This is a guest blog written by Hannah Fishman of Burness Communications.
“One thing is certain: When medicines aren’t available, people will die.”
So said Dennis Kibira March 29 at an event, “Civil Society: A Missing Link in Development, ” the first event of a series co-hosted by the Global Health Council and member organization Results for Development Institute. As health policy and advocacy manager at HEPS – Uganda, Kibira has led Ugandan efforts in a multinational campaign to stop stock-outs across the region. A stock-out occurs when pharmacies run out of medicine on the shelf – supply does not meet demand. The average stock-out in Uganda in 2008 was 2.5 months each year. And less than 50% of public health facilities had a set of necessary medications.
How, then, to stop the stock-outs and save lives? On this question, Kibira echoed many of yesterday’s speakers: “If there has to be change, it has to come from the people.”
To counter the problem, civil society groups developed a plan: they built an extensive campaign for public awareness and coupled it with targeted policymaker and media outreach. They worked with members of Parliament and local artists. They held press conferences, rallies and forums. They developed an SMS message reporting system that involved the public in monitoring stock-outs across the region. And they were successful. The media took notice, and the Ugandan government embraced the issue, changing the funding model for the National Medical Stores to reduce shortages. The president has spoken out about the problem, and created a Drug Monitoring Unit to check up on pharmacies.
Stop Stock-outs, just one project of the several discussed at the event, is at the forefront of a growing conversation about accountability and transparency– two integral pieces of a meaningful civil society. All three civil society organizations (CSOs) presenting were grantees of the Results for Development Institute’s Transparency and Accountability Program (TAP), which awards grants to expand the capacity of CSOs and build a more powerful civil society. Its focus: demand-side interventions that allow CSOs to argue effectively for improvements in spending at the local and national level. By directing funding at this “missing link” in accountability, TAP looks to answer a fundamental yet challenging question – why is development spending in areas like health, education and water not translating into improved results? And what tools can civil society, NGOs and others use to create meaningful change that lasts?
Another example comes from South Africa, where there is a tendency to treat accountability as a personal favor, not as a fundamental right. In the Eastern Cape Province, 60% of the population lives in poverty – less than $1 each day. This is where, in 2003, the government signed a $95 million contract for emergency medical services – a contract that made no impact. Reports of ambulances arriving late or not at all remained steady. The contractors weren’t doing their job, and they weren’t being held to account. And that wasn’t all: in 2005, 47% of all EMS helicopter trips were for members of the provincial executive council (MECs).
This is where the Public Service Accountability Monitor (PSAM) came in. PSAM took to the airwaves, publicizing the exorbitant equipment and service costs charged to the government, and exposing the rampant use of EMS helicopters by the executive council. And the outcry they sparked created change: The government reviewed and renegotiated its EMS contract was in 2005. And MECs are now banned from using EMS helicopters. Empowered with information, civil society successfully held government to account.
At the end of yesterday’s seminar, Global Health Council President and CEO Jeffrey L. Sturchio quoted Einstein’s famous definition of insanity: doing the same thing over and over and expecting different results. Too often, though, the development field seems caught in exactly this trap. Yesterday’s presenters demonstrate that civil society groups are starting to experiment with new programs – and that they are achieving results. They show that transparency and accountability can begin with the people. They are going beyond the role of mere watchdogs, to become collaborators and partners with government. The question is this: How can we nurture these examples of capacity building, extend them, and create better health results worldwide?
See video of the Civil Society event on March 29.