Participation for All: Triumphs and Struggles
Fortifying Networks and Promoting Transparency in the Health Sector
Monitoring Government to Improve Its Performance
Most Brazilian citizens know very little about government budgeting and the impact that decisions on raising and spending public funds has on their communities. To address this problem, on 31 August 2010 the Federal Budget Secretariat (SOF) of the Brazilian government produced the “Federal Budget for Everyone,” its first Citizens Budget — a broadly accessible and easily understandable presentation of the budget. On that same day the government sent its 2011 budget proposal to the National Congress for discussion and approval, resulting in the Brazilian Annual Budget Law. A second edition of the “Federal Budget for Everyone” was published exactly one year later and included additional details about the budgeting process, as well as the government’s priorities for allocating resources to fund certain public programs and implement new policies. Now, after two editions, the SOF has institutionalized the production of a “Federal Budget for Everyone” as part of the regular budget process. To see the 2011 version, click here.
It is important for citizens to know how public resources are being allocated so that they can be sure that their money is being used for the right purposes. Government budget information, however, is often presented in very technical language, which makes it very hard for the majority of the public to clearly understand how the government is managing public funds. The “Federal Budget for Everyone” is considered to be a Citizens Budget because it is a very simplified summary of the national budget that provides just enough information for citizens to assess the government’s priorities and programs. It is written in an easily accessible format that, through the inclusion of pictures and graphs, allows even the least budget-literate citizens to understand how the state plans to collect and spend revenue. The “Federal Budget for Everyone” also contributes to a better informed and more participatory society in which people have access to the information needed to play a meaningful role in decision making and combating inefficiencies, waste, and corruption. It,
The Brazilian government expects that the “Federal Budget for Everyone” will help citizens realize that it is their right to know the priorities reflected in budget policies, and the government hopes that efforts like this will jumpstart a culture of transparency and public participation. Each year the “Federal Budget for Everyone” will be published with the expectation that it will contribute to the development of an informed society that is both interested in and capable of contributing to local policy making. Through these efforts, we hope to make Brazilian budget processes more accountable, transparent, and participatory.
To see Brazil’s “Federal Budget for Everyone,” click on the following link: https://www.portalsof.planejamento.gov.br/sof/orc_2012/ploa2012/versao_ingles2012.pdf.
Twaweza, a word meaning “we can make it happen” in Swahili, is a civil society initiative focused on large-scale change in Tanzania, Kenya, and Uganda. The group advocates for improved service delivery, pragmatic citizen action, and increased access to information to promote a spirit of personal and community responsibility. Last month, Twaweza encountered resistance from the Ugandan government when it printed 2012 calendars with messages meant to mobilize greater civic participation.
The text of the calendars asked, “Who will change your world in 2012?” and included photos of 10 Ugandan (ruling party and opposition) politicians on one side and 14 international personalities (including statesmen, royalty, footballers, and musicians) on the other side. Below the photos is a place for the reader to put his or her own photo, and the question: “Will you wait all year for someone else? Or will you take action today?” The message is clear: people themselves are responsible for their own development, and everyone has an obligation to be involved in their communities and hold their government to account.
Unfortunately, ongoing political struggles in Uganda have heightened tensions between government and civil society groups operating in the country. While Twaweza is fiercely independent and not affiliated with any political party, the police have tried to link it to an opposition movement and confiscated nearly 700,000 calendars to be distributed in Uganda.
The IBP interviewed Twaweza Uganda Program Manager Morrison Rwakakamba, who noted that “Twaweza is nonpolitical, and the calendars are part of a campaign telling citizens that government leaders and heroes can never solve all your problems. They can create the right environment, but ultimately, Ugandans are the change they seek, and that’s what the message is about.”
Morrison continued, “Ugandans should not look after leaders, they should not look after heroes, they should not look after Barack Obama or Nelson Mandela. For the change they seek, they need to wake up every day, every morning, and take action. And those individual actions, those individual initiatives, are the ones that are going to change their lives and change their world. That’s the core of the message. It has been misunderstood by the authorities, and we have been trying to explain to the authorities that this is not a message for the change of regimes, but a message for the change of the citizenry in their own way to manage and govern their own world and their own life.”
