influencing policymakers. Here, we offer some options that can be used to design effective online advocacy campaigns in relation to hunger and poverty. Lobbying processes towards decision-makers are a more traditional campaign tool. Evidence-based advocacy tools are advocacy processes that are built around a survey or analysis on how services or state programs perform, with the objective of influencing the implementation of state policies.
Corresponding bottom-up assessment processes, as well as publications and dissemination events, make shadow reports part of powerful advocacy campaigns. Citizen Report Cards are user surveys of user perception of services such as water supply, health, or mother and child development programs.
Budget Tracking exercises, which are vital surveys that analyze how state budgets are planned, allocated, transferred and utilized in-state programs on various levels, and whether the funds actually reach the target group.
Community-based tools are bottom-up processes that look at monitoring the performance of state programs and services or at community-led planning and implementation of programs.
They look at the short-route of the governance triangle and can directly improve the delivery of services and programs.
Social Audits are powerful community monitoring processes that are often used to look at the utilization of resources in public works programs, employment schemes of state support towards vulnerable groups. Community Score Card is an effective community monitoring and planning process that looks at the perception and performance of state services such as health, mother and child development, or water supply.
Participatory budgeting offers a bottom-up approach for financial planning and management that can be used by citizens in cooperation with community-based organizations or local governments.
Community-led planning and implementation is a process in which certain authorities in planning and implementing projects are delegated to the community to empower citizens as well as improve ownership and effectiveness of the interventions.
About the Author:. Joachim is passionate about Civil Society and has been a main engine of the Civil Society Academy since its inception in Within each type, research suggests four necessary components to maximize opportunities for success: transparency of necessary data, top-down responsiveness, representative participation, and citizen-led oversight discussed further below. Democratic accountability includes systems, laws, and contexts that build an enabling environment for citizen-led accountability.
Traditionally, democratic accountability is thought of as comprising free and open elections and the existence of freedom of information laws 2 for more information from USAID, see this resource on vertical democratic accountability.
For the purpose of strengthening PHC, we broaden this definition and consider democratic accountability to be initiatives by governments to open up space for citizen monitoring of the health system. Democratic accountability initiatives often include a combination of transparency and responsiveness efforts. Performance accountability is defined as initiatives and actions by citizens and civil society organizations CSOs to hold government actors and service providers accountable for their performance through bottom-up monitoring and engagement 2 for more information from USAID, see this resource on vertical democratic accountability.
This includes participation of community members and mechanisms to hold administrators and policy makers accountable to the needs of the people. An example of a performance accountability initiative is the Uttar Pradesh Health Systems Strengthening Project for India, which aims to improve the efficiency, quality, and accountability of health services delivery by strengthening the state health department's management and systems capacity.
A second component involves community members monitoring primary health care services, addressing concerns to village representatives, and participating in preparing a village scorecard that rates the quality of the health services they receive. Financial accountability is defined as initiatives and actions by citizens and CSOs to track leakage and mismanagement of public budgets and expenditure within the health system.
In practice, this process is quite similar to performance accountability with a different set of outcomes, namely monitoring of expenditure of funds for services. Like performance accountability, it includes a combination of activities that encourage participation of community members and mechanisms to hold those in the system accountable to the needs of the people.
Financial accountability includes initiatives such as public expenditure tracking surveys, participatory budgeting and planning, and budget transparency initiatives. Fundar specifically focused on two key outcomes: introducing specific policies to ensure sustainable and consistent public reporting of the health budget to ensure that active civil society organizations could regularly track health expenditures and building their own internal capacity to act as a leader in national advocacy for equitable financing for health services.
Both of these components of the project were critical to ensuring that the right information and the right actors to act on this information were in place to achieve better spending for health in Mexico. More information on this project can be found here. Social accountability works best with coordinated efforts from two key sets of actors: those with decision-making power, and citizens or civil society.
While these accountability approaches are framed as bottom-up and top-down, accountability is likely to be most effective when it also brings in the voices and experiences of service providers themselves on the frontline. Therefore, the four necessary components of social accountability include transparency of necessary data, top-down responsiveness, representative participation, and citizen-led oversight.
The success of social accountability initiatives is dependent on the government and institutions opening space for citizens from above, which includes ensuring the transparency of information and top-down responsiveness from government officials and private institutions. Social accountability is mainly driven by action from citizens and health system users. Necessary components of social accountability from below are representative participation and citizen-led oversight.
PHCPI is a partnership dedicated to transforming the global state of primary health care, beginning with better measurement. While the content on this website represents the position of the partnership a whole, it does not necessarily reflect the official policy or position of any partner organization. The case studies included below are a small sample of social accountability interventions.
To show examples of the type of impact social accountability can have on health outcomes, most of the highlighted cases are examples of successful social accountability interventions. However, the evidence on the impact of social accountability initiatives is largely mixed, and much of the empirical research in social accountability has focused more explicitly on whether specific interventions work in specific places rather than why or how those interventions work or fail.
Several systematic evidence reviews of social accountability seek to fill this gap by assessing trends and theoretical framing for best practices in social accountability, including Fox 1 and Danhoundo et al. It is also important to note that two of the following case studies have a financial angle. Part of the reason is that social accountability is a relatively new field which stemmed from financial tracking efforts.
Therefore, some of the most developed case studies on this topic are in the financial sector. Please see Fox 1 and Danhoundo et al.
In , a CSO in Nigeria implemented a financial accountability initiative to improve health system outcomes through strengthened infrastructure. To do this, the PPDC team formed a unique collaboration with a university, procurement specialists, and a newspaper. As the technical support partner, the Pan Atlantic University helped to organize budget data from multiple sources. Data journalists from the Premium Times Centre for Investigative Journalism analyzed the data to determine value for money in the procurement process.
