The field of transparency is packed with vocabulary that suggests opposition or conflict, with labels that imply, somehow, that the watchers are above the watched, like white knights fighting the dark forces of development aid, the corrupt and incompetent. However collaboration between watched and watchers may also offers a better chance of generating positive change, by understanding the political context of the activities being monitored, targeting the right people, in a non-threatening way, offering solutions as much as identifying problems. In other words, being a successful ‘watchdog’ is argued to be all about knowing how to approach different people in different circumstances to achieve mutually beneficial goals. This article explores how to build the demand side of aid transparency. It raises that beyond accessing relevant, timely and accurate data, is to learn to make use of it in a strategic way, with a constructive mind, taking into consideration local political dynamics, and the reality and psychology of the people whose performance one aims to monitor and improve.
Governance and participation in health
Talking to French magazine Esprit, theorist Achille Mbembe discusses a postcolonial thinking that has developed in a transnational, eclectic vein, enabling a specific take on globalization. He outlines three cardinal moments in the development of postcolonial thought. The first, of anti-colonial struggles, included the self-reflection by people of their colonization and debates on the relationship between class and race as factors. The discourse centred on the politics of autonomy, to acquire citizen status and, thereby, to participate in the universal. The second moment, around the 1980s, he outlines as the moment of "high theory", with new thinking on knowledge about modernity. This understood the colonial project beyond its military-economic system, to one that was underpinned by a discursive infrastructure and a whole apparatus of knowledge the violence of which was as much epistemic as it was physical. The second post colopnial discourse sought to recover the voices and capabilities of decolonization's rejects (peasants, women, underprivileged people) and to better understand why the anti-colonial struggle led not to a radical transformation of society. Mbembe argues also argues that it sought to expose the procedures by which individuals are subjugated to categories of race and class that block access to the status of subject in history. In the third moment, Mbembe argues that globalisation has, as for colonial capitalism, subjugated living spheres to economic appropriation, and that the "colony" was in fact a laboratory for the wider authoritarian destiny of today’s globalisation. He proposes that in this context the reinvention of politics in postcolonial conditions first requires people to reinvent their place in history, not in a logic of repeating the same violence as vengeance, but in a demand for a justice that supports an "ascent in humanity“.
Abahlali baseMjondolo formed in 2005 has more than 12,000 members in more than 60 shack settlements. The organisation campaigns against evictions, and for public housing: struggling for a world in which human dignity comes before private profit, and land, cities, wealth and power are shared fairly. The article by the founder of Abahlali baseMjondolo expresses people's frustration with lack of delivery on rights to free housing, free education and free healthcare in urban South Africa, and the consequent resolve to take direct action to move rights from paper to reality, from abstract to concrete. While they acknowledge that this brings risk to their members, the author raises frustration with political and civil society processes, they also argue that they no choice but to take their own place in the cities and in the political life of the country.
This article poses reflections from two leads of Twaweza, an east African non government organisation, on their approaches and work, particularly in response to a series of blogs on this by D Green (Oxfam GB advisor. They reflect on learning on citizen action; and on the need to better articulate what is meant by citizen action, including private v public and individual v collective. "In essence, this is a move away from an unexplained “magic sauce” model where we feed some inputs (i.e. information) into a complex system, hope twaweza-logothat the (self-selecting, undifferentiated) citizens will stir it themselves, and voila – a big outcome (such as increased citizen monitoring of services, and improved service delivery) will somehow pop out on the other end".
This blog discusses issues and seven lessions raised by evaluations of the theory of change and first four years of work by an East African NGO, Twaweza. The author comments that research by groups like the Africa Power and Politics Programme and Matt Andrews argues that both demand side (build the citizens) and supply side (build the state) have failed in generating change. What works, they think, is collective problem solving, bringing together citizens, states and anyone else with skin in the game, to build trust and find solutions. People on the ground, like Goreti Nakabugo, Twaweza’s Uganda coordinator, get this: ‘we know we need buy-in from the government, officials, local politicians. We are brokering relationships with them on a daily basis’. Not only that, but in practice, even differentiating between citizen and state can be problematic – neither category is a monolith, and in some cases, the most active citizens are themselves state employees, members of public trade unions etc.