Learn more about Twaweza at: www.twaweza.org.
View the confiscated calendars here: www.twaweza.org/go/twaweza-calendar-20121.
Following the unexpected resignation of the former Minister of Health earlier this year in Ecuador, an unlikely replacement candidate was appointed. The new minister, Carina Vance, does not have the typical qualifications for this position. For starters, she is not a doctor. In Ecuador it is generally believed that doctors are the only source of authority on health issues. Although Vance has a Master of Public Health degree, her youth and lack of medical experience made her appointment a subject of controversy. She is also a lesbian, gay, bisexual, and transgender (LGBT) rights activist. Formerly the Secretary of Planning at the Ministry of Health, Vance was very vocal in condemning the proliferation of clinics that treat homosexuality as a disease and equate it with an addiction, such as one to drugs or alcohol. Her position on the issue is clear: she states that these “addiction clinics” violate human rights as guaranteed in the Ecuadorian Constitution and, therefore, must shut down or, at the very least, be regulated for treating only medically recognized addictions.
For IBP partner Grupo FARO, Vance’s appointment as the new Minister of Health offers an interesting opportunity for collaboration. Her work as a human rights activist for the LGBT community shows that she recognizes the importance of protecting human rights as documented in the Constitution. In Article 32, the new Ecuadorian Constitution mentions the right to health as a “right guaranteed by the state that is linked to other rights such as the right to water, food, [and] education,” among others. The health initiative in Grupo FARO promotes this right by empowering civil society actors to demand simplified budget information and to monitor their health services.
Before becoming a civil servant, Vance worked from within civil society (she was the executive director of a lesbian rights organization) and has acknowledged that the work of civil society organizations (CSOs) is fundamental for improving public services. In an interview she said that the only way improve health is to support the participation of CSOs in policy making and oversight and to open channels for citizens to be involved in their own well being. Grupo FARO highly values this inclusive approach to policy planning and implementation. As an organization we believe that policy must be the result of engaging different actors in the public sphere — decision makers, civil society and private sector representatives, and ordinary citizens.
In view of Vance’s diverse background Grupo FARO has reason to believe that the right to health and civil society participation are priorities for the Ministry of Health’s new administration. In the short term, Grupo FARO is launching a Civil Society Health Information System that compiles information from different sources to improve access to information for CSOs and will be available on the Internet. Grupo FARO recognizes, however, that this system must be endorsed by the ministry in order to be comprehensive and sustainable. We hope to work together with the new minister and her staff to validate the importance of access to information for the participation of CSOs in health planning and budgeting. Down the road we would like to continue working closely with this administration to pursue our objectives – to improve access to information and civil society participation in health policy.
For more information, contact Anabel Castillo at [email protected].
Sikika is a Tanzanian civil society organization that seeks to improve access to and the quality of healthcare services for all Tanzanians by enhancing community engagement and promoting transparency and accountability within district health systems. Recently, several of its members were arrested following a peaceful protest in support of a doctors strike. The IBP expressed concern about the arrests to the Tanzanian government and reached out to Irenei Kiria of Sikika for more information:
Albert Van Zyl: Why were doctors in Tanzania on strike? Why did you decide to support them, and how did you support them?
Irenei Kiria: We supported the doctors because they were fighting for a cause that Sikika was also fighting for. The doctors were marching for better remuneration and availability of the commodities and supplies they use to provide better services. Doctors currently make about US$590 a month, and they are asking for US$2,200 per month. Sikika works on three main areas, health financing, medicines and supplies, and human resources. For human resources, we are looking at the working environment of the doctors, as well as the ability to deliver the services. This is how our priorities intersect with those of the doctors. In addition, medicine and supplies are an element we are working on, and the doctors are demanding [that] the government provide enough medicines and supplies and solve the problem of overcrowding in hospital wards. So we supported the doctors because they were fighting not only for their own welfare but for better delivery of quality services in Tanzania.
