Ariel Frisancho

National Directorate

ForoSalud

afrisanchoarroyo@yahoo.es

WB Civil Society Policy Forum

Washington DC, April 19th, 2017

Citizen-led

Accountability

to improve UHC

Actor- Oriented Approach to Promote Accountability

Since 2008, citizen surveillance mechanisms are spearheaded by women monitors, working on a voluntary basis within local areas (i.e. Puno Region: 40 vigilantes for two provinces, 3 health posts, 3 health centers and one local hospital in each)

After attending a series of capacity-building workshops, each vigilante receives accreditation and they plan their visits to health facilities

They visit health centers’ officers and explain the mechanism to health providers

Women surveillance for accountable health services

The citizen monitors visit the health facilities 2-3 / week, stay 6 hours. They make direct observations and conversations with female patients in their native language

On the basis of their findings, they produce regular reports and analyze them monthly with the regional Ombudsman's office, ForoSalud and CARE Peru members

They prioritize the findings, both the good and the bad, and construct a “dialogue agenda” which is presented to the health care networks / hospital directors and health team, to agree commitments of improvement

Stages (“Moments”) and Processes of

Citizen Monitoring

ORGANIZATION

& COMPREHENSIVE

PLANNING

SELECTION / CAPACITY

BUILDING / PLANNING

IMPLEMENTATION OF FIELD

ACTIVITIES MONITORING &

EVALUATION

Process I Process II Process III Process IV Process V Process VI

Process of

Organization /

Planning –

Constituting of the

technical supporting

and facilitating team

of the citizen

monitoring of health

services

Public

announce-

ment &

selection

process of the

citizen

monitors of

health

services’

quality

Capacity

building,

planning of the

visits to health

facilities and

introduction to

health

authorities

Implementationof

monitoring visits

to health facilities

and meetings for

the participatory

analysis of the

findings

Dialogue and

negotiation to

agree commit-

ments to

improve health

services’

quality

Monitoring of the

Commit-ments

made and

planning of the

next steps for

monitoring

health services’

quality

(transversal) SOCIAL COMUNICATION / INFORMATION TO THE PEOPLE / COMMUNITY

Results

• Identification of practices that were deterring women

from utilizing services

• Space for a systematic dialogue on what women

expect and achievements / pitfalls of health care

• Commitments to improve health care (opportunity,

treat, information, language, culture appropriateness)

• Medical practitioners and health authorities more

accountable to people’s needs

• Improvement in obstetric care, child care•

• Increased demand of maternal health services and

institutional birth deliver

Context and Health System Challenges

• Same words, different meanings (Universal Health

Coverage = Universal Health Insurance?)

• Big inequality gaps

• Lack of an Accountability Culture (Acctability to whom?)

• In-equal Power relations

• Most donors are focused on value for money and

performance metrics ( pressure to our M&E and

Advocacy work, defining impact and results of complex,

long run processes)

• Costs of citizen participation & Volunteers’ crisis

• Co-option and partisans political interests

How does an accountability enabling environment looks like?

a) Political will translated on context and people-based norms

b) “appropriateness” and support to the transforming initiatives

by authorities: institutional arrangements for implementation,

analysis and allocation of resources

c) Informed citizens on their rights and responsibilities , with

inter-acting capacities (attention to gender approaches)

d) Policy-dialogue & Accountability spaces:

- Clear, participatory rules of the game (“learn to listen”)

- Capacity Building on both sides

- responsiveness

- Binding decisions

e) Voice with Strategic Amplifiers:

- Vertical integration towards the construction of a “Sandwich

strategy” (Local action, Bottom – up “voice” articulated to

sub-national and national “teeth”)

g) Civil society organizational “maturity”:

- Share leadership

- downplay own power relations

- leadership of women and young people

- Articulation amongst diverse civil society organizations

- social mobilization and advocacy skills

Ariel Frisancho A.