DBL- Centre for Health Research and Development

Context

DBL aims to contribute to poverty reduction and sustainable development through improved and equitable health in developing countries. DBL’s aim is achieved through a coherent program of applied research, education, capacity building and knowledge management. The organization primarily addresses poverty-related infectious diseases through a cross-disciplinary and inter-sectoral entry point which builds on its extended network of collaborating partners in Africa and Asia. In each of the countries, DBL works with a combination of national level  managers, district health team staff, civil society organizations and community representatives.
DBL receives a basic grant from the Danish Ministry of Foreign Affairs and it’s development agency DANIDA, and is thus closely linked to the planning and monitoring of health sector support programs.

Website
www.dbl.life.ku.dk

Area of Work
Kenya, Tanzania, Zambia, Malawi, Uganda, Ghana and Vietnam

Contact Person
Jens Byskov

Approaches to implementing Community monitoring/accountability

The organization has from 2006 implemented an EU funded study entitled "REsponse to ACcountable priority setting for Trust in health systems" (REACT). Through this project, studies on priority setting using the accountability for reasonableness framework (AFR) is implemented in one district in Kenya, Tanzania and Zambia.
The AFR framework is applied in an action research and case study design through continuous alignment with its key conditions of relevance, publicity, appeals/revision and leadership in support of managerial and public accountability. The process of its introduction and the effects are evaluated using qualitative and quantitative methods for indicators of quality, equity and trust. 
The REACT project has confirmed the feasibility of the AFR approach to harness local concepts of fairness and legitimacy in the district guided priority setting as well as detailed day to day decision making processes within finite resources. It is a process of guidance without pre-determined results where the district health team opens up to adaptations to both personal, organizational, cultural and other values to be explicitly influencing priority setting compromise. The main conditions of relevance, publicity and appeals are enforced under the fourth condition concerned with leadership. This starts off with organizational leadership and increases public expectations of fair processes and contribution to the enforcement of a fair process by an increasing range of stakeholder and the community. It thus tries to address the weakness of more purely bottom up community based empowerment efforts that are too easily blocked by government and organizational resistance if these are not made conducive for the joint commitment aimed for. Fairness incorporates many other values of equity, accountability, compassion, and participation in interplay with more technical values of cost effectiveness and quantified burden of disease. AFR is expected to lead to more sustainable health action and the wider perspective is a strengthening of continuous democratic practice starting from the community level and supported right up to national level.

Results

• The application of the AfR framework is beginning to bring important issues for all stakeholders to the government agendas.  This is in contraposition to the customary expert driven agendas.
• Trust among stakeholders is important and also a condition for a non-conflict change process.
• Some cultural and political values may be revealed as suppressive to the participatory priority-setting process.