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Centro de Estudios para la Equidad y Gobernanza en los Sistemas de Salud- CEGSS
Context
CEGSS is a civil society organization that carries-out research, advocacy and capacity building around social participation, public health policies and right to health. For the last six years, the organization has been working in six rural municipalities, and has recently expanded to include ten more. All of these are municipalities that have large percentages of indigenous Mayan population. CEGSS has started to work at the national level providing technical assistance to the Ministry of Health, specifically in the design and implementation of institutionalized community monitoring.
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Social Participation for Equity in Health in Guatemala
A short video clip on empowering rural indigenous communities in Guatemala to participate in health planning and undertake community monitoring demand accountability from public health authorities. The video clip was produced by CEGSS, Guatemala.
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Area of Work
Guatemala Contact Person
Walter Flores |
Approaches to implementing Community monitoring/ accountability
CEGSS implements an approach that was developed in collaboration with representatives from Community Based Organizations and public health personnel. This approach was developed through participatory-action research.
The monitoring approach is organized around the assessment of availability of essential drugs, medical supplies and health personnel. All of the above are compared against national standards. In addition, the approach also includes the monitoring of the decision-making within health commissions and municipal governments.
The monitoring system has a steering commission with representatives from health authorities, municipal authorities and CBOs. Representatives evaluate and monitor the availability of resources and resolution capacity at public health care facilities and collect information and monitor families’ experience while seeking health care at public healthcare facilities.
The analysis is carried out by CBOs with the technical assistance of CEGSS. A report is produced and findings presented during the meetings of the Municipal Council for Development. From these meetings, an action plan is drafted with decisions aimed to correcting problems and allocating resources towards needed services and communities. The next step is to monitor the decisions making process, and whether targets are being achieved. The monitoring of decision-making has an emphasis on democratic governance variables. Previous research implemented by CEGSS found that decisions at the COMUDE occur under very asymmetrical conditions. The system therefore includes tools to monitor whether decisions are benefiting communities facing larger shortage of resources and also whether transparency and accountability is being strengthened throughout this process.
The monitoring approach is organized around the assessment of availability of essential drugs, medical supplies and health personnel. All of the above are compared against national standards. In addition, the approach also includes the monitoring of the decision-making within health commissions and municipal governments.
The monitoring system has a steering commission with representatives from health authorities, municipal authorities and CBOs. Representatives evaluate and monitor the availability of resources and resolution capacity at public health care facilities and collect information and monitor families’ experience while seeking health care at public healthcare facilities.
The analysis is carried out by CBOs with the technical assistance of CEGSS. A report is produced and findings presented during the meetings of the Municipal Council for Development. From these meetings, an action plan is drafted with decisions aimed to correcting problems and allocating resources towards needed services and communities. The next step is to monitor the decisions making process, and whether targets are being achieved. The monitoring of decision-making has an emphasis on democratic governance variables. Previous research implemented by CEGSS found that decisions at the COMUDE occur under very asymmetrical conditions. The system therefore includes tools to monitor whether decisions are benefiting communities facing larger shortage of resources and also whether transparency and accountability is being strengthened throughout this process.
Results
- Municipal governments have increased their funding to buy petrol for the local ambulance during emergency transport (families were paying before).
- Two sub-contracted providers for immunization and other basic health services had their contracts terminated due to corruption (revealed by the monitoring work of communities). The working hours of health facilities have been extended.
- Complaints by indigenous families that they had received disrespectful treatment by medical doctors have been taken seriously.
- The above achievements have resulted in a tremendous boost in the self-confidence and motivation of community leaders.
Lessons
- Community monitoring is labour intensive, it requires a good deal of accompanying to CBOs.
- Seeing the positive results of CM, many NGOs are interested in replicating the approach. However, they think all the work is reduced to the tools and do not realize or do not value, the importance of the process.
