October 15, 2015

When citizens join forces, change happens

Written by Ray Mitchell, Director of Advocacy and Campaigns, White Ribbon Alliance

White Ribbon Alliance welcomes the publication of the Global Health Visions’ report, Engendering Accountability: Upholding Commitments to Maternal and Newborn Health, supported by the Children’s Investment Fund Foundation and the Bill & Melinda Gates Foundation. It is a very timely report and we hope that governments, civil society, donors and others who share the common goal of improving maternal and newborn health will take up its recommendations.

WRA fully endorses the report’s central finding that maternal and newborn health accountability efforts, both at a national and sub-national level, are critical to improving services. We also strongly agree with the recommendation that such efforts must be prioritized if we are to experience real progress and achieve the Sustainable Development Goals.

WRA’s theory of change is built on the idea that lasting change in society comes about when enough people join forces to demand that their governments adopt and implement the right national policies, and devote sufficient resources to deliver those policies. Our approach to creating change, therefore, resonates with many of the recommendations made in the report including:

Create diverse coalitions

At the heart of WRA’s way of working, and our success, is our ability and experience in creating and leading effective, diverse coalitions. Since our formation over a decade ago, WRA has developed a uniquely collective way of working, in which the aim of the leadership of each National Alliance is to facilitate the actions of their diverse membership. Members of Alliances include individual community members, civil society organisations, journalists, government officials, health workers and many more, all working in partnership to address issues of shared concern. One important strength of our coalitions is that they draw on the support and expertise of members not just focused on maternal and newborn health, or even health, but also organisations concerned with issues such as human rights, justice and education. In Nigeria, for example, our campaign for respectful maternity care received a significant boost from the involvement of the National Human Rights Commission.

The strength we derive from our diverse coalitions then extends to our global alliance where the learning and best practices gathered from the work of individual Alliances are shared between us all and applied as appropriate to improve all of our work. The capacity of our global alliance to deliver effective advocacy is therefore constantly growing and adapting to meet ever-changing challenges.

Support and amplify civil society voices

Our advocacy priorities are set in the countries where we work – where the people affected can help us identify the most urgent problems, and their solutions. The evidence for advocacy is then built on the experiences of citizens themselves. For example, in Uganda, WRA carried out health facility assessments in three districts that involved members of the local communities – users of the facilities – as well as health providers and elected officials. At each step in their advocacy campaign, WRA Uganda then organised activities to mobilise and support citizens so that they were heard by decision makers, and decision makers felt compelled to act.

What the health facilities assessment in Uganda demonstrated, and WRA has also witnessed during this year’s Citizens’ Hearings, is that accountability processes provide governments with contemporary evidence of problems that is credible and does not rely on a single source (usually the government itself). We have also seen that, rather than being opportunities to apportion blame, these processes offer an important opportunity for everyone to identify barriers and then move on to share the solution.

Build strong partnerships between government, civil society and other key stakeholders

Time and again, we have seen successful health outcomes when citizens, government officials, health workers and others come together to improve their maternal and newborn health services. In WRA’s case, these partnerships are our Alliances, which are effective and successful in driving change precisely because they play the important role of bringing these disparate groups together. As Dr Ezerio Kibuga, District Medical Officer in Sumbawana Rural, described our advocacy work in Tanzania, “White Ribbon Alliance Tanzania has done a wonderful job and especially in my district Sumbawanga… your arrival in Rukwa motivated all leaders, health workers and community. We were able to do what we thought was impossible”.

Establish global linkages from the bottom-up

Just as it is essential that governments’ planning and provision of maternal and newborn health services is informed by the needs of their citizens, so it is important that global efforts are equally informed. As the report states, civil society can play a more meaningful role in linking the community to the global if governments recognize our value in this process; not just an upwards process but also downwards – effectively creating a feedback loop – turning global commitments into the reality for communities.

The Citizens’ Hearings organized by White Ribbon Alliance and partners this year have been an initiative to demonstrate the value of linking citizens to their governments to the global stage. WRA sees the hearings not as one-off events or consultation but as a key tool that governments should adopt as part of their commitment to social accountability. It is our hope that governments will look beyond the idea of a single mechanism or process. We want governments to recognize that citizens’ hearings and other citizen engagement activities are necessary to meet the challenges of the SDGs, and institutionalise them accordingly. Not only will this enable governments to contribute directly to the “unified accountability mechanism” at the global level, but it will also ensure that recommendations derived at the global level are translated into concrete actions in their countries, all the way down to the community level.

In support of the SDGs, White Ribbon Alliance will continue its mission to catalyse change by convening, mobilising and supporting citizens and partners in civil society to hold their governments to account for the commitments they have made to improve RMNCAH services in their countries. Governments and donors must, of course, also play their part and we welcome the report’s recognition, all too often ignored, that this must include funding civil society organisations, such as WRA, to carry out our important work. We, therefore, urge governments and donors to recognize that investing in civil society is an investment in better accountability, better governance, and a healthier future for their citizens.