1 STRENGTHENING ACCOUNTABILITY FOR CHILD SURVIVAL GOALS OUTLINE The accountability framework The accountability web What makes for effective accountability? Good Practices Critical Issues Charles Abugre (Head of Policy and Advocacy, Christian Aid) December, 14, 2005

2 Accountability is about answerability and responsiveness. Rooted in: Mutual gain as well as mutual pain (incentives) Responsibility (Legal/Contractual and/or a normative framework) Enforceability – influence, representation and a stakeholder framework (in terms of transformational relationships) and a systems of reward/sanctions. Accountability is about the management of power relations to maximise mutual benefits.

3 Accountability in child survival context The Convention of the Rights of the Child and the associated national legislations within the International Human Rights framework. This involves: A regime/hierarchy of duty holders – responsibility framework A regime of agency – institutions of duty and rights holders Normative standards and codes of behaviour against which progress can be assessed A regulatory framework and instruments of redress A systems and structural approach/plan and budgets to deliver a comprehensive child health plan – the preventive and curative services to reduce mortality etc. And then, instruments including technology, delivery mechanisms (including decentralisation) and specific interventions A participation and transparency regime fostering active agency An international policy environment and funding arrangements supportive of the above

4 Critical Actors and Issues at national level A policy framework defining a systemic approach favouring primary health committed to universal non-privatised provisioning and linked to other sectoral plans of government. A Planning and budgeting process which encourages participation of service users especially in terms of oversight, transparency in procurement and resource use and output/outcome reporting of service providers. A simple quality assurance/performance framework to encourage consumer-led quality enforcement. A funding system which supports technological interventions within, and not outside, the framework of health systems strengthening. A role for parliamentary oversight. Civil society led processes aimed at tracking expenditure, campaigning for rights and access and undertaking independent performance assessments.

5 Sub-national Level Issues Decentralised services linked to and driven by national strategies Decentralisation which encourages community participation in decentralised planning and budgeting, decentralised political participation and oversight and effective fiscal devolution. Citizens-led initiatives aimed at assessing quality and intake e.g. citizens’ juries and community assessments of health service. Regulation of anarchic private sector services, guided by simple easy-to-communicate quality assessment arrangements and norms. A conscious consumer/citizens’ rights ethos. Formal platforms for public interactions, e.g. around performance assessments and planning and budgeting. Transparent display of annual health service performance against targets

6 Critical Issues for International Partners Have we leant the lessons of world Bank driven cost-recovery measures? Are we going down another route of disaster through the new age health insurance systems being driven down aid dependent economies? Subtle and overt privatization of basic health services: Have we adequately taken stock and assessed the potential impact of such an expanding trend on the poor and the health systems of poor countries? Technology-driven interventions favoured by private financiers: Have we adequately assessed the long term impact of such an approach on health service systems of poor countries. The expanding role of the World Bank and the use of loans for basic health, including child survival goals: Why is the World Bank getting bigger in this area and the UN institutions that provide finances in grant form struggling for resources? What is the long term effect of an expansion in World Bank lending and its subtle support for private sector solutions to health services in poor countries? Strategies in other related services: Privatization of water. Isnt this a child survival issue?