How citizen-led accountability can improve the health of the most vulnerable

    Thomas (front, right), a health worker and Juliana (front, left), an activist in Batnes, Indonesia where World Vision's Citizen Voice and Action approach equips communities to hold their governments accountable for services they provide and promises they make. Photo by: World Vision

    If private markets can produce smartphones and tablets, can aid organizations create innovations that are equally sought after? And could those innovations dramatically improve the quality of life for people in the most vulnerable and remote corners of the world?

    That’s what I recently hoped to find out in a remote village in Indonesia.

    The village is a long way from the bourgeoning skyscrapers and bright lights of Jakarta. Even after touching down in the Indonesian capital, my journey involved several additional flights and a five-hour drive to the border of East Timor. I had travelled to meet with Thomas and Juliana, two very different but dedicated individuals.

    Thomas works for the government as provincial head of health services. Juliana is an activist who leads her community in the use of World Vision’s Citizen Voice and Action approach, a social accountability tool that equips communities to hold their governments accountable for the services they provide and the promises they make.

    Feedback loop

    To put it more simply, social accountability creates a feedback loop.

    Think of a successful company. Their consumers have given them feedback on what they want to buy, and the company has listened and used it to improve their products or services. Social accountability works in much the same way.

    Juliana and her fellow villagers worked with the local government to monitor the quality of health care at their local clinic. They learned about their rights, compared reality against local law, and advocated for change.  

    Four years ago, the health clinic was little more than an empty building. Today, the once-dilapidated clinic has been rejuvenated and become a model for the province — winning prizes along the way.

    A new doctor and midwife now serve children and their families. Medical equipment has been delivered and an ambulance delivers patients from far-flung rural areas.  

    What Batnes discovered is a feedback loop can bring “wins” to both communities and governments. The process gave villagers a clearer picture of the challenges civil servants like Thomas faced. It also gave Thomas the evidence and political support he needed to go to the district health office and demand the village’s rights be fulfilled.  

    That’s why we’re so interested in how collective action by communities, and the feedback loops they generate, can improve developmental outcomes.

    Measuring social accountability

    World Vision was recently part of a randomized control trial in Uganda, in which 100 communities took part in a social accountability project — developing a scorecard to measure the performance of their schools. As a result, these schools experienced a 9 percent jump in primary test scores, and saw student and teacher absenteeism decline by 10 and 13 percent respectively.

    But in this study, we also used a tool — attractively called the “dichotomous voluntary contribution mechanism” game — to measure the community’s ability to solve problems collectively. We found communities who had used the scorecard were 16 percent more likely to solve collective action problems.  

    In the 34 countries where we’ve applied social accountability approaches, we’re finding that when communities, governments, and service providers come together to examine services from an evidence-based perspective, they can collectively solve the problems they face.  

    For us at World Vision, the next question is how can we help facilitate broader feedback loops that allow citizens to address patterns of government inaction?  How might the best civil servants, like Thomas, and energized activists, like Juliana, join with other citizens to act collectively for a more just society?  

    These are the issues we’ll be raising as the U.N. Open Working Group on the post-2015 development agenda convenes this week in New York to design ambitious, global goals that will help galvanize international attention — and resources — toward tackling poverty and injustice.

    By integrating feedback loops like CVA, we can ensure the next development framework is driven by and for the people to whom it matters the most.

    World Vision will host on Friday, Dec. 13 in New York a side event called “Citizen Voices: How Citizen Participation and Social Accountability Can Drive Development Effectiveness,” in which global accountability experts, academics and government representatives will discuss how sustainability goals and the post-2105 framework can incorporate citizen-led accountability.

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    About the author

    • Jeff Hall

      Jeff Hall is director of local advocacy at World Vision International and leads the organization's Citizen Voice and Action approach to social accountability. Before joining World Vision, Hall was a lawyer at the Inter-American Court and grassroots activist for human rights and development.