AVZ: What did you do to support the doctors strike?
IK: We started lightly by issuing a statement as Sikika. But when the strike continued, we worked with the Legal and Human Rights Center to issue a joint statement. When the government still did not respond we reached out to more NGOs and called for a meeting with them, because some of the NGOs don’t work in the health sector. At this time some Members of Parliament requested that the issue of the strike be discussed in Parliament, but the Speaker would not allow it. We had hoped that the Parliament would intervene and force the government to do something, but the Parliament, and especially its leadership, supported the government. So, then we decided to organize demonstrations, but we understood that usually in Tanzania, demonstrations are squashed and you won’t get anywhere. When we learned that the government and the police were preparing for our demonstration, we decided to hold it a day earlier. We decided to close the roads at a busy intersection leading to the residences of senior public officers and politicians.
After we closed the roads on 8 March 2012, the government responded as quickly as possible. The Prime Minister issued a request to meet the doctors on the following day. At this meeting doctors and the government agreed on certain terms, and they also agreed to continue discussing or negotiating other demands over the following three weeks. At this stage the strike was stopped, on the condition that the government would implement the agreement.
AVZ: What surprised me was that at the point where progress seemed to be made, at the point where the government met with the doctors and some agreement was reached on a path forward, you and others were arrested. Could you say more about when exactly the arrest occurred?
IK: Sixteen of us were arrested while the Prime Minister was meeting with the doctors, at Muhimbili National Hospital. The police searched our vehicles for materials and pictures. We were finally released on bail at around six in the evening. After numerous calls and meetings we are still waiting to hear whether we will actually be charged. We believe that they are not going to charge us, because our lawyers are saying legally we were supposed to have already been charged, if they still have the intention of charging us. There were reactions from people and from organizations, internally and externally, including a letter that was written by the IBP. But since then the police have been following us and monitoring our activities with listening devices.
AVZ: What are the broader consequences of these arrests for the way in which you engage with government? What do they mean for the relationship Sikika and other organizations have with the government?
IK: So far, I don’t think the relationship is going be harmed in any way, because we continue to speak with the senior- and middle-level government officials in the Health Ministry. And we also continue to receive invitations for meetings. Some of these officials even called us during the time of the set strike and asked us apply more pressure because they were concerned with the leadership. As part of the agreement with the doctors, several top leaders of the Health Ministry were actually suspended. Now that we are calling for the suspension of the Minister and the Deputy Minister, there is also support from inside the ministry.
AVZ: That’s interesting, because that would indicate that there are significant divisions in the government. There’s a part of the government that is clearly trying to silence you, and there’s a part of the government that is encouraging you to do more. Is it true that the government’s response to public protests has always been quite heavy-handed?
IK: Yes. The problem in Tanzania is [that] the international media does not cover these kinds of protests, even though there have been quite a lot in Tanzania. I think that is probably the reason why the government continues to deal with peaceful protests the same way they do – because the media does not report on these protests, and the government is not afraid of damaging its image among the international community.
AVZ: You mentioned that one of the ways in which you respond to government intimidation is by building networks along issues. I also know that you and others maintain a very prominent presence in the social media networks. Are there any other ways that you respond to and protect yourself against these efforts to discourage your work?
IK: We have been trying to also use the media. We appear on television and radio interviews to try to explain our position. At the moment, with this doctors strike, I think we have appeared frequently in both print and electronic media, trying to explain that we support the doctors strike not for the benefit of the doctors but for the benefit of the majority poor.
To learn more about Sikika’s work to promote quality health services, click here.
Governments often make promises to citizens regarding the right to health services. These promises should translate into expenditures that are critical to ensuring that the poorest and most vulnerable in a society have access to adequate care.
