Presented By Yashwantrao Chavan Academy of Development Administration December 16, 2009, Jaipur

1. Impact of Social Accountability Mechanisms on Service Delivery and Human Development Outcomesin Satara District of Maharashtra Presented By Yashwantrao Chavan Academy of Development Administration December 16, 2009, Jaipur

2. Section IContext&Accountability Interventions

3. Zilla Parishad (District) District Health Office Block Health Office Panchayat Samiti (Block) Primary Health Centre Cluster of Villages Health Sub-Centre Gram Panchayat (Village) Village Health Committee Local Governance & Service Delivery Setup • Three-tier Panchayati Raj and its health care delivery system in Maharashtra: • Panchayats are primarily accountable for delivery of crucial services under the flagships such as National Rural Health Mission, Integrated Child Development Scheme, Total Sanitation Campaign, etc.

4. Problem • Poor targeting of beneficiaries and under-utilization of funds due to a lack of: • Demand for services by the communities • Dialogue between communities, service providers and government functionaries • Structured mechanisms for assessment of service quality and efficacy at various levels • Result: Poor indicators of basic human development such as child and maternal mortality, nutrition, sanitation, school education, etc., in spite of relatively better economic status of Satara district

5. Genesis of Accountability Initiatives • Drawing from the rich experience of Village Microplanning in Maharashtra: Partnership of Unicef, YASHADA, NGOs and Youth Networks • Integrating the tool of Community Score Card with Microplanning • Strong support and ownership by Zilla Parishad • Generous support of the World Bank

6. Accountability Initiatives • Village Microplanning: Creating a strong demand for services through participatory community mobilization • A five-day process consisting of PRA exercises • Participatory stock-taking, problem-analysis, solution-seeking and intervention-planning • A village action plan owned by the community • SHGs, youth groups and village committees • Community Score Cards: Creating a dialogue between communities, service providers and government functionaries for more accountable service delivery • Input tracking • Independent rounds of service assessment by communities and service providers • Common discussion on scores in a gramsabha

7. Accountability Process

8. Focus Sectors Sr. Sector Groups CBOs 1 Health All families, especially pregnant women, sick persons, BPL families Village Health Committee 2 Nutrition 0-6 years children, pregnant & lactating mothers and adolescent girls Village Health Committee 3 School Education 6-14 years children Village Education Committee 4 Water & sanitation All families, especially the marginalized sections of the community Village Water Supply and Sanitation Committee

9. Outcomes Envisaged • Achievement of total sanitation in every village; • Improving nutritional levels in children, total eradication of acute malnutrition; • Bringing every child in 6-14 age group to school; • Eradicating the water borne diseases by creating awareness about safe drinking water and the monitoring of water quality • Halving the Infant Mortality Rate in three years.; • Reducing maternal deaths; • Ensuring 95% institutional deliveries and 100% deliveries by trained personnel. • Ensure that all marriages take place only after the legal age of marriage.

10. Village Microplanning • Village level Micro Planning is a five day activity carried out by NGO facilitators from local area • Itincludes a package of PRA activities, community games, IEC activities targeted towards creating awareness, analysing the situation on various HD parameters, identifying the resources of the village, enlisting the problems, prioritising and setting up an action plan for solving these problems.

11. Village Microplanning • Micro planning is a strategy for communication. Communication can be mass communication, group communication and one to one communication. • Micro planning is a package of PRA tools, IEC tools, surveys, community games. • Micro planning attempts at mobilizing the communities to take ownership of the community assets, programs, services, etc and become responsible for the protection and maintenance of the assets, delivery of the services and implementation of the programs. • Micro planning culminates in the final village plan with community priorities and an action plan to implement this plan.

12. Themes In Microplanning • Haemoglobin assessment especially of women • Weighing of children in presence of mothers • Creating awareness regarding sanitation, water quality, solid and liquid waste management, use of iodised salt, nutrition, education, renewable energy sources, health issues, etc. • Construction of soak pits, toilets, water conservation structures, vermiculture pits, etc. • Group reflections of adolescent girls, self-help groups, women and other such groups • Gender analysis to reveal gender bias • Creating an action plan for achieving HD goals

13. Tools for Microplanning • Transect walk to understand the situation in the village regarding water, sanitation, resources • Social mapping to throw light on social distribution of resources, amenities and problems • Time line to analyse the issues of population, availability of water, development of social infrastructure • Seasonality chart related to diseases, work, school attendance, etc. • Household survey to prepare a baseline on various HD parameters • Venn Diagrams to understand the relative utility of various service providers • Marble game to understand accessibility to government schemes and discrimination . • Human knot to discover the key to solutions of all problems.

