Accountability In The Humanitarian Field
ISS/EUR, Netherlands, The
Humanitarian action has for a long time developed rather isolated from developments, discussions and practices in the world of development. Until the mid-1990s - when accountability had already been a topic in development for decades – accountability, participation and evaluation were alien to the field of humanitarianism. Saving lives was deemed be guided solely by the humanitarian principles. Even though accountability became an issue with the advent of the global code of conduct for humanitarianism, and the formation of the Humanitarian Accountability Project in the late 1990s, accountability - especially to affected populations - has continued to develop in a slow pace.
This paper aims to take stock of accountability practices the sector. It builds on accountability theory in distinguishing upward, sideways and downwards accountability, and incorporates formal and informal forms of accountability. It is based on empirical research in Myanmar, Afghanistan and Sierra Leone.
The first part of the paper outlines the history with accountability in the humanitarian sector, and discusses the state-of-the-art as well as current trends in performances around accountability. It then presents the findings from the three countries. Perhaps not surprisingly, actual practices at country level fall far behind the ambitions and trends can be identified at the international policy level.
The paper ends with some recommendations on how accountability returned sector can be taken to a higher level.
Provision Of Healthcare Services And Social Accountability: A Qualitative Method Study in Rural Nigeria
UNIVERSITY OF SOUTH AFRICA, South Africa
Social accountability is an important strategy towards ensuring that political leaders and actors implement the right policies and projects in the interest of the entire society or community. In 2007, a community-based health insurance programme was implemented in selected rural communities in Kwara State Nigeria through a collaboration among Dutch Health Insurance Fund, PharmAccess Foundation, Kwara State Government and Hygeia Nigeria Limited to provide access to basic healthcare for the people. After operating for 9 years, the programme stopped in 2016. This paper attempts to examine the social accountability measures put in place during the implementation of the programme and the social accountability measures deployed by the communities, in relation to the sudden stoppage of service delivery under the programme. The study adopted qualitative approach for data collection, particularly in-depth interview and focus group discussion. Findings indicate that the state government was instrumental in the stoppage of the programme; and that the change in government (via voting against a political bloc that had been in power since 2003) in Kwara State during the 2019 general elections was part of the social accountability measures employed by the citizenry in reaction to the stoppage of the Community-Based Health Insurance programme. The implication of this is that the current government, expectedly, will not only draw up a more robust healthcare policy for implementation but will also ensure that the people are carried along through adequate accountability system.
Self-reliance or Social Accountability? The Raison D'être of Community Health Committees in Nigeria
1University of Sydney, Australia, Australia; 2National Primary Health Care Development Agency, Nigeria
Efforts to facilitate social accountability through entities such as community health committees require that those involved have a clear understanding of how the committees see themselves.
We conducted this study to inform such efforts in Nigeria. We theorised that committees may see themselves in two ways – as outwardly-facing (i.e. “social accountability”) and/or as inwardly-facing (i.e. “self-reliance”).
We analysed the minutes of their meeetings, alongside interviews and group discussions with committee members, community members, health workers, and health managers in four states in Nigeria. The committees’ raison d'être manifests in three ways.
First, whether formed endogenously or by governments or NGOs, it is typically to be a platform for the community to co-finance health services, so their membership defaults to the local elite, and is optimised for self-reliance.
Second, their relationship with government officials is one-sided, designed to achieve the goals of governments (e.g. to improve the uptake of services), and not of the community (e.g. rights-based demands for government support); again indicating self-reliance.
Third, their activities in the community reflect a greater concern for ensuring that their community makes the most of what the government has already provided (e.g. helping to drive the uptake of existing services), than asking for more; again indicating self-reliance.
The self-interest of the local elite (to preserve the status quo) and of the actors who train, mentor and define their roles (e.g. by working in the government or health facility from which they will make demands) appears to play a role in why committees display a bias for self-reliance.
Optimising the committees for social accountability may therefore require training, mentoring, and guidelines by actors who do not have potential conflicts of interests in ensuring that they have the necessary information and strategies to demand social accountability.
Social Accountability Driven by Marginalised Women to Strengthen Health Systems
SAHAYOG is a registered voluntary organization working in India since 1992 with the mission of promoting gender equality and women’s health using human rights frameworks. SAHAYOG works closely with Community Based Organisations (CBOs) and a grassroot organisation comprising of marginalised women called the Mahila Swasthya Adhikar Manch (MSAM).