Civil society can monitor how health-related promises are reflected in concrete actions by analyzing the government’s budget. Advocates can see whether their government is meeting the health care needs of its people, and its commitments to meeting those needs, in terms of access to services and the adequacy and quality of care provided. Unfortunately, the lack of budget transparency and adequate accountability mechanisms in the health sector creates opportunities for discrimination and corruption, affecting the accessibility and availability of health services. Moreover, health systems serve a multitude of different patient groups based on social and economic differences, known as segmentation – and include a wide variety of entities that serve these groups, known as fragmentation – these factors when combined deepen the lack of transparency and limit social accountability and participation.
In order to share the knowledge, lessons, experiences, and strategies to analyze health budgets of civil society organizations working in the sector, the IBP’s Partnership Initiative recently organized a regional exchange in El Salvador from 30 January to 3 February. Attendees represented civil society organizations that analyze health budgets in Mexico (Sonora Ciudadana and FUNDAR), Ecuador (Grupo Faro), Guatemala (CIIDH), and El Salvador (FUNDE and FUMA).
Participants discussed strategies for communications, civic participation in different contexts, and characteristics of health systems in the Latin Ameica. The participants presented and discussed case studies where such issues as decentralization, strategic litigation, and public-private shifts came to life. All attendees left the exchange armed with new ideas to influence the health reforms in the region and a regional network of colleagues excited about the work that each is carrying out from their respective trenches. As Anabel Castillo, a participant from Grupo FARO in Ecuador, noted, “I learned the most from case studies presented by Sonora Ciudadana (SC). SC is a small organization; their work is mostly local and relevant to a particular area of Mexico. Even though our work is at the national level, the experiences of SC felt like a success story that could be replicated by Grupo FARO. . . . Especially important for us is the way they formed alliances with organizations to complement their work in areas that were not part of their expertise.”
To learn more about how civil society organizations use budget analysis to monitor whether or not government is fulfilling health-related promises, click here.
Decentralization is often seen as a necessary reform to advance democracy in a country. In Peru, decentralization involved the transfer of functions, skills, and decision-making capacity and autonomy to subnational authorities that are elected by universal vote. It also brought the state closer to the people by introducing mechanisms to channel civic participation into public management. Following its launch in 2001, however, decentralization has not, in and of itself, been a priority in the agenda of political parties, and it is constantly threatened by efforts to weaken or reverse it.
It is thus essential for Peruvian civil society to closely monitor decentralization efforts. IBP partner Grupo Propuesta Ciudadana does this through its Vigila Peru (“Citizen Watch Peru”) project. The project’s monitoring work highlights a risk of recentralization as evidenced by proposals and other actions to undermine regulations designed to deepen the decentralization process, such as those that promote fiscal decentralization and more effective management of budgeting and public contracting processes by subnational governments. Other monitoring priorities include the role of subnational governments in relation to civic participation, accountability, transparency, and access to information.
To counteract distortion campaigns by sectors opposing decentralization, Vigila Peru produces information on decentralization reform, including that related to civic participation, management of investments, distribution and use of royalties and fees, and fiscal management. And, because of the monitoring efforts of civil society like Vigila Peru, the mechanisms for transparency and access to public information, particularly regarding budget management, have consistently improved.
Despite growing public expenditure to address social problems and improve Peruvians’ lives, there has been little improvement on social indicators. To address this, Vigila Peru seeks to increase civic demand for information from public institutions and greater participation in budgeting in order to hold public officials to account. And by articulating the successes that we’ve had in using greater access to information to fight corruption, we hope to change the public perception that improvements in transparency have not prevented municipal corruption, particularly as it concerns the budget, contracts, taxes, and revenues from extractive companies.
At Grupo Propuesta Ciudadana, our vision for the government includes deepened and consolidated decentralized reform, with improved mechanisms for local public participation. We want fiscal decentralization and a distribution of the budget that ensures equity, transparency, and predictability for subnational governments. And to improve the quality of public expenditure, we call for the government to establish performance-based budgeting, particularly in social expenditures in education and health. We know that Peru can achieve these changes, but it is crucial that civil society play its part in monitoring progress along the way.
