October 20, 2015

Demanding accountability isn’t (just) about shouting and making noise: Reflections from GMNHC2015 day 1

Written by Rima Jolivet, Maternal Health Technical Director, Maternal Health Task Force

This post originally appeared on the blog of the Maternal Health Task Force.

Citizens with signs

Citizens Hearing in India (Photo: White Ribbon Alliance)

Accountability ran through today’s offerings at the GMNHC, both those explicitly dedicated to the topic and others I attended. I chose the title for this blog from the opening remarks made by Betsy McCallon, Executive Director of the White Ribbon Alliance global secretariat, in WRA’s panel entitled “Demanding Accountability for Quality Maternal and Newborn Health Services: Lessons Learned and Best Practices”.

She pointed out that while demanding accountability might conjure visions of people protesting in the streets (and this is one important tactic), it is much more than that.

Accountability is a process. McCallon went on to define the demanding of accountability as a systematic process that includes analysis of barriers, identification of context-specific solutions, targeted goal-setting and attention to results, scaling up successes and learning from less successful attempts (my paraphrasing).

WRA National Alliance representatives described the steps they undertook to hold health systems and decision makers accountable for commitments to ensure availability of emergency maternal and newborn health (MNH) services in Tanzania and Uganda, to legislate women’s entitlement to respectful maternity care through a Safe Motherhood bill in Nepal, and to hold facilities responsible for providing quality care in India through a cellphone-based citizen monitoring program that simultaneously educates women on their entitlements and empowers them to rate the quality of the services they receive.

Accountability is also a mindset. Accountability to stakeholders and beneficiaries has to be built into both the design and the evaluation of health programs and policies. Abhijit Das, from the Centre for Health and Social Justice in India, a panelist in the session titled “The Role of Evaluations in Bridging Inequities: Experiences from Latin America, Asia and Africa,” made this point passionately. He asked participants to critically question the assumption that the priority interventions for saving maternal and newborn lives are known and it simply a matter of getting them to marginalized communities in all corners of the globe, pointing instead to the great diversity reflected in these populations. He criticized the current strategy for addressing inequities as “policy fundamentalism”: to identify gaps and then simply intensify efforts using the same approaches. Instead, he exhorted the audience to listen to key stakeholders, to understand their lived experience and their key concerns, and to design and evaluate programs on the basis of how well they meet the needs and expectations of women who experience inequities in access, availability, acceptability and quality of MNH services.

Das pointed out that all women are concerned with survival of pregnancy and childbirth, for themselves and their babies; he said that by pushing people into a system they do not understand, that doesn’t match their experiences or meet their needs, and then faulting them for not complying, we convey the message that we believe they are naïve and ignorant and that we know best. He concluded that this leads to disempowerment of communities, and sets the stage for coercion and stigmatization of their already marginalized members within health care delivery systems.

In 2011, under the umbrella of the UN Secretary-General’s Global Strategy for Every Woman, Every Child, the Commission on Information and Accountability for Women’s and Children’s Health (CoIA) was created. One of the key goals of CoIA was to propel budget transparency to track the flow of resources for women’s and children’s health, and to monitor the return on investments in the form of measurable results.

Today, a multi-sector panel presented on the Global Financing Facility (GFF), a shared financing partnership created and launched in support of the updated Global Strategy 2.0 for Every Woman, Every Child and Every Adolescent, which aims to fulfill many of these functions. The GFF is a multi-stakeholder financing partnership that will pool resources from multiple donors, the private sector, and governments themselves, to ensure adequate resources are available to finance costed national plans that are based on context-specific priorities and national investment cases, and to track expenditures and return on these investments and deliver financing based on results, with the ultimate goal of enabling and accelerating efforts to end preventable maternal, newborn, child and adolescent deaths by 2030. Four countries, the Democratic Republic of Congo, Ethiopia, Kenya and Tanzania are currently in the process of developing investment cases and negotiating financing packages through the GFF. Civil society representatives are participating in every stage of the project to ensure that issues of concern to communities, for example attention to equity, are addressed. This financing facility delivers on the promise of CoIA.

Today’s panels demonstrated amply that demanding accountability for MNH is much more than (just) shouting and making noise.