14. Usefulness of Microplanning • Rights based self-help approach of microplanning leads to community empowerment and self reliance • Strengthen Panchayati Raj System and active participation of women in decision making • Active collaboration between communities and government agencies • Social inclusion of underprivileged and youth • Unique, flexible and highly effective IEC device with wider replicability • Social Audit of service delivery system • Strengthening administrative functioning through Block Response Plan and District Plan • Create conducive environment for decentralized community managed programming - NRHM, Jalswarajya, NREGS, SSA and ICDS

15. Input Tracking Community Score Card Four-Step Process Community Scorecard Process Interface Meeting Performance Assessment Self-Evaluation

16. Partnerships and Alliances The World Bank YASHADA & UNICEF NGOs Zilla Parishad Satara Village Communities Tie-Ups World Bank - YASHADA YASHADA - ZP Satara ZP Satara - NGOS NGOs - Youth Facilitators

17. The Follow Up • The CSC process finally culminates in an action plan prepared by the community and the facility staff to correct the gaps in the delivery system. • The actions may be required to be taken by the community or by the local authorities, or by the district administration or by the government. Whichever the agency for carrying out the requisite action the community has to set up a team to follow up the progress of the action. • Repeat the process of CSC periodically to monitor the progress in the delivery systems.

18. Section IIImpacts

19. Changed Outlook through MP and CSC • The role of each individual vis a vis government is clearly understood. The message of Microplanning: " the outside agencies cannot solve our problems which we have ourselves created, they can be solved together by the individuals and the community. Government is the facilitator not the solution provider“. • The message of the CSC is Government is a service provider and accountable for what it provides. The community has a right to demand and assess what it is entitled to get. Mutual interaction improves service delivery.

20. Impact Cycle

21. Impact Milestones Accountable Governance & Development Behavior Change System Change Development Seeking Policy Change Accountability Seeking Process Change Information Seeking Institutional Change

22. Sense of Empowerment • Continuous community dialogue and action • Ability to mould community practices • Information & accountability seeking • Community contribution to programme funds Behavior Change • Sanitation • Regular cleaning of water sources • Regular use of chlorine • Regular upkeep of drainage • Ban on open defecation • Regular use of toilets • Use of soap for hand-wash • Village cleanliness drives • Mother & Child Health • Proactive seeking of ANC • Regular intake of iron tablets • Strong preference to institutional delivery • Enhanced breast feeding • Monitoring of immunization • Better Anganwadi enrollment • Monitoring of child weighing • Better child feeding practices

23. More Responsive System • District & block taskforces for monitoring • Block response plans based on felt needs • Service strengthening using CSC feedback • Ownership of accountability through investing ZP’s own funds in interventions System Change • Accountability • Dialogue of service seekers & providers • NGOs/ volunteers as neutral monitors • Formal recognition to community data • Regular review of corrective actions • Tracking of outcomes rather than inputs • Service Strengthening • Swift action on staff shortages • Stocktaking of medicines, vaccines, nutrition supplements • Regular health checkups, home visits, immunization rounds • Door-to-door search for needy • Toilet construction drive • Special counseling centres • Capacity building of service providers

24. Human Development Outcomes

25. Costs and Benefit • Per village cost of accountability interventions: Approximately Rs. 7000 • Cost of accountability interventions for district: Rs. 7000 x roughly 1000 villages = Rs. 7 million • Average district development budget: Well over Rs. 700 million • Cost of accountability interventions: Barely 1% of the development budget

26. Costs and Benefit… Saving of financial, social and human costs caused by a lack of accountability Cost of Accountability Processes Average Annual District Budget

27. Challenges • Creative mobilization of funds for accountability interventions: Sources are not fixed • Continuous follow up: Maintaining the tempo • Sustainability: Community initiatives, NGO partnerships, ownership by administration

28. Solution: Institutionalization • Village microplans are now a mandatory requirement for district planning as per Planning Commission’s Manual for Integrated District Planning (January 2009) • Block and district budgets are to be actually based on community demands • Annual bottom-up planning: An avenue for institutionalization of MP and CSC

29. Thank You!