Citizen Voice and Action: World Vision's Approach to Social Accountability

1. CITIZEN VOICE AND ACTION
World 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.

2. 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.

3. Citizen Voice and Action in FY14:
411 ADPs in 43 Countries

4. How does
Citizen Voice and
Action
work?

5. “Citizen Voice and Action” in Practice

6. How can
Citizen Voice and Action
Strengthen Health
Systems ?

7. CVA and HSS
CVA activity

8. 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?”)

9. 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

10. 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.

11. 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

12. 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.

13. Sample “Community Score Card”
results

14. 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.

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

16. RESULTS?
CVA’s Impact on
Child Well-Being

17. 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.

18. 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.

19. 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

20. 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

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

22. “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.

23. • 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)

24. 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.

25. Score Card for mapping ICDS Service Gaps

26. Thanks!
Dennis Cherian
Senior Director, Health
World Vision, Inc
dcherian@worldvision.org
tinyurl.com/citizenvoiceandaction