Read this post in: Spanish | French | Bahasa | Arabic
It takes a village to raise a child. And it takes a multitude of actions at multiple levels of government to ensure the child has a textbook when she goes to school. Public service delivery is complex. Problems are rarely confined to a particular school, locality, or government institution. This is one of the points American University’s Jonathan Fox made in a recent post for the Open Budgets blog, arguing that a “conceptual reboot” is needed among those pushing for more accountable governance. A myopic focus on isolated service delivery problems risks mistaking the symptoms of accountability breakdowns for the causes.
The solution? We need to start Doing Accountability Differently. Reformers need support to forge diverse coalitions that are able to navigate this complexity and drive change. Such coalitions should be capable of simultaneously influencing multiple levels of government and monitoring links in the service delivery chain from the local, to the state, and even national level (i.e., “vertically integrated”).
Recent IBP research would seem to align with much of Fox’s thinking. Paolo de Renzio’s work on the budget accountability ecosystem points to the complexities of managing public finance and the need for a more holistic conception of the drivers of accountability. Jillian Larsen’s research into the attributes of successful budget campaigns calls for forming coalitions that allow for a division of labor, letting each organization focus on what they do best.
Two new IBP case studies documenting CSO work in India — one documenting the work of Support for Advocacy and Training to Health Initiatives (SATHI), the other looking at Samarthan — provide some fresh insights into what doing accountability differently may look like in practice.
Grappling with the Complexities of the Indian Health System
A longstanding IBP partner, SATHI has been working for decades to improve public healthcare in the Indian state of Maharashtra. The organization has worked at the village level to organize social audits of individual health clinics, mobilizing networks of CSOs to help communities investigate and document problems, and propose solutions. SATHI not only uses the audit findings to help improve individual health clinics but also to identify gaps and blockages related to higher levels of government. Leveraging CSO networks and its official position on government committees, SATHI has pushed for changes wherever they were needed — from the district or the national level — by bridging the gap between those directly affected by problems in the health system and decision makers and implementers.
SATHI’s strategy seems to be bearing fruit. It has already contributed to the expansion of participatory practices in Maharashtra’s health sector. SATHI drew on its community-level work to show that patients were 10 times more likely to give positive ratings to health clinics that were subject to community-based monitoring than those that were not. It was then able to leverage its knowledge and networks to push the state government to act by expanding the practice to other parts of Maharashtra.
Improving the World’s Largest Social Safety Net
Like SATHI, Samarthan has a long track record of tackling governance issues in India. The organization works to strengthen participatory governance and development in Madhya Pradesh. One of its key areas of work is on improving the Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS). Reportedly the world’s largest social security scheme, MGNREGS guarantees 100 days of paid work to every rural household in India. This labor is meant to be directed into public works projects that communities themselves identify as priorities. The scheme has the potential to be transformative to tens of millions of poor households in rural India, yet it is plagued by inefficiency, manipulation, and outright corruption at multiple points from the state down to the village level.
Samarthan quickly learned that breakdowns in accountability defied easy compartmentalization. A problem could be isolated to a single village or point to wider, more systemic holes in how the scheme was being administered. It decided become a conduit for tackling both.
Tapping its grassroots networks, Samarthan helped coordinate social audits at the village level and organized training session with the local officials who administer the scheme. At the same time, the organization actively engaged with CSO networks, such as the People’s Budget Initiative, to bring systemic issues to the fore.
Again, much like SATHI, Samarthan’s work has kept it deeply connected to the realities of how service delivery plays out on the ground. It has helped communities and local organizations tackle problems that are specific to a particular village or block, but Samarthan is also able to influence higher levels of government for problems that are broader and more systemic.
Doing Accountability Differently
Both SATHI and Samarthan seem to be working in ways that exemplify at least some of what Fox means by “Doing Accountability Differently.” They have not sought to scale up by just monitoring more and more communities or health facilities. Rather, both organizations have taken a more holistic view of accountability and joined or forged networks that allow them to engage in monitoring and advocacy at multiple levels of government. Each has maintained a firm grounding at the community level while building the capacities needed to navigate the technical and political dimensions of governance at the state and national levels. Both have been able to note symptoms, diagnose underlying causes, and shape their engagement strategies accordingly.
This last step is crucial. Their work has not just been about devising the ideal policy solution, though they are both well placed to do so. Their goal has not been having a seat at the table, though both are involved in various official bodies that do grant them access. Their effectiveness has come from being able to cannily navigate a complex public service delivery system and assemble powerful networks of reformers to amplify their voice — and the voices of those they serve — so it reaches the ears of those who need to act.
Further Reading
- Taking an Ecosystems Approach: Samarthan’s Work on Rural Poverty in India (Case Study, September 2016)
- Taking an Ecosystems Approach: Support for Advocacy Training Initiatives’ (SATHI) Public Health Work in India (Case Study, September 2016)
Thank you, this has been a good beginning. In the Indian context, for health service delivery accounting and budgeting there is also an HR issue of the Public health system which leads to there not being enough confidence in the capacity and this impinges on decision-making is locally. There is no clear line or cadre of staff for financial management. Vested interest takes over when long held posts and line managers at the Block and District level are not moved, evaluated, promoted or supervised adequately.