Finally, the PPDC partnered with procurement monitors to visit PHC sites to monitor and match up construction status with financial records. Through this process, PPDC discovered that only 36 percent of expenditures that were set aside to build new facilities resulted in operational facilities. They also found that funds budgeted to build new PHCs exceeded the amount that was contracted; while this initially may appear to be a case of cost savings, only five of the seventeen new PHCs with the largest 'savings' of 33 to 54 percent were operational, indicating that the funds may have been misused.
Tracking these funds, PPDC found that the winning bid of 26 contracts were all of the same amount. This suggested either that the companies had coordinated on the bidding amount or, more likely, that they are all contracted to the same company under different names. According to Nigerian law, bidders must participate in open and competitive tendering, and this initiative uncovered evidence that competitive tendering may have been compromised.
The initiative found that the government construction of PHCs was at best extremely inefficient and at worst suffered from corruption and collusion. After PPDC shared the results with the Nigerian government and in conjuction with the Health Minister announcing the construction of 10, new PHCs, the Nigerian government has pledged to use open contracting in new procurement. PPDC also received a grant from donors to continue development of the open contracting platform, Budeshi, to continue this type of civil society-led monitoring.
Citizen report cards promote performance accountability by creating feedback loops on quality of care — including amenities, waiting times, respectful care, and availability of providers and drugs -- between citizens and the health system.
One way in which these report cards can improve outcomes is by shifting the incentives for service providers to be directly responsive to health system users. Bjorkman et al. Researchers analyzed the data along with health facility records to create a report card on key health performance subjects utilization, quality, etc. Next, researchers shared these results with the village members and health facilities through a series of village meetings and events, aiming to draw as much participation as possible.
Finally, researchers set up representative interface meetings between citizens and health facility staff to identify strategies to improve performance. Following this experiment, there was 30 percent turnover of local Health Unit Management Committee representatives, whose role it is to monitor the health system on behalf of user. This indicated that the program was successful in increasing participation in the health system and in holding committees accountable.
Performance indicators also improved, including increased utilization, decreased wait times, decreased absenteeism, and increased cleanliness of facilities.
There was also a statistically significant impact on child mortality rates. Overall, the use of citizen report cards in this context led to improvement in the quantity and quality of care. While this study reveals the potential of these types of performance accountability initiatives, it is worth noting that many other evaluations of similar programs find mixed or null results. For example, the Transparency for Development program led by Results for Development and the Harvard Kennedy School conducted a similar study in five countries using an adapted community scorecard intervention.
This and other studies highlight the need for more research on why and how social accountability programs like this one succeed or fail. Effective primary health care should involve community participation in all aspects of service delivery. Participatory budgeting can help align budgets to the needs of the population by building citizen feedback directly in the budgeting process. Participatory budgeting also improves information flows between policy-makers and citizens.
An assessment of participatory budgeting in Brazil from to shows increased participation by citizens over time as well as participation becoming increasingly representative over time. This change is correlated with a reduction in infant mortality rates.
This suggests that promoting a more direct interaction between service users and elected officials in budgetary policy can affect both the allocation of local resources and health outcomes. By providing not just a voice but also power to make budgeting decisions to citizens, service users and those who experience the biggest problems and priorities in their communities on a daily basis can ensure that those are the problems and priorities that are being addressed.
The questions below may be a useful starting place for determining if Social Accountability is an appropriate area of focus for a given context and how one might begin to plan and enact reforms:. Even if there are no social accountability initiatives integrated specifically into the health system, there may already be initiatives on the ground supporting performance and financial accountability more generally. Identifying any existing ongoing initiatives in communities can help both the health system and the initiatives to improve effectiveness.
There may also be government-wide democratic accountability initiatives in place that impact the health system. For example, many countries have open procurement systems, but citizens and civil society organizations may not currently be using these systems to monitor health procurement decisions. Understanding these systems and any potential synergies is a good first step. The literature suggests that a bundled approach of top-down and bottom-up efforts increase the likelihood of success for social accountability initiatives.
There may be social accountability initiatives underway in primary health care that are missing critical pieces to maximize effectiveness. In some cases, this gap may be the lack of linkages from citizen reporting to government bodies for top-down accountability. In other cases, this could be insufficient capacity of CSOs. Identifying these gaps can help those supporting social accountability to understand how to strengthen and further develop these initiatives.
While social accountability by definition requires the voice and participation of civil society, citizens and other actors such as media and CSOs can play important roles in these initiatives as facilitators, brokers, and information sharers.
In addition, identifying government champions who are interested in listening to and incorporating the voices of citizens into their decisions can help improve the likely impact of social accountability. Different social accountability tools are designed to address different types of problems within the health system; for example, citizen report cards are well-suited to identifying problems with client experience with frontline service providers whereas social audits are better suited to identifying places where budgeting especially for infrastructure and supplies has not been properly used.
Current best practice is to employ a holistic and strategic approach to social accountability rather than a tool-based approach; however, it is important to design any program to fit the actual problem s on the ground — or to identify these problems. For example, supreme audit institutions and the justice system can help to support initiatives that seek to hold actors accountable for corrupt practices, and open contracting and e-procurement programs can help ensure that corruption is avoided before it can occur.
In order for interventions aimed at improving Social Accountability to be most successful, the following elements of the PHCPI Conceptual Framework should be in place or pursued simultaneously:. Social accountability. While social accountability offers an overarching methodology to ensure citizen feedback in health systems, it can only be possible through strong community engagement. Community engagement is a necessary prerequisite to ensuring representative participation. Learn more in the Community Engagement Improvement Strategies module.
Primary health care policies and quality management infrastructure build a necessary enabling environment for effective social accountability initiatives.
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