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This policy brief, apart from describing the dilemmas of the democratization process of health services it, aims to analyze its implications on the dynamics of social accountability in the health sector and, finally, to inform on possible ways for a more coherent democratization, considering the normative discourses

Corruption through opaque public contracts costs Africa billions of dollars in revenue loss annually. Globally, initiatives to address this have centred on information disclosure (ID) but under what conditions does it work to promote accountability in the extractive sector that for a long time has seen its revenue management as being a major cause of conflict in Africa? Our study on this issue in Mozambique reveals intriguing findings, which suggest that protagonists of ID would need to...

A economia de Moçambique encontra-se num ponto de viragem, e os esforços para abordar as vulnerabilidades em matéria de governação e corrupção podem ter um impacto positivo duradouro. Já tomámos medidas para abordar as vulnerabilidades em matéria de governação e corrupção. Contudo, reconhecemos que subsistem falhas em diversas áreas relevantes da economia. A fim de abordar algumas das debilidades restantes, temos reformas de governação em curso e em perspectiva em várias áreas, muitas...

Background How do governance interventions that engage citizens in public service delivery planning, management and oversight impact the quality of and access to services and citizens’ quality of life? This systematic review examined high quality evidence from 35 citizen engagement programmes in low- and middle-income countries that promote the engagement of citizens in service delivery through four routes: participation (participatory priority setting); inclusion of marginalised groups;...

Inequality is a key political issue of our times. It has political consequences, fuelling conflict and raising legitimacy chal‑ lenges for regimes around the world, in democratic and non‑demo‑ cratic settings alike. At the centre of these challenges is the question of accountability: who can be held accountable, on what basis, how and by whom for tackling or failing to tackle which inequalities. In the field of global health, inequality has long been a key issue. A significant body of work —...

As I explored in my previous blog, the health sector and provision of health services in Mozambique is an uneven playing field. Since 1980 it has been shaped by a range of donors who have strategically positioned themselves according to their political weight and ability to contribute with ‘commodities’ and financial resources.  Although donors’ contributions […]

A recent study on information disclosure in the extractive sector has found 18 factors that result in citizen and institutional (state and non-state) inaction in demanding government accountability. Conducted by the Partnership for African Social and Governance Research (PASGR) in collaboration with the Centre for Public Integrity (CIP), as part of the Action for Empowerment and Accountability (A4EA) research programme, the study shows that citizens and/or institutions are unlikely to...

This article aims to understand the inversion of roles between the state and citizens, by exploring its historical roots and current implications for processes of social accountability in Mozambique, particularly in the health sector. This is a practice-based reflection grounded in the evidence collected through the implementation of Community Scorecards in the health sector in 13 districts of Mozambique. The evidence has revealed a transfer of responsibilities from local governance...

This paper explores the current state of thinking among a range of aid actors (multilaterals, bilateral, applied scholars and international non-governmental organisations) on how to promote empowerment and accountability in fragile, conflict and violence affected settings. It seeks to identify trends, gaps and weaknesses in that thinking, and propose research questions and hypotheses to test. Three underlying sources of confusion are identified that are hindering progress on both...

Social accountability in the health sector has been promoted as a strategy to improve the quality and performance of health providers in low- and middle-income countries. Whether improvements occur, however, depends on the willingness and ability of health providers to respond to societal pressure for better care. This article uses a realist approach to review cases of collective citizen action and advocacy with the aim to identify key mechanisms of provider responsiveness. Purposeful...

Recommendations: 1. On planning and budgeting, greater coordination is recommended between planning (setting priorities) and budgeting (financial apportionment). Transformation of all District Health Services, Women and Social Action (SDSMAS) into Management Beneficiary Units (MBU) is necessary. 2. Stakeholders should bet more on application of national public financial management systems (PFM). The use of parallel financial systems instead of enabling the National Health System (NHS) to be...

Empirical evidence of tangible impacts of social accountability initiatives is mixed. This meta-analysis reinterprets evaluations through a new lens: the distinction between tactical and strategic approaches to the promotion of citizen voice to contribute to improved public sector performance. Field experiments study bounded, tactical interventions based on optimistic assumptions about the power of information alone, both to motivate collective action and to influence the state. Enabling...

The objective of the baseline survey is to analyze and document the situation around accountability, transparency and governance of the O&G sector in the country prior to the implementation of the Oxfam project. It focuses on a selected group of indicators chosen for the country program logical framework, identified and approved in the Baseline Inception Phase. A total of 33 people were interviewed in the context of this baseline. This was accompanied by a thorough national and international...

This case study was commissioned by N’weti Comunicação para a Saúde to explore the changes emerging from the implementation of an adapted version of the Community Scorecard (CSC) tool in 11 health facilities catchment areas in Nampula. This case study discusses how N’weti has adapted the Community Scorecard (CSC) tool to better improve the quality of the participation and prospects of accountability for citizens. The case study presents evidence that the adapted CSC tool has resulted in an...

The Citizen Engagement Program (CEP) in Mozambique is an empowerment and accountability program aiming to improve the quality of health and education services through supporting citizens to monitor them. The program supports citizens to engage with service providers to address identified problems; it also aims to generate evidence for policy and program improvement at the local and national levels. This case study is structured in three main sections. The first section provides a background...

O presente guião é um instrumento que tem em vista dotar as OSC e cidadãos de modo geral, de conhecimentos sobre o funcionamento dos Conselhos Consultivos Locais (CCLs) de maneira a facilitar a sua participação e a alargar as suas intervenções na área de monitoria e advocacia da governação a nível distrital. Estão apresentados neste guião, os elementos que permitem perceber a organização, a estrutura, funções, e responsabilidades dos Conselhos Consultivos Locais, como eles funcionam, as...

O Programa Cidadania e Participação (CEP) (2013-2018) apoia os cidadãos na monitoria da qualidade de prestação de serviços de saúde e de educação em quatro províncias de Moçambique, assim como a advogar para a melhoria da qualidade desses serviços nos níveis distrital, provincial e nacional. O CEP pretende contribuir para: uma maior disponibilidade de informação relevante de modo a que os cidadãos tenham um melhor acesso e benefício dos serviços prestados pelo sector público; melhorar as...

Why do different services encounter particular constraints and opportunities in their delivery? This working paper identifies a set of characteristics that can be used to differentiate between services, and between functions within them, and asks how these defining or ‘fixed’ characteristics may influence key relationships of accountability and control.

The development industry is increasingly pushing practitioners to achieve results, and to do better in demonstrating what works, what does not, and explaining why. There is a growing interest in going beyond the measurement of results to being able to understand the basis for success or failure. Consequently, the development of explicit theories of change (ToCs) is starting to be viewed as central to this process, as a key part of what constitutes ‘rigour’ in impact evaluations. Citizen...

Accountability is a central feature of democracy. Governments must explain what they are doing, justify why they are doing certain things and not others. Moreover, accountability increases the likelihood of the improvement of public services if citizens have the political scope to hold politicians and administrators accountable, and potentially sanction them. Consequently, developing countries as well as the OECD-donor community have committed themselves to working towards the improvement of...