Community Working Group on Health- CWGH

Context

In Zimbabwe, the stated policy goals for decentralization have been to bring comprehensive and democratic systems of involving the local community in the process of planning and implementation and taking into account the developmental needs and priorities of the district, ward and village levels. The local government legal framework includes the Rural District Councils (RDC) Act of 1998, the Traditional Leaders Act 200 and the Urban Councils Act of 1988. The RDC and Urban Councils are the devolved authority of local government and are composed of elected Councilors. They are responsible for planning and implementation of local development projects in their respective districts, based on the needs expressed by local residents through WADCOs, VIDCOs/ neighborhoods. RDC and town councils mobilize funds for their operations through rates, licenses and investments but these have to be approved by central government. The RDC and Urban Council levels provide more potential for the participation of local communities in development and decision-making than the provincial level.
Despite the above, Zimbabwe has a lot of parallel local government structures that still need to be harmonized including the elected leadership, traditional leadership, central government appointed leadership and political party leadership structures.  At present, the majority of residents in both rural and urban areas are frustrated by the poor performance of the local government structures and by the political interference from central government and the ruling party. The existing structural problem in Zimbabwe is that local government is controlled by and more answerable to central government than to the ordinary citizens and ratepayers who would have elected local Councilors. In Zimbabwe, limited access to information and knowledge on civil and political rights hinders effective participation in decision making among the poor and marginalized people, particularly young people and women. The local authorities/decision makers tend to take advantage of the ignorance of the poor and ordinary citizens and therefore make key decisions without consulting them. Local government in Zimbabwe is decentralized in principle and theory but centralized in its operations and administrative procedures.
The Community Working Group on Health (CWGH) is a network of civic and community-based organizations that aim to collectively enhance community participation in health in Zimbabwe.  It was formed in early 1998 to take up health issues of common concern. It now networks over 35 organisations in 27 districts in all 10 provinces of Zimbabwe. Since inception, CWGH has been applying community monitoring approaches in all districts of operation, though the work has become more pronounced with the transformation of the civic education program into the health literacy program.  Using Participatory Reflection and Action approaches, communities have organised for and monitored health actions at local.

Website
www.cwgh.co.zw
Area of Work
Zimbabwe
Contact Person
Itai Rusike

Approaches to implementing Community monitoring/accountability

Our approach to community monitoring is that of inclusivity. The organization focuses on working with local government structures, traditional leadership as well as elected leadership, health services providers and authorities at  community level and most importantly the community in cultivating the culture of accountability. The organisation has adopted a rights-based approach to community monitoring. The right to social accountability asserts that duty bearers (representing the state) have an obligation to provide justifications & explanations regarding their performance in utilising public resources and take corrective action where public resources have been ineffectively used or abused.  Similarly, rights holders (citizens) have a right to obtain justifications and explanations for the allocation & use of public goods and resources, and the performance of duty-bearers in progressively realising their needs, rights and capabilities within the available resources.
However, realisation of the right to social accountability depends to a large extent on enabling legislation on access to public information. Access to information laws in Zimbabwe are rather weak or non-existent. The Access to Information and Protection of Privacy Act (AIPPA) is quite misleading as it neither caters for organisations nor individuals whose interests are to advance socio-economic rights. It is largely a piece of legislation crafted to place restrictions on media freedoms in Zimbabwe. At the same time, parliament, which plays the oversight role, needs to be capacitated with skills for more effective engagement. Moreover, the absence of an independent judiciary makes it almost impossible to litigate in the event the state fails in its duty to realise the people’s rights.
In order for legislators to play their oversight role, they require the support and input of the communities (through civil society organisations in most cases) they represent. At the same time communities need to generate evidence in order to meaningfully contribute and engage with the legislature. Community monitoring generates such evidence at community level through monitoring, expenditure management and performance management. Public Integrity Management is a critical area which communities also monitor to limit the discretion of the executive arm of the state.

The CWGH has adopted the following strategies to promoting public and social accountability
  • Revitalising and strengthening local level structures that foster a culture of social accountability, Health Centre Committees (HCCs).  The HCC is a joint community-health service structure linked to the clinic and covering the catchment area of that clinic.[1]
  • Training of community monitors in monitoring resources for treatment and services at local level to make services more responsive to people’s needs through the Strengthening Public and Social Accountability on Resources for HIV treatment and Services using Mechanisms for Community Participation project
  • Generation of evidence from community monitoring used for advocacy and lobbying at local and national level
  • Capacitating communities through training on participatory budgeting approaches. Here  communities receive information on  budget process, provide input in prioritizing health issues  affecting them at local level  and are continuously involved  in local level  health planning through HCCs. Attendance and contribution in  consultative budget meetings local level, district and  national level are some of the activities that our communities are involved in.
  • Lobbying through submission of evidence from community monitoring on pressing health issues, including the health budget, to the Parliamentary Portfolio Committee on Health.
  • Advocacy as well as engagement by organised communities through HCCs around the Patient’s Charter
Health Centre Committee is the mechanisms by which people get involved in health service planning at local level. HCCs report on community grievances about quality of services and discuss community health issues with health workers.

Results and lessons

  • Community monitoring has the potential of shifting power relations between duty bearers and communities. This element is quite significant in enabling communities to influence practice and policy. Information/evidence is power and community monitoring provides that evidence needed to influence change.
  • Through continuous engagement between supply side and demand side, the supply side is provided with feedback on how best to provide services responsive to people’s needs. This promotes productive dialogue and constructive working relationships between public sector actors, citizens, CSOs and communities.
  • Citizens have a better appreciation of the resources available through community monitoring. This creates transparency and trust between the state and its citizens and a shared responsibility on o distribute resources which are often scarce for the promotion of fairness and equity.
  • Community monitoring encourages community cohesion and helps build understanding, trust and consensus among citizens. Where Participatory Budgeting (PB) is new, it is important to invest time and effort upfront to ensure that both the citizens and the government officials understand its principles and rationale.
  • Governments / Local authorities may not be interested in involving citizens and civil society in the budget making process. Civil society participation is usually viewed as interference and a threat to political legitimacy of elected official. Cases whereby public officials doubt citizens’ competence to identify and agree on priorities are not rare.
  • Communities and civil society actors are faced with the challenge of securing get copies of primary project documents and government records which are usually “top secret”. The situation is aggravated when duty bearers involved are involved in corrupt activities.