“Community Voices”Annual Score Card on Civil Society Monitoring of Pro-

poor Policies & Programs under Ghana’s Poverty Reduction Strategy, 2004

Prepared by:Dr. Sulley Gariba

Jonathan LangdonIssifu Lampo

Institute for Policy Alternatives, Ghanawww.ipaghana.org

Community voices is an attempt to:

Use a social accountability tool ommunity SCORE CARD -- to interrogate the implementation of pro-poor policyFrom the perspective of rural and impoverished communitiesFacilitated by organizations of civil societyWho have a potential to catalyze advocacy at Local Government level, with Parliament, at the level of central government

Civil Society Monitoring of Poverty Reduction

Using Community Scorecard

What were the main issues?

What did we do?

&

What did we find?

Context:

Policy environment which legitimizes participation in formulation, implementation and oversight of pro-poor policies

Legitimacy and rights of organizations of civil society to set-out unique and independent monitoring of poverty reduction policies

Conceptual Framework

Monitoring for efficiency of public policies – were the targets of GPRS met? APRHow effective are the policies and programs – Impact Evaluations of GPRS (not yet initiated in Ghana)How accountable are these policies to the rights and responsibilities that citizens have vis-à-vis the state?

Social Accountability defined as:

Process of balancing citizen leadership and capacity to demand their rights, while fulfilling their responsibilities; with the capacity and willingness of the state to facilitate the fulfillment of these rights and responding to citizen demand.

When applied to poverty reduction policies, social accountability has an added dimension of the fulfillment of the rights of the vulnerable and the marginalized society

Therefore, we were challenged by GPRS to Assess:

Health Exemption Policies for the Poor

Education that is pro-poor

Resource Allocation as it applies to District Assemblies

National Scope

Together, as a grouping of over ten civil society organizations we covered:

13 Districts in Ghana

8 Regions out of the 10 administrative regions

76 communities

Over 5,000 community leaders and members, local government officials, service providers and managers of health and education delivery

National Coverage

Wa

Jirapa/Lambusie

Sekeyre East

Cape Coast

Bawku East

Builsa

West MamprusiZabzugu/Tatale

East Gonja

Kpandu

Dangme East

Savelugu/Nanton

Afram Plains

What did we do?

The Three key themes of Health, Education and Resource Allocation were looked at, with a number of district covering each theme:

Health 4 Districts

Education 5 Districts

Resource Allocation 4 Districts

Health for the Poor through Exemptions?

What did we Find?Communities, especially stakeholders of the poor and the vulnerable, want the right to quality and affordable health care, and a health service that respects them and their rights as “human beings”

Indicators of Pro-poor Health

• 79 % of communities selected Staff Attitude and Quality Care as a major indicator assessing health services to the poor

• 75% selected Availability and Affordability of Drugs

75% 79%67% 58% 54%

0%

20%

40%

60%

80%

100%

Frequency of Indicator by % Selection

Frequency

Health Grades, at a glance

51%

44%

47%

55%

41%

0% 20% 40% 60% 80% 100%

affordability of Drugs

Staff Attitude Access to Exemption (Pregnant

Women)Service delivery Time

Awareness

Health Exemption and Access Composite Community Scorecard Results

Grade

Community Voices - HealthStaff Attitude and Quality of Care

They do not give the needed attention to patients – they sometimes completely refuse to attend to poor people who are sick people at times (particularly during the night and weekends), insult and shout at these patients. – Afram Plains District, Eastern Region

 Drug Affordability and Availability

Bad; we buy the expensive drugs from the drug stores – Danku, Wa District, Upper West Region

Pregnant Women Many mothers prefer to deliver at home or with TBAs due to poor attitudes of nurses. This sometimes results in complications and death. The needed attention and care is also not given at clinics. . – Afram Plains District, Eastern Region

AwarenessI paid for my wife who went to deliver, only to hear from some one that I was not supposed to pay but I could not go back for my money. – Boli, Wa District, Upper West Region

Some more Voices

Women in Bugiya, West Mamprusi, speak out about exemption policy & access to drugs

Another Voice

A chief in West Mamprusi adds his voice to the discussion. He concludes that health service has led him to believe, “to die is honey and to live is salt.”

In Education…

What did we find?: Communities are living up to their responsibilities as parents and as students, but GES and Government are not providing the support they need:

• There is a national crisis over the adequacy and quality of teaching in rural communities, considered to be the poorest

• The textbooks needed for rural students to have an opportunity to compete with their urban counter parts are not there

• The right to education for girls are denied

What Indicators did communities use to assess Education?

• 100 % of communities selected Adequate, Qualified and Effective Teaching

• 96% selected Textbook access

100% 96%

54%46%

42%

0%10%20%30%40%50%60%70%80%90%

100%

Indicator by % Selection

% selected

Education Grades, at a glance

48%

26%40%42%

35%

0% 20% 40% 60% 80% 100%

Textbooks

Adequate Teachers

School Building

Drinking water

Furniture

Quality Education Composite Community Scorecard Results

grade

Community Voices - EducationAdequate, Qualified and Effective Teaching

You send your child to school because you want him to be somebody in future, now this is not possible because there are no teachers – woman, Suke

Textbook In the rainy season, a farmer without a hoe benefits nothing from the rains; so is a student without text book. – woman, Chetu

School Building

Building not protected so rainfall, sunshine and animals interfere and interrupt children’s attention during classes. Blackboards are pasted on walls instead and this creates inconvenience.

