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Indonesia: How social accountability changed power dynamics and strengthened the health system

Sue Cant

People who never speak, speak. Through Citizen Voice and Action, they dare to speak up about the things that need to be improved.
(Mother, Timor Tengah Utara, East Nusa Tenggara Province, Indonesia)

This is among comments shared with evaluators of the first Global Partnership for Social Accountability (GPSA) project in Indonesia. Citizen Voice and Action for Government Accountability and Improved Services: Maternal, Newborn, Infant and Child Health Services was implemented by Wahana Visi from 2013 to 2018 and aimed at improving maternal, newborn, child health, and nutrition (MNCHN) services.[1]

The project evaluation, completed late in 2018, is the first GPSA evaluation to provide systematic evidence of mechanisms around system strengthening and changing local power dynamics:

“Increased awareness of rights and standards on the part of service managers and officials triggered internal accountability systems, such that resources were reallocated and staff were both enabled to, and held accountable for, provision of services to meet standards.” (Project evaluation report, p. 13)

Other examples of system strengthening through the CVA approach in Uganda, Senegal and Zambia, documented by Columbia University, [2] have been highlighted over the past decade, and the same appears to be occurring in other GPSA projects, though the Indonesia evaluation is the first to capture this. The evidence on local power dynamics appears to advance knowledge in the field of social accountability and may be the first evaluation to make such findings anywhere.

Using a Realist impact evaluation methodology, the lead evaluator of the Wahana Visi project, Gill Westhorp, found some evidence of women’s empowerment as well.

The evaluation found that CVA changed local power relations through transparent platforms for collective opinion, by empowering women; and by bringing different types and levels of decision-makers into the process. The health system was strengthened through improved relationships, increased information, resource flows and positive feedback loops.

Under the approach, village facilitators provided civic education on government health standards and facilitated community members to rate their services through scorecards and social audits. Of the 2000 action plans developed through community and government meetings, 64% were completed.

The project was implemented in 60 villages in three districts of Nusa Tengara Timor province in Indonesia: Kupang, Sikka and TTU. Other results include:

  • A 33 per cent increase in the percentage of pregnant women and mothers who reported that nutrition advice was provided at the Posyandu (village maternal and child health centre).
  • Based on scorecard data, the percentage of respondents who gave ratings of good or very good almost doubled from 23 per cent in 2014 to 45 per cent in 2017

The evaluation can be accessed here and is the focus of a GPSA Knowledge Platform webinar on March 13, 2019. Join the e-discussion, ask the project’s experts your questions, and share your related experiences!


[1] For more information, visit the project page here.

[2] Schaaf, M Topp, S and Ngulube, M, 2017 From favours to entitlements: community voice and action and health service quality in Zambia, Department of Population and Family Health, Mailman School of Public Health, Columbia University, Oxford University Press, February. Also, based on WV experience across more than 40 countries and GPSA experience over the past 5 years.


About the Author

Sue Cant

Sue Cant provides technical advisory for World Vision’s social accountability programs across 800 projects in 40 countries. She has 15 years experience working in international development policy & programs in Africa, Asia and the Pacific.
                   

1 Responses on Indonesia: How social accountability changed power dynamics and strengthened the health system"

  1. Great work Sue–this is really useful. Ann Hendrix-Jenkins, Movement for Community-led Development

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