By Joseph Wales

10961059765_f91a396975_o copiaThe debate around social accountability is on the move. While once the crucial question was whether it could produce tangible results, the debate now centres on what social accountability can achieve (and when, and where, and, crucially, how).

Recent collaborative research from CARE International and the Overseas Development Institute explored these questions for a single programme (CARE’s community score cards) across a range of sub-Saharan African countries (Ethiopia, Malawi, Rwanda and Tanzania). It found a wide range of impacts from improved chlorination of water sources to reductions in gender-based violence, and from better relationships between district officials, health workers and citizens to the construction of new staff houses.

It also casts light on one of the difficult questions facing practitioners of social accountability methods – how to build national impact from programmes that often operate at the very local level. Documented impacts beyond the immediate community or district in which the score card process operates are rare, and understanding how to extend this influence is key given that many problems experienced at the local level are affected by the decisions of higher levels of government.

The single example from this research comes from Rwanda and, while we should be wary of drawing sweeping conclusions from one-off events, it does hold some useful lessons.

The issue in question centred on Rwanda’s health insurance mechanism. The premium paid by households is structured progressively based on a wealth assessment, which classified households into categories used to target assistance (ubudehe). Improving health provision is a national priority and district authorities have tough performance objectives for enrolling citizens in the insurance scheme – with targets extending to the very local level (or cell). The dialogue process of the community score card revealed numerous complaints about this system – both that cell level officials were overreaching in enforcing compliance (such as forcing sales of goods to cover premiums) and that mistakes in assessing household wealth meant that many households were actually in inappropriate categories. These households faced not only higher health insurance costs, which they found hard to pay, but had also become ineligible for university scholarships and a variety of other means-tested benefits. While this information enabled the district level authorities to clamp down on the hard line methods being used by cell officials, the decision to re-categorise citizens could only be taken at higher levels of government. In most analogous cases we had observed in other contexts changes halted at this level, but the story in Rwanda was different.

In this case concerns over household categorisations were repeated at existing regional fora for discussing grievances and policy. The information from this process was then passed up to major ministries in the central government and provided important additional evidence to an ongoing high-level process examining the classification system, which subsequently led to a decision to review the criteria for categorisation at the national level.

These results are remarkable given that Rwanda is often perceived as being politically closed, with CARE initially being uncertain as to how to facilitate state-citizen dialogue in a way that would ensure the score card process could take place effectively.

The key to CARE’s success here was rooted in both context and strategy. Firstly, while Rwanda has a strong state and dominant party, it is also characterised by more coherent decentralised structures and strong performance mechanisms for service providers (such as the imihigo contracts). These meant that information from the score card was shared upwards and authorities at many different levels had the incentives and institutional means to make changes. Secondly, CARE’s adoption of a non-confrontational approach and the alignment of the score card process with the interests and incentives of officials meant they were able to work effectively with the state. Many district officials noted that the score card process had helped them meet their targets by giving them the information needed to make changes that would improve services. The linking of the score card to an effective state whose development priorities aligned with those of the programme was therefore a powerful combination for change – allowing it to stretch all the way to the national level.

While this combination shows one route social accountability can take to improve services it leaves open some major questions that now need addressing. How can these types of mechanisms be used for national change where the state is not as coherent? What influence can they have where priorities are not so well aligned? And how do we balance a desire to improve services for citizens with a desire to tilt the balance of power more towards the citizen? Working with the existing incentives and structures seems to lie at the heart of effective strategies, but more sharing of strategies and experiences is needed if we are to effectively answer these questions.


Joseph Wales
Research Officer, Overseas Development Institute

Joseph Wales is a Research Officer in the Politics and Governance Programme at the Overseas Development Institute. His work focuses on the politics of service delivery, with a particular interest in social accountability and the education sector. His research covers a variety of qualitative and quantitative methodologies, and he has worked with a range of development agencies, academics, NGOs and CSOs. He is a graduate of Oxford University and has an MPA in International Development from the London School of Economics.

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4 responses on "A question of gravity – how do we get social accountability off the ground?"

  1. Thanks. Some great example here of understanding and aligning government incentives and scaling vertically.

    “Many district officials noted that the score card process had helped them meet their targets by giving them the information needed to make changes that would improve services”. This is a really good example of how we can align citizen and government officials interests, and create incentives for buy-in by officials. As you say this method might only work as in an ‘effective’ State, where officials are held accountable to targets in the first place.

  2. Thank you Joseph for your post, and the description of CARE’s success in health insurance process in Rwanda and Olive for your comments.
    Coming back to the definition of social accountability given by Mary McNeil which “refers to the process of holding actors and in this case the state for its actions”.
    The process of Social accountability would go from awareness to responsability and the mecanism to hold a state responsible for its actions and forced to take corrective action for its community are going to be mostly rooted in institutional responses which in the case of CE would be a legislation consequence and not a process to get “off the ground”, or even bottom up.
    Unlike Jonathan Fox (with his definition of tactical CE linked to small, short term, … limited to the very local… cannot have larger impact) I truely believe that replication of decentralized small scale low tech, low budget social solutions/processes can creat huge impact: first by nature: small budgets, small scale, easily replicable, secondly by the scalation it can allow.
    Moreover short term allows CE to keep momemtum, easier and deeper community reach through local education and buy-in…
    To conclude I experimented in a few empirical studies in Bolivia and Brazil on CBWM (Community Based Waste Management) implementations that showed very strong impact first from the simple fact of acting, setting actions that the community could understand, could relate to, and see its positve effect (wheel), design and embrace. Action prooving inspiring, easying replication and scalation factors.
    I will develop in a later post and during the exercise proposed on CE the concept I am working on, called the “Wheel of community engagement” descritbing the steps of community empowerment through decentralized simple Waste Management processes led by local people, and sustained by market valuation of recyclables.

  3. This is an interesting example and I want to assume it was possible because the officials cared about succeeding in the first place. Part of the reason why most interventions stop at the community or district level is that the further up you go in the governance structure the more complex the bureaucracy and incentive for responding to the needs of the people are. My position is based on experience working in a complex and large country. It might be helpful in this context if relevant officials from all levels of government are carried along from the beginning once it is determined that they would have a role to play in ensuring that the outcome is translated into positive impact for the people.

  4. Thank you for your post Joseph

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