Samankwae

How resources are allocated for Pro-poor development at District level

What did we Find?:Communities do not have the information about resources already committed to their development; feel their elected representatives are denied this information, and want the right to be involved in resource allocation decisions that affect their lives. They are tired of being under-valued and under-consulted when something is brought into their villages and towns.

Community-driven indicators for assessing Resource Allocation

• 100 % of communities selected Consultation and involvement in Resource Planning

• 100% selected Information, including budgets, on resources allocated

100%100%89%89%

67%

0%10%20%30%40%50%60%70%80%90%

100%

Frequency of Indicator by % Selection

Frequency

Resource Allocation Grades, at a glance

34%

72%

42%

26%

35%

0% 20% 40% 60% 80% 100%

Consultation/involvementInformation(including

Quality

Felt Need

Participation

Resource Allocation Composite Community Scorecard Results

Grade

Community Voices – Resource Allocation

Consultation“We have no value, else they would have consulted us before sighting this culvert” – woman, Agbedrafor, Dangme East

Information (including budgets)

If They have nothing to hide, why we don’t know the costs of projects so as to appreciate how they value us.” – Elder, Nakomkope

QualityCan a Marginalized person of this community be given anything of value? – Elder Salom

Felt NeedWho knows what you may need, when planning is done in their big offices? – Youth, Toflokpo

ParticipationWhen they look mean on us, how can they allow us to participate? – Woman, Bonikope

TransparencyConstruction works on the road are done at night ïf you are not stealing, why do you not work during the day?

Implications of these Findings for Pro-poor Policies and Programs:

Review of GPRS (currently on-going)

On-going implementation, monitoring and evaluation

Policy changes needed

GPRS Review:

The initiatives in previous GPRS that were explicitly pro-poor must be retained and expanded

Ring-fencing of these specific pro-poor initiatives is needed in order that organizations of civil society representing the poor can focus on the accountability of these policies and programs to the poor

Policy Change:

This assessment has revealed 4 main elements of rights of the poor that must be up-held:

The right to information about policy priorities and resources devoted to these on behalf of the poorThe right to participate in decision-makingThe right to be “valued” and,The right to question policies and programs (demand of accountability from officer bearers and service providers)

Any pro-poor policy and program initiative in GPRS must now include how these rights will be fulfilled by office bearers and service providers

Continuing Community Voices:

This is the first, we are committed to doing this annually

Indicators that are determined by communities themselves need to inform the “objectively verifiable indicators” determined from the “top”

In time, we foresee a monitoring and evaluation regime that has two sides of the same coin – what the state has provided, and what communities have said about these

Dissemination Strategies:

Dissemination within Districts

Dissemination at the national level

District-level Dissemination:

Interface as the first stage in dissemination

Production of reports in popular version comprising:

One issue summaries with graphics

Illustrated local language versions

Radio talk shows on the issues

Media coverage of community meetings to discuss issues arising from the poverty monitoring

National Level Dissemination

Validation and refinement of composite analyses and reportFinal Preparation of “Community FirstNational Launch of the Community First outlining the results and their implicationsAkontabuo -- Newsletter on Social AccountabilityVideo documentary on Poverty Monitoring and Social AccountabilityNational Talk-show on radio and television

Policy Implications and dialogue:

Briefing sessions with key sector Ministries of Health, Education, Common Fund Administrator

Briefing sessions with the Multi-donor Budget Support Group

Engagement of Ministry of Finance and also NDPC to review the key findings vis-à-vis the Annual Progress Review (APR) of GPRS

Advocacy with Parliament:

IPA is developing an agenda for advocacy with Parliament to be funded partly by the Parliamentary Center, Canada

Will be launched in April, to coincide with the next session of Parliament

Who are we?Afram Plains Dev’t Organization (E.Region)Amasachina (Northern)Community Partnership for Health & Development (Northern)ISODEC (Ashanti)Radio Ada (Greater Accra)Civic Response (Central & Western)

Pronet-North (Upper West)SimliAid (Northern Region)Rural Media Network (Northern Ghana)Northern Ghana Network for Development (3 Northern Regions)Partnership for Sustainable Development (Bawku)Municipal Action Foundation (Volta Region)

The 3 Cs:

Competence – in engaging citizens, in understanding the policies and programmes and in conducting the research

Credibility – seen as advocates of the poor, engaged in programmes ourselves, and also a close recognition of the officials and the communities as partners in the same process

Confidence – ability of the CSO to articulate the process and the findings of the monitoring process

How Process is Governed:An 8-member Reference Group of Peers drawn from:

• Civil Society• Academic• Private Sector• Government• Legal profession

A volunteer group that reflects and advises; challenging ourselves to carve autonomous spaces where civil society can take initiatives and assume leadership

Who is coordinating this?

Institute for Policy Alternatives (IPA) provided:Training services in social accountability

Supported the implementation of the social accountability initiatives – through monitoring and field support

Managed a social accountability fund provided by DfiD

Undertook community monitoring initiatives in 2 Districts, focusing on health exemption in one and mutual health insurance in another

Appreciation:DfiD-Ghana provided funding to see these initiatives to fruitionCivic Engagement Group of the World Bank provided early methodological support and supported refinement of tools and training of trainersCommunities provided the energy and the resolveCSO partners undertook the journeyPublic officials grew in tolerance…and hopefully will grow in confidence to facilitate and hear the “Community Voices”

An invitation to go North, to IPA:

Whether you a MP from Uganda or Tanzania

An invitation to go North, to IPA:

Seeking engagement at the village

An invitation to go North, to IPA:

Or simply to attend training training on monitoring, evaluation and policy analysis…at our training center in Tamale, Ghana