Community of Practitioners on Accountability and Social Action in Health
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Citizen Engagement for Social Service Delivery

Context

Khyber Pakhtunkhwa (KP), home to over 22.5 million Pakistanis (approximately 300,000 households) and an estimated 1.5 million Afghan refugees, is characterized by insecurity due to terrorist attacks and militant incursions from Afghanistan and the Federally Administered Tribal Areas. These security threats and incidents undermine both good governance and citizen trust in the government’s capacity to deliver social services. In 2012, Pakistan ranked 139 out of 174 countries on Transparency International’s Corruption Perception Index (with a score of 27)[1]. While efforts are being made by the Government of Pakistan to curb this trend, corruption remains endemic across the country and in Khyber Pakhtunkhwa.Poor achievements in health, education and drinking water provision make it improbable that KP will reach its Millennium Development Goal (MDG) targets in these sectors. KP is also susceptible to natural disasters, including an earthquake in 2005 and major flooding in 2010, leading to the destruction of social sector infrastructure, large numbers of internally displaced persons and colossal human suffering. Major disparities between rural and urban areas,combined with acute gender inequalities, compound the disadvantages suffered by its residents.  
Website:
www.cessd.pk
Area of Work:
Pakistan
Contact Person:
Gulbaz Ali Khan
The 2011 UN Gender Inequality Index (GII) ranks Pakistan 115thout of 146 countries, with a GII of 0.573. As noted by Pakistan`s Post Crisis Needs assessment (PCNA)[2], girls and women are particularly vulnerable in KP, where they are generally permitted little autonomy or mobility. Many live in both poverty and purdah[3]. Access to health care and education services is often difficult or impossible and the delivery of community drinking water is controlled by men. These realities not only have an impact on the lives and prospects of women and girls themselves, but they also reduce the survival rates of children, perpetuate the cycle of ignorance and poverty into the next generation, and contribute to instability and insecurity. 

Citizen Engagement for Social Service Delivery (CESSD) is operating in 11 districts of Khyber Pakhtunkhwa province of Pakistan. CESSD promotes citizen engagement in close collaboration with concerned government departments for effective, gender responsive, and socially accountable service delivery in primary education, basic health care and drinking water supply schemes. CESSD project has also introduced numerous good governance initiatives including complaint redressal mechanism, public information boards, citizen charters, community score card, and budget tracking. These all CESSD project initiatives help reinforce provincial vision of good governance in the province.

Approaches to implementing Community monitoring/accountability

CESSD overall approach has focused on developing capacities of community groups, locally elected leaders and bodies, districts and provincial governments, and IPs to enable citizens to influence change. It also strives to equip government and locally elected leaders to effectively respond to the needs of the population in a socially accountable and gender responsive manner. Under CESSD, capacity development has been carried out through training, coaching, facilitation, mentoring and the provision of technical advice in developing sector-specific policies, procedures, training materials, SCC guidelines and strategic plans.

At district level, CESSD supports to government departments, which includes the introduction and establishment of different transparency and social accountability mechanisms and approaches, which are being piloted in selected districts. Increasingly officials are guided to utilize greater community participation in decision-making and priority setting in social service delivery. Training in social accountability is also provided to SSCs, drawing on both general principles and practices and sector-specific approaches. CESSD has successfully implemented several social accountability tools that are mandated by the prevailing law e.g. Citizen charters, display of public information, complaint and suggestion centers, community forums, community score card and use of media in selected districts of the KP province. The experiences of civil society with social accountability tools have demonstrated the potential results of empowering citizens not only to hold government accountable for public service delivery in terms of improved and more inclusive services but also to help initiate a shift in state-community relations as community members begin to feel entitled to claim services and rights and capable to contribute, and some government officials take on and promote a commitment to public service.

At provincial level, CESSD governance-focused initiatives contribute a more enabling environment for improved service delivery, particularly in terms of providing bridges between the provincial and district levels. CESSD has supported the provincial Local Government, Elections and Rural Development Department (LGE&RDD) in drafting the new provincial Local Government Act (LGA), which will provide the framework for local governance in KP. The Project has supported the institutional strengthening of the national level Pakistan Academy for Rural Development (PARD) and the establishment of a new provincial Local Governance School (LGS). The improved quality of induction and in – service training offered by these training institutions is contributing to sustainable improvement in the capacity of government officials. CESSD has also provided ongoing support Provincial Health Services Academy (PHSA), Provincial Institute for Teachers Education (PITE), PARD and LGS to review their courses and incorporate gender and social accountability in them. Further CESSD also build the capacities of their trainers from gender and social accountability perspective.

Results and lessons

CESSD’s community involvement approaches have been widely accepted and adopted by other organizations for improvement in social services delivery. Specifically, SRSP, a national level non-governmental organization (NGO) working as an implementing partner (IP) of CESSD, has replicated CESSD complaint redressal initiatives through local support organizations (LSOs) in Abbottabad district. SAIBAAN, another CESSD IP in district Manshera has adopted the CESSD approach to community management in its WASH project in Kohistan and Chitral. Water User Committees (WUCs) are now also funded by various non-CESSD supported organizations, as well as elected representatives, with a view to strengthen community based water management models and ensure the smooth functioning of water supply schemes (WSS). In the health sector, CESSD provided orientation to select PCMCs and assisted towards the development of their facility development plans (FDPs). Physical infrastructure and operational needs supported by these donors and partners includes repair and renovation of health facilities, toilets and waiting areas, as well as the provision of clean drinking water supply, medical equipment and human resources.

[1]The Corruption Perceptions Index ranks countries and territories based on how corrupt their public sector is perceived to be. A country or territory’s score indicates the perceived level of public sector corruption on a scale of 0 - 100, where 0 means that a country is perceived as highly corrupt and 100 means it is perceived as very clean.
[2]In the aftermath of the crisis of 2009, that struck Khyber-Pakhtunkhwa (KP) and the Federally Administered Tribal Areas (FATA), the Post-Crisis Needs Assessment (PCNA) was activated in September 2010 by request of the Government of Pakistan (GoP) to assist in crisis management and mitigation.
[3]A religious and social institution of female seclusion in Muslim-majority countries.