CITIZEN VOICE AND ACTIONWorld Vision’s Approach to Social Accountability

WFPHA, February 2015

Kolkata

Judy Lewis, Board Chair, CORE Group

Karen LeBan, Executive Director, CORE Group

Tom Davis, Chief Program Officer Feed the Children

Janine Schooley, Sr. VP for Programs, PCI

Dennis Cherian, Sr. Director of Health, HIV and AIDS, World Vision, Inc.

What is “Citizen Voice and Action”?

Citizen Voice and Action is a social accountability approach designed to

improve the relationship between communities and government,

in order to improve services, like health care and education,

that impact the daily lives of children and their families.

Citizen Voice and Action in FY14:

411 ADPs in 43 Countries

How does Citizen Voice and

Action work?

“Citizen Voice and Action” in Practice

How can Citizen Voice and Action

Strengthen Health Systems ?

CVA and HSS

CVA activity

CVA Phase One:“Enabling Citizen Engagement”

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

CVA Phase Two:The “Community Gathering”

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

CVA Phase Two:The “Monitoring Standards” Process

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

Sample “Monitoring Standards” Data

Midwives

ORS

Vaccines for children

Beds

1 per RHC

Free and available

Free and available

3 2

Free and available

Available, but with fee

None Left in June

1 broken not replaced

CVA Phase Two:The Community Scorecard

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

Sample “Community Score Card” results

CVA Phase Two: The Interface Meeting

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

CVA Phase Three – How will we address the issues identified?

RESULTS?CVA’s Impact on Child Well-Being

Social Accountability - Impact on Health Outcomes – Bjorkman/Svennson 2009

J-PAL researchers used Randomized Control Trials to study the impact of an approach like Citizen Voice and Action at 50 clinics in 9 districts of Uganda:Quality of Care. After one year, relative to comparison villages,

health facilities in treatment villages: • Experienced a 12-minute reduction in average wait time • Experienced a 13% reduction in absenteeism Health Outcomes. After one year, relative to the comparison villages,

the treatment villages showed a: • 33% drop in under-five mortality• 58% increase in use of skilled birth attendants• 19% increase in number of patients seeking prenatal care• Results holding after 4 years.

Bjorkman, M and Svensson, J, 2009. Power to the People: Evidence from a Randomised Field Experiment on Community Based Monitoring in Uganda. Quarterly Journal of Economics.

Citizen Voice and Action in Uganda• In 13 of the 17 clinics where CVA has been introduced,

staff have increased; 7 of the clinics showed staff increases of more than 2 staff.

• In 3 clinics, the number of women in a month attending for antenatal services and to give birth more than doubled.

• In 4 clinics, dedicated maternity services were initiated. • In 3 of the clinics, Prevention of Mother to Child

Transmission (PMTCT) services either started or were expanded.

• Communities, clinic staff, and local government officials attribute the changes to increased advocacy by the community.

Citizen Voice and Action in Zambia• 4 out of 5 targeted facilities have reported deployment of

additional staff• Community members in 5 sites reported reduced waiting

hours (average reduced from 6 hours to 2 hours).• The Community of Milopa, in Lufwanyama District,

successfully pressured for the construction of a new clinic by 2015.

• Construction of clinic has resumed in Chibombo District.• # of deliveries at health centres increased by 64% in

Lufwanyama District between 2011-12.• Chibombo recorded an upward movement of 3% in under-5

immunization between 2011 and 2012.• Governments, communities, and service providers attribute

improvements to increased engagement between citizens and government

Collective Action among communities: strengthening local leadership

"Community input provides a

good control mechanism.

Now, we have a better idea

about what people need and

where gaps exist".

-Thomas Laka,

Head of health services

Batnes, Indonesia

“Vertical” Citizen Voice and Action:

Linking communities to policy influence

“Vertical” Citizen Voice and Action: Linking communities to policy influence

• Uganda: Practitioners used data from CVA to demonstrate inadequate clinic staffing on MNCH.

• Result: Coalition work ultimately persuaded parliament to forgo drastic cuts in health budget. Prime Minister committed to hire of 6100 new health workers.

• Armenia: Practitioners and coalition partners used CVA data to identify problems in MoH pay structure that were discouraging doctor visits to poor rural areas.

Result: Policy-level reform of pay structure of doctors.

• Peru: Practitioners created new departmental CSO forum.

Result: Regional monitoring of health facilities in 7 districts by a coalition of 27 CSOs.

• Coordinated and aligned national campaigns in 28 countries to influence global frameworks and ensure national government commitment.

National and local Child Health Now strategies & activities hold governments to account for commitments made to

global maternal newborn child health frameworks:

Implementation of policies/practices by national governments to improve maternal and child health at local and national level to achieve health child well-being targets

(reinforced by World Vision health programming)

Emerging Lessons from Practitioners• Accountability can be constructive - need not be

confrontational.

• Services improve when alliances are brokered between civil servants and community members. These alliances encourage collective ownership of service delivery.

• Scale matters.

• Civil society implementer must model the transparency that citizens demand of government.

Score Card for mapping ICDS Service Gaps

Thanks!

Dennis CherianSenior Director, Health

World Vision, Incdcherian@worldvision.org

tinyurl.com/citizenvoiceandaction