Community members vote on the quality of local services at a Citizens Voice and Action meeting.
Journal Entry from Natasha Tamplin – April 2006, Uganda
“I could just sense the anguish and grief of the father, as he buried his 6 year old daughter yesterday. … Her name was Deborah – she fell sick one day – Her father rushed her to the government health centre, where they were told she had malaria…..but of course, like most health centres in the country, there was no appropriate treatment (ie. Coartem) left in stock. So, he took her to a local ‘drug shop’, where they injected her with 3 doses of a very strong drug used to treat severe (rather than basic) malaria (called Quinine). After some days at home, she didn’t improve. They took her to a private clinic in town, where they again injected her with more Quinine because there were no ‘official’ papers from the local ‘drug shop’ to indicate exactly what they given her already. However, her condition worsened at home – and despite rushing her to hospital where she was given even more Quinine … she died the next morning.”
I didn’t know Deborah personally but I will never forget feeling so much anger when I met her father and heard this story. Where was the justice in Deborah’s preventable death? If only the government had kept their promise to equip every health centre with the free malaria treatment to prevent so many children dying unnecessarily within 24 hours of malaria fever!
Did the people in her community even realise that their basic human rights and entitlements were being denied? And if they did, did they know what to do about it, at least at the local level?
It wasn’t until I joined World Vision that I realised the importance of our Social Accountability and Advocacy work in our Area Development Programs, most especially one of our most effective approaches called Citizen Voice and Action (CV&A).
CV&A empowers citizens with a voice by transforming the dialogue between citizens and the power holders/government service providers in order to improve the quality of services (eg. Health centres, schools, etc) by keeping governments accountable.
What does that mean? In many areas where World Vision works, local government systems (like Health or Education) may be weak or dysfunctional even when Governments have policies and standards to improve to the well-being of children. World Vision supports citizens to work with and push governments to deliver and lead change to improve poor health and education services. Citizens first need to know what their rights, roles and entitlements are, before demanding the minimum requirements from their leaders, such as supplies of basic drugs or a trained school teacher.
Top five ways in which Citizen Voice and Action supports sustainable outcomes:
1. CV&A gives the voiceless a “voice” who learn about their roles and entitlements and then unite to demand accountability from service providers for minimum requirements (like drug supplies or trained school teachers). Through focus groups, they vote/rate the quality of the service (eg. health centre or school) and propose local reforms. These are typically illiterate people who have few chances to express themselves or contribute to policy or service change
2. CV&A helps break down barriers and power dynamics between the service providers and the citizens with open and transparent dialogue, connecting public servants with communities to ease social tensions and misunderstandings. Citizens start to understand the constraints the local service providers face, rather than blame them, and often both start to improve the service rather than operating in opposition.
3. CV&A empowers and motivates citizens to take action themselves and “own” their own development. They are inspired and empowered to work together to address the gaps and challenges, with a new appreciation of their own roles and responsibilities.
4. CV&A improves not only quality of services but people’s health and educational outcomes. Evidence shows CV&A processes has resulted in local service providers improving the quality of their operations; of local governments increasing their budgets to meet the ‘standards’ they are accountable to; and of change in attitude and treatment of patients and students. This has led to better child well being outcomes like increased test scores and pupil enrolment, as well as increased use of health services (like immunisation) and reduction in child mortality.
5. Data used from local CV&A action plans helps identify trends/patterns of government failures across entire regions to influence National Policy. For example, in 2013 in Uganda, evidence based advocacy using local CV&A data resulted in a National health budget increase to recruit additional 8600 medical staff.
I now wonder whether Deborah’s unjust death might have been avoided if a CV&A program had been operating in her community back in 2006. I believe it may have. We might not be able to change the past, but we can equip communities to create a better future.