Research has shown that mHealth initiatives, or health programs enhanced by mobile phone technologies, can foster womens empowerment. Yet, there is growing concern that mobile-based programs geared towards women may exacerbate gender inequalities. A systematic literature review was conducted to examine the empirical evidence of changes in men and women?s interactions as a result of mHealth interventions. Out of the 173 articles retrieved for review, seven articles met the inclusion criteria and were retained in the final analysis. Most mHealth interventions were SMS-based and conducted in sub-Saharan Africa on topics relating to HIV/AIDS, sexual and reproductive health, health-based microenterprise, and non-communicable diseases. Several methodological limitations were identified among eligible quantitative and qualitative studies. The current literature suggests that mobile phone programs can influence gender relations in meaningfully positive ways by providing new modes for couples health communication and cooperation and by enabling greater male participation in health areas typically targeted towards women. MHealth initiatives also increased womens decision-making, social status, and access to health resources. However, programmatic experiences by design may inadvertently reinforce the digital divide, and perpetuate existing gender-based power imbalances. Domestic disputes and lack of spousal approval additionally hampered women?s participation. Efforts to scale-up health interventions enhanced by mobile technologies should consider the implementation and evaluation imperative of ensuring that mHealth programs transform rather than reinforce gender inequalities. The evidence base on the effect of mHealth interventions on gender relations is weak, and rigorous research is urgently needed.
Using a descriptive literature review, this paper examines the factors that influence the functioning of accountability mechanisms and relationships within the district health system, and draws out the implications for responsiveness to patients and communities. We also seek to understand the practices that might strengthen accountability in ways that improve responsiveness – of the health system to citizens’ needs and rights, and of providers to patients. The review highlights the ways in which bureaucratic accountability mechanisms often constrain the functioning of external accountability mechanisms. For example, meeting the expectations of relatively powerful managers further up the system may crowd out efforts to respond to citizens and patients. Organisational cultures characterized by supervision and management systems focused on compliance to centrally defined outputs and targets can constrain front line managers and providers from responding to patient and population priorities.
In this review, the authors highlight the silos that currently characterise transparency and accountability initiatives (TAIs). The authors argue that a decade on from their inception, and notwithstanding a growth in litigation-based social accountability that invokes popular mobilisation and democratic rights, there is much to suggest that TAIs in aid and development are increasingly being used within an efficiency paradigm, with scant attention to underlying issues of power and politics. Many TAIs focus on the delivery of development outcomes, neglecting or articulating only superficially the potential for deepening democracy or empowering citizens, overemphasising tools to the detriment of analysis of context, of forms of mobilisation and action, and of the dynamics behind potential impact. Many TAIs focus on achieving‘downstream’ accountability –the efficient delivery of policies and priorities – bypassing the question of how incorporating citizen voice and participation at earlier stages of these processes could have shaped the policies, priorities and budgets ‘upstream’. The authors contrast new public management approaches with rights based approaches. The paper examines ways of assessing effectiveness of TAIs.
Advocacy and lobbying are more taking an ever more central place in health agendas of African countries. It is impossible to have a conversation about public policy these days without someone mentioning 'civil society'. The author argues that clarity and rigor are conspicuously absent within civil society. A States' first duty towards citizens is to respect the right to health by refraining from adopting laws or measures that directly impinge on people's health. The paper presents evidence from the literature of civil society organization (CSO) intervention in support of primary health care, equity in health and state health services covering 38 online documents and from interviews with key informants from government and civil society. They suggest from the findings that countries ensure that public health principles and priorities are clear and legally binding; that countries have a clear coordinating mechanism on issues of trade and health that involve government, particularly health ministries and civil society and that civil society disseminate health and trade information in accessible ways.
In the capability approach to poverty, wellbeing is threatened by both deficits of wealth and deficits of agency. Sen describes that “unfreedom,” or low levels of agency, will suppress the wellbeing effects of higher levels of wealth. In this paper the authors introduce another condition, “frustrated freedom,” in which higher levels of agency belief can heighten the poverty effects of low levels of wealth. Presenting data from a study of female heads of household in rural Mozambique, they find that agency belief moderates the relationship between wealth and wellbeing, uncovering evidence of frustrated freedom.