STRENGTHENING ACCOUNTABILITY FOR CHILD SURVIVAL GOALS

1
STRENGTHENING ACCOUNTABILITY FOR CHILD SURVIVAL
GOALS

• OUTLINE
• The accountability framework
• The accountability web
• What makes for effective accountability?
• Good Practices
• Critical Issues
• Charles Abugre
• (Head of Policy and Advocacy, Christian Aid)
• December, 14, 2005

2
Accountability is about answerability and
responsiveness.

• Rooted in
• Mutual gain as well as mutual pain (incentives)
• Responsibility (Legal/Contractual and/or a
  normative framework)
• Enforceability influence, representation and a
  stakeholder framework (in terms of
  transformational relationships) and a systems of
  reward/sanctions.
• Accountability is about the management of power
  relations to maximise mutual benefits.

3
Accountability in child survival context

• The Convention of the Rights of the Child and the
  associated national legislations within the
  International Human Rights framework. This
  involves
• A regime/hierarchy of duty holders
  responsibility framework
• A regime of agency institutions of duty and
  rights holders
• Normative standards and codes of behaviour
  against which progress can be assessed
• A regulatory framework and instruments of redress
• A systems and structural approach/plan and
  budgets to deliver a comprehensive child health
  plan the preventive and curative services to
  reduce mortality etc.
• And then, instruments including technology,
  delivery mechanisms (including decentralisation)
  and specific interventions
• A participation and transparency regime fostering
  active agency
• An international policy environment and funding
  arrangements supportive of the above

4
Critical Actors and Issues at national level

• A policy framework defining a systemic approach
  favouring primary health committed to universal
  non-privatised provisioning and linked to other
  sectoral plans of government.
• A Planning and budgeting process which encourages
  participation of service users especially in
  terms of oversight, transparency in procurement
  and resource use and output/outcome reporting of
  service providers.
• A simple quality assurance/performance framework
  to encourage consumer-led quality enforcement.
• A funding system which supports technological
  interventions within, and not outside, the
  framework of health systems strengthening.
• A role for parliamentary oversight.
• Civil society led processes aimed at tracking
  expenditure, campaigning for rights and access
  and undertaking independent performance
  assessments.

5
Sub-national Level Issues

• Decentralised services linked to and driven by
  national strategies
• Decentralisation which encourages community
  participation in decentralised planning and
  budgeting, decentralised political participation
  and oversight and effective fiscal devolution.
• Citizens-led initiatives aimed at assessing
  quality and intake e.g. citizens juries and
  community assessments of health service.
• Regulation of anarchic private sector services,
  guided by simple easy-to-communicate quality
  assessment arrangements and norms.
• A conscious consumer/citizens rights ethos.
• Formal platforms for public interactions, e.g.
  around performance assessments and planning and
  budgeting.
• Transparent display of annual health service
  performance against targets

6
Critical Issues for International Partners

• Have we leant the lessons of world Bank driven
  cost-recovery measures? Are we going down another
  route of disaster through the new age health
  insurance systems being driven down aid dependent
  economies?
• Subtle and overt privatization of basic health
  services Have we adequately taken stock and
  assessed the potential impact of such an
  expanding trend on the poor and the health
  systems of poor countries?
• Technology-driven interventions favoured by
  private financiers Have we adequately assessed
  the long term impact of such an approach on
  health service systems of poor countries.
• The expanding role of the World Bank and the use
  of loans for basic health, including child
  survival goals Why is the World Bank getting
  bigger in this area and the UN institutions that
  provide finances in grant form struggling for
  resources? What is the long term effect of an
  expansion in World Bank lending and its subtle
  support for private sector solutions to health
  services in poor countries?
• Strategies in other related services
  Privatization of water. Isnt this a child
  survival issue?