SAHAYOG recognises that accountability is a critical element as it ensures that all the actors within the system will be held responsible for their actions in light of mandated standards of performance. Implicit in effective accountability mechanisms are transparency, the active participation of civil society, responsive monitoring systems, and procedures to ensure enforcement, remedies of grievances, and the imposition of sanctions. SAHAYOG experiences have shown that there is a massive accountability deficit within the various government systems in Uttar Pradesh (UP) which results in poorly functioning health facilities that gets compounded due to problems of shortage of specialised health providers, low staff motivation, lack of equipments and supplies. All of this leads to poor quality of maternal health services in public health facilities which act as deterrents that discourage women to use public health facilities. District health managers and state health officials (due to the lack of answerability and lack of enforceability) do not take adequate measures to improve the quality of maternal health services. Further the poor feel disempowered and do not complain; in the absence of any evidence on the poor functioning of the facilities, no redress mechanisms are initiated.
SAHAYOG and its partners began working in three districts of UP, with the assumption that if there were active users with agency who could monitor services and make complaints, these could be used to exert pressure and force the activation of Hosptial Management Committees (HMC). Hence SAHAYOG trained MSAM women leaders on health and role of HMCs; building their understanding of entitlements within public health facilities, their skills in monitoring these and their ability to present the monitoring findings (in the form of photo stories of health facilities) to relevant officials thereby negotiating for improved services. It was assumed that the generation of evidence on the poor functioning of the facilities by the MSAM women leaders would create a culture of non-tolerance and would promote answerability and accountability thereby leading to enforceability. Our intervention aimed at building a cycle of learning, monitoring and feedback to the HMCs which was expected to challenge the lack of accountability and answerability leading to improvements in service provisioning, ultimately translating into better health outcomes
Our findings revealed that changes can be brought about by empowering marginalised women to monitor public health facilities and generate monitoring evidence. Our evaluation of the intervention yielded a rich understanding of how citizen-led demands led to improved performance of public service delivery and how the role of champions inside and outside the system was catalytic in the formation and activation of the HMCs. We also learnt that while social accountability was successful in challenging the knowledge asymmetry and power imbalance between marginalised women and health providers, it was not able to initiate the process of the formation of monitoring committee despite several attempts; nor was it able to mitigate the use of political clout to transfer honest and dedicated officials. Findings also showed how a lack of awareness of roles and responsibilities among non-health department HMC members and a clever use of power dynamics by health department HMC members perpetuated lack of accountability. Further, we found that social accountability could not change the existing political environment in one of the districts or prevent the delay of fund flows which had a significant impact on the functioning of the HMCs.
Enhancing Agency, Shifting Structures: Beyond Service Delivery Outcomes in India
National Foundation for India, India
Social Accountability work in India historically emerged from poor rural communities’ demands for transparency around how resources were used for public purposes. Ordinary citizens claimed answerability from the government using approaches which changed not only local interactions with officials or service providers but also impacted state policy-making and law. However, much of development practice in India today employs ‘social accountability tools’ as an instrumental mechanism for getting public services to be responsive to users within the ‘good governance’ framework promoted by multi-lateral donors. The emphasis on getting services to work often left existing power imbalances untouched, including those within communities, or power relations between community members and state actors.
National Foundation for India (NFI) is an autonomous grant-making philanthropic foundation working to promote social justice through strengthening civil society on the two thematic areas of inclusion and governance. NFI learnt that there is a dearth of literature on context-specific indigenous models of social accountability in India, as well as on the local practices of marginalised groups, such as sexual minorities for instance. This paper examines a case example of how NFI provided support to one such group, Kolkata Rista engaging with working-class trans-persons with whom notions of formal citizenship do not even apply as their state-citizen relations are poorly defined. The methods used include review of literature including grey literature such as NGO documents and reports, as well as qualitative data from focus group discussions among the team of Kolkata Rista and among the trans community they work with.
Based on the theoretical framework proposed by Sen et al (2020), the paper analyses the types and sources of power of the various stakeholders in an accountability strategy for TG communities to exercise their citizenship claims upon the state. The paper first briefly explores the literature on SA highlighting the importance of context and existing state society relations, then examines how existing state society relations, political context and citizen agency shaped the trajectory of the transgender community’s claims for state recognition and access to the benefits of the welfare state. The paper considers the ‘artefacts’ of the accountability strategy such as the Supreme Court rulings, the Transgender Act (TG Act) 2019 and the social norms, scrutinizing how each of these reinforced or contested the power and position of different stakeholders, both duty bearers and rights holders. These include the trans community served by Kolkata Rista, the social milieu within which they survive, the state machinery and the funding organization NFI. Using the framework for evaluating forms of accountability in SRHR, the paper assesses the interactions of these stakeholders with the artefacts of an accountability strategy, based on their social position, material interests and voice (Sen et al 2020:6).
Using a deep contextual analysis of power, the paper critically interrogates the extent to which SA can be an effective strategy with such a community organization at this particular juncture in state society relations. The paper brings out some lessons and promising practices on how funders need to support Social Accountability work by civil society organisations working among the most marginalised. The paper concludes with suggestions for strategies that can be developed to respond to the workings of power and how it may be possible for SA initiatives to contribute to social justice goals of equitable participation, respect for diversity and support the transformation of power relations.