To learn more about Vigila Peru’s efforts, click here.
More than 40 percent of El Salvador’s population lives in poverty, and the country is one of the most indebted nations in Latin America in relation to gross domestic product. El Salvador also faces fiscal deterioration, a high Corruption Perception Index score, and a culture of poor transparency as reflected in persistently low scores on the IBP’s Open Budget Index. It is thus crucial to ensure that scarce public resources are used to transform the lives of those living in extreme poverty.
The government’s social investment programs are vitally important in reaching this goal. El Salvador’s Social Investment Fund for Local Development (FISDL) was created in 1991 to contribute to poverty reduction by promoting local development. It focuses on projects that invest in human capital and basic social infrastructure throughout the country, with an emphasis on the poorest zones.
The government has made more than US$500 million available for social investment projects administrated primarily by FISDL from 2010 to 2014. Transparency and civic participation in these efforts are critical to ensuring that resources will be used efficiently to help meet the needs of the poorest and most vulnerable.
Civil society is actively promoting transparency and participation — particularly the Fundación Nacional para el Desarrollo (FUNDE), which works to ensure that families in extreme poverty can attain better living conditions and have more opportunities for development. Through its project, “Transparency and Participation in Budgets for Social Investment Destined for El Salvador’s Poor Communities,” FUNDE advocates for greater transparency and civic participation in the administration of public institutions, particularly that of FISDL. The project is based on the belief that people who live in extreme poverty should be able to exercise their rights to access to information, participation, and control over the social investments in their communities.
Currently, FUNDE is monitoring FISDL administration in such areas as budget management, project administration, and channels of information and participation. Additionally, FUNDE is developing public participation processes in six municipalities that will subject projects in those areas to social audit.
As social investment projects develop, access to information is key to effectively monitoring their implementation. Despite the 2010 enactment of the Law of Access to Public Information in El Salvador, information has not always been made available in a timely manner, nor has it always been comprehensive, relevant, trustworthy, or easy to access. And while FISDL was the first public institution to draft and promote a Policy on Institutional Transparency, access remains limited. In the name of transparency, FISDL should adopt a system allowing for better communication within the institution and for better access to information for civil society and the broader public.
In spite of these challenges, efforts by Salvadoran civil society organizations to promote transparency and participation can help to ensure that funds managed by public institutions, such as FISDL, have true potential to change the lives of those living in extreme poverty.
To learn more about FUNDE’s efforts, visit www.funde.org.
To learn more about the FISDL, click here.
Governments can encourage citizen participation by creating conditions that enable them to participate in a meaningful way. A very important one of these conditions is that all citizens have ready access to government information. Access means not simply physical access to documents, but accessibility. Where the government’s work is highly technical, it is not sufficient to simply make technical documents available. Citizens should have access to information in a language and through formats that ordinary people can understand and appreciate.
The Power of Making It Simple: A Government Guide to Developing Citizens Budgets is the third in a series of IBP publications for governments seeking practical guidance on how to make their public finance systems more transparent. The Power of Making It Simple focuses specifically on Citizens Budgets and offering useful tips to governments interested in developing one.
Click below to access PDFs of the guide in English (French and Spanish versions forthcoming).
The Steering Committee of the Global Movement for Budget Transparency and Accountability, currently based at the International Budget Partnership, is looking to recruit a Campaign Manager to shape and lead a global campaign to secure greater public access to budget information and accountability for public funds. This is an exciting opportunity for an experienced civil society advocate to play a formative role in developing and leading a global campaign to open budgets to public scrutiny and transform the lives of citizens throughout the world. Read the full job description and learn how to apply by clicking here.
Director, Institutions and Governance Program, World Resources Institute
The World Resources Institute is looking for a highly qualified Program Director to lead its work to collaborate with institutions and civil society organizations worldwide to ensure that decisions about natural resources reflect environmental values as well as people’s rights and interests. To apply and to read the full job description, please click here.