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

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

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

4. 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

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

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

7. 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}

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

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

21. 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

22. 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?