The Power of People in Strengthening Community Health Systems — How WRA is Realizing Social Accountability
I was privileged to be among the 375 participants that represented 45 countries at the Institutionalizing Community Health Conference (ICHC) held in Johannesburg, South Africa from 27th-30th March, 2017. The ICHC was organized by USAID and UNICEF, in collaboration with USAID’s flagship Maternal and Child Survival Program (MCSP), the World Health Organization and the Bill and Melinda Gates Foundation.
The purpose of this international conference was to engage ministries of health and social affairs, society leaders, policymakers, sub-national managers and practitioners, researchers and the private sector to discuss the progress and challenges in community health and community health worker programs. Over the years, it has become increasingly clear that there is need to integrate successful community health campaigns in primary health care if the Sustainable Development Goals are to be achieved.
The conference, the first of its kind, focused on sharing of lessons and experiences; enabling country stakeholders to talk about their progress and come up with solutions to continual challenges; informing country policies and plans through evidence, analyzing successes and failures; and enlisting communities as core agents of change both locally and nationally.
WRA’s success story
I was honored to represent White Ribbon Alliance (WRA) and talk about the progress we have made by engaging citizens in social accountability for health. I shared how the WRA Uganda citizen-led accountability campaign, implemented together with other partners in Uganda’s maternal and child health sector, has led to landmark improvements for mothers and babies.
Elevating Community Voices
During my first session, a plenary titled Multi-stakeholder and Multi-Sectoral Partnerships to Elevate Community Voices: Principles and Country Models, there was a spotlight on the different players that need to be at the table to achieve impact and community empowerment. I emphasized the importance of partnerships in empowering and elevating community voices and how to link the grassroots with the international to bring about positive change.
WRA uses a bottom-up approach, and here, it sets its priorities where the people affected help to identify their problems and potential solutions. Having citizens at the table is premised on lessons WRA has learnt through its advocacy efforts, most notably that change is more easily achieved when the affected people are equipped to demand the services they want.
But other community voices must also be elevated and include health workers who provide health services and need better working conditions, district officials who are keen to help when maternal health is a priority, policy makers who must respond to citizens’ demands, and the media whose role is to amplify the voices of the community by highlighting the gaps in delivery of lifesaving health services for women and newborns and bringing them to the attention of the decision makers. Civil society must also help drive these processes and work in partnership with the various stakeholders listed above to achieve impact.
Later, in a concurrent session, Evidence-based Approaches for Targeting Equity and Social Accountability, I spoke in detail about citizen-led advocacy for accountability in health and how WRA Uganda successfully worked with citizens to engage government and other stakeholders to achieve impressive results in maternal and child health, all in a short period.
Our Approach
Throughout the conference I emphasized WRA’s three-pronged approach to social accountability: mobilizing communities by giving them information about their rights and obligations; amplifying citizens’ voices demanding accountability through media, champions and utilizing opportunities at global health forums such as World Health Assembly (WHA) and United National General Assembly (UNGA); and supporting policy makers to respond to community demands for accountability.
WRA has worked with partners to elevate community voices through citizens’ hearings-a social accountability tool that brings together a wide range of stakeholders to discuss pertinent issues in reproductive, maternal, newborn and child health (RMNCAH). The partners are promoting accountability by raising voices from the communities, to the district, national and global levels.
Because of citizen engagement, we saw measurable results in just three years. Where we had acute shortages of health workers, there are now more, motivated staff in post, where we had dilapidated health facilities and theatres, more are being built or have been renovated and getting better equipped. Where there was a general lack of medicines and supplies, these commodities are now in stock. Read about this campaign here.
Do partnerships work? How can we think differently to get community interventions to scale up?
Through the engagements of different stakeholders, WRA appreciates the value of collaboration in ensuring growth and expansion of successful interventions. By working together, you speak with one louder voice. For example, WRA, Save the Children, IPPF and World Vision worked together to organize citizen hearings and could present recommendations to the UN Secretary General from 100 citizen hearings organized across the world instead of a few recommendations solicited by any one organization alone. The recommendations then informed the Updated Global Strategy for Women’s Children’s and Adolescent health.
While most organizations might worry about competing for similar resources and visibility, the resulting impact when we work together is far larger, and each shares credit and feels proud of being associated with the effort and having helped the larger goal.
By working together, we all win. In the case of WRA Uganda, the Members of Parliament (MPs) were happy to be part of the social accountability campaign Act Now to Save Mothers, because it linked them with their constituencies and made them more relevant to their community. The campaign also demonstrated to the community how they benefit from engaging with their MPs. When the citizens petitioned their MPs over poor service delivery for maternal health, the MPs responded and took these petitions to Parliament. Parliament then visited the health facilities to ascertain the citizens’ concerns and they were shocked at the poor state of maternal health. Parliament tasked the Ministry of Health to respond. MPs in other districts said their districts were experiencing the same problems and expanded their response. Change has taken place thus, with more staff in post, health facilities and theatres built and renovated with more medicines and supplies availed. Women and children in these communities are indeed enjoying their right to quality health services.
The game changer
The game change amongst all has been the fact that throughout the campaign, WRA avoided blaming leaders for the poor service delivery but instead worked with them in an amicable way to respond to the gaps that had been identified by the community. The community collected the evidence, they made recommendations to their leaders, the leaders responded and all shared in the credit.
To generate evidence for advocacy, WRA conducted a participatory health facility assessment that broke down the barriers between the community members, district leaders, health workers, policy makers, media and they all began working together as one to solve a problem all agreed needed to be addressed — 16 mothers and 106 newborns die everyday due to preventable causes such as severe bleeding, high/low blood pressure and infections among other preventable factors. The evidence collected was used to drum up support for emergency obstetric and newborn care at local, national, and international levels where citizens participated in global meetings calling onto the Ugandan government to accelerate progress on its commitment to the UN Secretary General’s Strategy for Women’s and Children’s health.
The campaign has shown that social accountability is the fastest and most sustainable way to bring about change. Indeed, social accountability has proved to be key in strengthening community health systems. The WRA citizens’ movement is by the people and for the people and it continues to grow in numbers and bring about change. It has demonstrated that citizens want to be part of the decisions that affect their health and should be at the center of different accountability processes.
Read about ICHC 2017: Five Key Takeaways for Maternal Health.
Faridah Luyiga is the Communications Manager for the White Ribbon Alliance.
