1. Social Accountability for SRHR what does it involve? Renu Khanna (SAHAJ, CommonHealth) NATIONAL SEMINAR ON MATERNAL-NEONATAL HEALTH AND SAFE ABORTION: OPPORTUNITIES AND CHALLENGES Hyderabad, India, April 24-25 2014 CommonHealth: Coalition for Maternal-Neonatal Health and Safe Abortion In partnership with Tata Institute for Social Sciences, Hyderabad

2. Outline Understanding Accountability Accountability for SRHR - International mechanisms and processes Accountability for SRHR – National level Critical role of Indicators Where do we go from here?

3. 1. Understanding Accountability Relational - between Rights Holders/Rights Claimants and Duty Bearers obligation of power-holders to account for or take responsibility for their actions, to answer questions regarding decisions and/or actions Power-holders - those who hold political, financial or other forms of power Towards democratisation and reducing power differentials Answerability, Enforceability, Redress

4. Types of Accountability Financial - reporting on allocation, disbursement, and utilization of financial resource Performance - agreed-upon targets with focus on services, outputs, and results Political - has the government delivered on electoral promises, and responded to societal needs and concerns? Social - accountability that relies on civic engagement, - participation of ordinary citizens and/or civil society organizations Vertical or External, Horizontal or Internal, Hybrid

5. Social Accountability in Health a broad range of actions and mechanisms that citizens, communities, independent media and civil society organizations can use to hold health officials and service providers accountable for their obligations towards health rights Includes community monitoring, participatory planning and budgeting, public expenditure tracking, investigative journalism, citizen advisory boards

6. Accountability and Participation citizens have the right to demand accountability and public actors have an obligation to account – dialogue and discussion Evolving notion of ‘participation’ – beneficiary to citizen, project to programme, consultation to decision making, micro to macro. (Gaventa and Valderrama, 1999) ‘Voice and Accountability’ - increasing citizens' voice and providing a space for such voice Spaces – ‘invited’ and ‘claimed’ (Cornwall, Gaventa)

7. 2. Accountability for SRHR – International mechanisms ICPD Programme of Action, Commission on Population and Development Beijing Platform for Action, CEDAW, Commission on Status of Women Human Rights Council – 2009 – ‘preventable maternal mortality a human rights violation’. Technical Guidance to reduce MMM - 2012 MDGs - Commission on Information and Accountability

8. ICPD, Commission on Population and Development ICPD +5, +10, +15, +20 – Role of feminists and health activists pre ICPD and since CPD – April 7-11, 2014 – Feminists in government delegations supported by ARROW, pushing the agenda – Regional Commissions – Statement ‘Need to address gaps in SRH’

9. CEDAW, Commission on Status of Women Annual CSW meetings, NGO forum, caucuses Shadow Reports to complement Government Reports Statements by NGOs Special inquiries, ‘exceptional reports’ – eg Gujarat sexual violence against women (2010), Armed Forces Special Protection Act August 2011 CEDAW decision on maternal mortality - Alyne da Silva Pimentel, a 26 year old poor Afro- Brazilian woman who died in her 6 th month of pregnancy in 2002. Brazil govt. To pay compensation to her mother.

10. Accountability in the context of MDGs Countdown to 2015 since 2005 September 2010 – UN Secy Gen launched Global Strategy for Women’s and Children's Health – MDGs 4, 5 and 6. Commission on Information and Accountability set up to monitor progress on Strategy – core indicators Independent Expert Review Group – iERG – in Sept. 2011 to report annually on 75 priority countries Debates around Indicators

11. Recommendations of iERG -2013 Strengthen country accountability: Country led, inclusive, transparent and participatory national oversight mechanism Demand accountability for women’s and children’s health: Independent accountability mechanism Take adolescents seriously: (i) Adolescent indicator (ii) Meaningful involvement Prioritize quality to reinforce value of a human rights approach to RMNCAH: (i) make and measure quality of care route to equity and dignity; (ii) create task force on quality of care Make health professionals count Launch a new movement for better data

12. 3. Accountability for SRHR – National Level National Plan – RMNCH+A, Maternal Health Policy What kind of Accountability frameworks exist? – Horizontal or within the system? – Vertical? Indicators – what is being measured/tracked? What should be measured and tracked?

13. Indicators for SRHR in India What is being tracked? – Family planning – JSY beneficiaries and disbursements MDG Indicators – GOI decided to monitor only the MMR and proportion of births attended by Skilled Birth Attendants – No explanation of why Contraceptive Prevalence Rate, Adolescent Birth Rate, ANC and Unmet Need for Family Planning are not actionable indicators or considered ‘strategic’ or ‘contextually relevant’ for India! Although we routinely collect data on these indicators…

14. Issues around Indicators Skilled birth attendance, Institutional deliveries, or ‘Safe’ deliveries? Post Natal Care? Access to safe abortion services? Access to Emergency Obstetric Care? Universal access to reproductive health care – what about – Morbidities like fistulas, genital prolapses, – Prevention and treatment of RTIs/STIs/HIV and AIDS – Reproductive cancers – Infertility – Mental Health issues – PP depression, anxiety and depression around proving ‘right’ kind of fertility, violence – Comprehensive sexuality and relationship education

15. What kind of Accountability frameworks exist? Within the system – fudged data, not cross checked in the field, scapegoating the most vulnerable, ignoring corruption, ‘Invited’ spaces – eg. MH technical support group, 12 th Plan Working Groups, Mission Steering Group – accountability issues within these? ‘Claimed’ spaces – eg. Fact findings, Maternal health campaigns, jan sunwais around MDRs ‘Hybrid’ spaces – eg. Community Monitoring Committees, Rogi Kalyan Samities, District Health Societies - several issues…

16. Where do we go from here? Influence what should be measured? Which indicators are important for us ? Advocate for facility level ‘constructive’ accountability measures? Continue to build ‘voice’ amongst affected groups Use national and international human rights mechanisms and processes for maternal deaths – PIL on MDR Shadow Reports? Use of Technical Guidance Note to demand specific remedies?

17. Thank you sahajbrc@yahoo.com