Social Accountability Programme by Sikika, Tanzania By Irenei Kiria Geneva, April 2012

Gov Priority Areas to 2015 Human Resources (training, deployment, and retention) Improve Maternal Health Improve health facilities and service delivery

Health Sector Budget (FY 2007/08 – 2010/11) Tshs

Sikika’s priority Areas Health Financing and Governance Budget efficiency, transparency and accountability at both central and local Human Resources for Health Increase financial allocation, equitable distribution and adherence to professional ethics Medicines and Supplies Increased availability and accessibility of quality medicines and supplies HIV and AIDS Enhanced accountability and oversight over HIV and AIDS resources at both central and local

APPROACH (1) Monitoring surveys (providers) Participatory research (service users) Analyses (budget, reports, and policy) Share data with target stakeholders followed by advocacy strategies/activities

Approach (2) Networking! Direct contacts Technical meetings Workshops MoH Donors Parliament MoF MSD UN JUDICIARY TACAIDS Districts Networking! Direct contacts Technical meetings Workshops

Approach (3) Internal External Internal webpage {intra blogging} Staff capacity building on targeting specific audience and how to work with the media Notice board Exchange Section Skype Newspapers engagement Press conferences Radio & TV Programs Radio & TV Spots Website Social Media {Twitter, Facebook, blog, You tube} Newsletters Community Radio Station Publications Promotional materials Documentaries Exchange section- {e-library, various reports ect}

Approach (4) Demand Side Citizen contact representatives Citizens participatory research activities using citizens score cards and citizens report cards Citizens through community meetings Engagement with governing committees Engagement with service providers

Social Accountability at District level Dispensary level Citizens Facility Committee Village leadership Health Center level Health Center Committee Ward Dev Committee Councilors Hospital/District CHMT District Health Board MPs DED DC

The Process Issue identification ToR and tools Permits and Introductions 20 Citizens in identified facilities Analysis and Reporting Report sharing central and LGAs Community Meetings District Political and Providers meetings Follow up action plans Advocacy and inform planning Analysis: Plans and budget allocation New round starts

Issues in Service delivery monitoring Medicine stock outs Medicine sold in the consultation rooms Injection given in doctor’s rooms Over pricing of some service/commodity Treatment without prescription Absenteeism by health workers High workload Abusive language Petty corruption

Issues in Service delivery monitoring CD4 Count machines not available/working X-ray machines broken down for long time No money no test results Payment for ambulance Public equipment found in private facilities/businesses

Issues in Service Delivery Monitoring Non existent complaint mechanisms In-charge holds keeps key to suggestion box Citizens don’t complain! No feedback on complaints Suggestion box opened quartely basis Dedicated room to handle complaints Complaints through community meetings Complaining directly to politicians

Issues in Service Delivery Monitoring Non functioning of governing committees Committee members don’t know providers Com members not known by citizens Com members appointed by politicians Com meetings not held Com members not trained, no guidelines Guidelines in English Language

Issues in Service Delivery Monitoring No supervision by the CHMT Policies and procedures unclear Medicine price catalogue not updated CHMT not supportive of providers Facilities upgraded but same budget New facilities but not functioning Elected Councilors unaware of citizen issues, plans and budgets Different political affiliation by politicians

Issues in Service delivery monitoring Complaints about CHF Social insurance clients not receiving services Providers and politicians cant link issues with budget Exemption is 80% of all services, not realistic Cumbersome procedure to spend 60% of user fees Planning centralized at district level Unclear standards, procedures and policies

Action Plans - Citizens Follow up with facility administration Follow up with governing committees Follow up with DMO Follow up with DED, DC, MPs Petition Attend meetings

Action Plans - District Clarify policies and procedures Train committees members Follow up translation of guidelines at central Improve supportive supervision Communicate plans and budgets Implement complaint mechanisms Ensure adherence to ethics Use data from facilities when planning

Initial success Stimulating Downward accountability Facilitate honest communication between politicians and service providers Relief and hope to communities Cross learning and sharing Saved as feedback to politicians and service providers Offers opportunity to assess the system

What is working True, backed up evidence Pressure at different levels of government Voices from service users themselves Pressure through Media

What is not working Upward accountability – reports are not adequately considered and action not appropriate Armchair ways of engaging communities, e.g use of Multimedia – Newer technologies in particular SMS campaign Inviting media in community meetings

Parking place How do we achieve downward accountability? How do we control petty corruption and at the same time ensure service delivery? How can we make district health planning and implementation a reality? How many more years will we need to achieve capacities and awareness raising? How do we reduce aid dependency?