SOCIAL ACCOUNTABILITY through CITIZEN VOICE AND ACTION Connecting Local Governments and Communities to Improve Basic Services
Andreas Sihotang GPSA Project Manager Wahana Visi Indonesia
CITIZEN VOICE AND ACTION FOR GOVERNMENT ACCOUNTABILITY AND IMPROVED SERVICES Problem
Time
• High rate of IMR in NTT: 57/1000 (National: 54/1000) • High rate of MMR in NTT: 306/100,000 (National: 248/100.000) • Poor basic services on MCH
4 years (2014 – 2018)
Objective
60 villages, 11 sub-districts, 3 districts (Kupang, TTU, Sikka) NTT province
• To improve MCH services at village and sub-district level
Location
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CITIZEN VOICE AND ACTION Citizen Voice and Action (CVA) is a social accountability approach designed to improve dialogue and 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.
MAIN ACTIVITIES
ENABLING CITIZEN ENGAGEMENT • CVA Training for 312 Village Facilitators (135 M and 177 F) from 60 villages in 3 districts.
• Civic education at 60 villages in 3 districts attended by 9,680 people (3,202 M and 6,478 F) in 2015 to 2017.
CITIZEN ENGAGEMENT THROUGH COMMUNITY GATHERING • Initial meeting at 60 villages in 3 districts attended by 5,720 people (2,022 M and 3,698 F) • Standard monitoring of 211 Posyandu, 29 Polindes, 10 Poskesdes, 26 Pustu & 13 Puskesmas attended by 5,896 people (1,701 M and 4,195 F) • Score Card for 211 Posyandu, 29 Polindes, 10 Poskesdes, 26 Pustu & 13 Puskesmas attended by 5,918 people (1,566 M and 4,352 F) • Interface meeting at 11 sub-districts attended by 1,669 people (716 M and 953 F)
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IMPROVING SERVICES & INFLUENCING POLICY • Dialogue with local parliament (DPRD) and district government at 3 districts attended by 1,276 people (624 M and 652 F) • 575 action plans has been agreed and published in 2015, 815 action plans in 2016 and 1,258 in 2017. • Annual monitoring of action plans. • Budget and policy analysis on MNCH.
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OUTPUTS AND OUTCOMES
Changes Reported by Respondents
2016 ALL CHANGES
2015 ALL CHANGES Citizen participation 13%
Citizen awareness 25%
Govt respons 15%
Policy 6%
Budget 7%
Citizen participation 19%
Policy 14%
Budget 13%
Citizen awareness 12% Services 34% Gov responsiveness 15%
Services 27%
Increased knowledge and awareness of communities, local health staff and local government on service standards. Heard of Minimum Standards 100 90
% of respondents
80
Yes
70
60
No
50 40
Don't know
30 20
10 0 2014
2016
Heard of minimum standards for MCH services
“Now we know that there are standards that have been regulated by the government for MCH services in Posyandu, Polindes and Puskesmas. We are grateful to conduct a monitoring based on the standard. I hope we don’t have negative perception on this activity, but instead using the moment for selfreflection to improve our service” Head of Village, Waihawa Village, Sikka District
Village budgets for health services have increased, allowing provision of new inputs to improve health services at village and Puskesmas including recruitments of village midwives, equipment, building infrastructure, electricity and water provision, training and stipends for voluntary village health staff. Implementation of Action Plan 2015 District of Kupang, Sikka, and Timor Tengah Utara per January 2017 Total
Done
On going
Not Done
575 335
Total-2015
36 204
70 36
TTU-2015
District-Year
13 21
268 169
SIK-2015
17 82
237 130
KPG-2015
6 101 0
100
200
300 Number of Action Plan
400
500
600
Increased proportion of MCH facilities that achieve service standards; and Increased proportion of ‘good/very good’ and decreased proportion of ‘poor/very poor’ ratings by communities for MCH facilities.
Standard Monitoring 13 Puskesmas, 26 Pustu, 10 Poskesdes, 29 Polindes, 211 Posyandu At District of Kupang, Sikka, and Timor Tengah Utara Nusa Tenggara Timur Province 1-2015
2-2016
3-2017
1-2016
Score Card 13 Puskesmas, 26 Pustu, 10 Poskesdes, 29 Polindes, 211 Posyandu At District of Kupang, Sikka, and Timor Tengah Utara Nusa Tenggara Timur Province
2-2017
Very Poor
Poor
Fair
Good
Very Good
9.00 8.00 7.00
2-2017-11577
7%
1-2016-11089
8%
3-2017-11339
10%
24%
24%
25%
34%
25%
10%
32%
9%
6.00 5.00 4.00 17%
28%
30%
15%
3.00 2-2016-10535
2.00
7%
22%
35%
30%
5%
1.00 1-2015-14843
13%
34%
30%
20%
3%
Puskesmas
Pustu
Poskesdes
Polindes
Posyandu
Average
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
CHALLENGES AND LESSONS LEARNED Challenges
Lessons Learned
• Sustainability • Capacities of communities and cultures • Government’s support and openness
• CVA contributes to increase transparency, accountability and participation. • CVA contributes to poverty reduction. • CVA is inline with government policies and regulations. • Community’s and government’s champions will accelerate social accountability process.
THANK YOU!