| Community of Practitioners on Accountability and Social Action in Health |
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Editorial
Social Accountability in East Southern Africa Community Action and Empowerment
ABHIJIT DAS
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This issue of COPASAH Communique has an exclusive focus on the practice of Social Accountability in Sub Saharan Africa. You will read of different initiatives primarily from Uganda and from Zimbabwe. They highlight different arenas of action – from the settlement community to the Parliament, and different methods through which citizen's interact with their health service providers and policy makers including the use of more well-known methods like Score Cards and Participatory Action Research (PAR) and the use of emerging methods like photo-documentation. As practitioners we are all certain that citizen feedback on programming is essential to increase ownership as well as utilisation of health services. Social accountability practices have been known to show that they bring the users and providers closer together to plan and implement better services. In addition these practices build a sense of autonomy and empowerment within otherwise poor and disempowered communities.
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However this belief in the need for empowerment as an independent outcome of social accountability processes is often not part of the conversation in many formal spaces. In such spaces the ideas of aid-effectiveness and efficiency are more favoured outcomes. Take for example the development of the Uganda Maternal Health Score Card process that is described in this issue. It includes development of indicators based on community score cards which will be later converted into dashboards. In the Uganda experience the preparation and sharing of the score card included a multi-level process including the community. However I have also been present in processes where the data for such scorecards is often drawn from official data and such dashboards are more at the national aggregate level. Here the community voice is not truly represented at the table both in any substantive manner, which the method of 'score-card' provides some degree of validity to this exercise as an exercise of social accountability. Such processes can become 'management tools' for improving programme performance, which is a welcome goal in itself, but cannot be said to fulfill the objectives of 'social accountability'.
Community engagement and empowerment need to be seen as central to the process of 'social accountability'. This process of community empowerment, especially in poorly governed areas can lead to some community dissent with existing governance mechanisms and the people concerned. Some donors are reluctant to get into such 'controversial' areas as donors often depend upon official endorsements to fund such processes. Many of the smaller exercises of social accountability that we have been highlighting through COPASAH communiqué often create some local ferment. However at present are there enough means and measures to sufficiently capture 'empowerment' to the satisfaction of the 'gurus' who determine effectiveness of particular intervention. Empowerment in many ways is a political process of consciousness which allows critical reflection and action. The experience from Cassa Banana, in Zimbabwe describes the use of photography by community representative to document and reflect upon reality. Increasingly we may need to move to methods which provide more and more control to communities to define their own priorities.
Through the COPASAH Communiqué we have been trying to build up a repository of diverse practice from across different region. We are moving towards creating a compendium of such practices to support the process of mutual learning. We will continue the regional focus that we have started through this issue to highlight the diversity of initiatives from different regions. I do hope you have found the experiences interesting and insightful and we look forward to receiving both feedback and contributions from you.
Community engagement and empowerment need to be seen as central to the process of 'social accountability'. This process of community empowerment, especially in poorly governed areas can lead to some community dissent with existing governance mechanisms and the people concerned. Some donors are reluctant to get into such 'controversial' areas as donors often depend upon official endorsements to fund such processes. Many of the smaller exercises of social accountability that we have been highlighting through COPASAH communiqué often create some local ferment. However at present are there enough means and measures to sufficiently capture 'empowerment' to the satisfaction of the 'gurus' who determine effectiveness of particular intervention. Empowerment in many ways is a political process of consciousness which allows critical reflection and action. The experience from Cassa Banana, in Zimbabwe describes the use of photography by community representative to document and reflect upon reality. Increasingly we may need to move to methods which provide more and more control to communities to define their own priorities.
Through the COPASAH Communiqué we have been trying to build up a repository of diverse practice from across different region. We are moving towards creating a compendium of such practices to support the process of mutual learning. We will continue the regional focus that we have started through this issue to highlight the diversity of initiatives from different regions. I do hope you have found the experiences interesting and insightful and we look forward to receiving both feedback and contributions from you.
About the Author
Abhijit Das, Director - Centre for Health and Social Justice (CHSJ), Delhi, India is one of the co-initiators of the idea of COPASAH. Currently he is the global convener of COPASAH. The global secretariat of COPASAH is now housed at CHSJ, Delhi (India), which is one of the pioneering organisations in the field of social accountability in health and community monitoring in South Asia. (www.chsj.org, www.copasah.net)
Abhijit Das, Director - Centre for Health and Social Justice (CHSJ), Delhi, India is one of the co-initiators of the idea of COPASAH. Currently he is the global convener of COPASAH. The global secretariat of COPASAH is now housed at CHSJ, Delhi (India), which is one of the pioneering organisations in the field of social accountability in health and community monitoring in South Asia. (www.chsj.org, www.copasah.net)