The objective of this assignment is to provide input to the Health, Population and Nutrition Sector Development Programme (HPNSDP) Annual Programme Review in September 2013 on opportunities and options to enhance ‘voice and accountability’ (V&A) in the health sector programme in Bangladesh. It does this through:
- Mapping current V&A initiatives, including those initiated outside the Government of Bangladesh (GoB) structures, which build upon the scope of the health sector programme;
- Preparing case studies with analyses of the strengths and limitations of influential V&A initiatives and the circumstances, factors and levers that increase their effectiveness and impact; and
- Identifying feasible and constructive lessons learned and recommendations on V&A of relevance to HPNSDP and to DFID health sector programming in Bangladesh.
The work was undertaken between June and August 2013 through a review of international and national literature, a semi structured set of visits, meetings, and key informant interviews, and an iterative process of report development particularly with DFID Bangladesh health, governance and social development staff.
The following recommendations were made based on the findings of the report:
Recommendations to government
- To maintain a vigorous approach to completing the programme of establishing a comprehensive network of Community Clinics (CCs) and associated Community Clinic Management Group (CCMGs) and Community Support Group (CSGs).
- To work closely with Ministry of Local Government (MOLG) so as to continue strengthening the links between CCMGs, union parishads, and upazila councils.
- To undertake operational research and implement effective measures for using new technologies to provide a route for community organisations to provide structured feedback about quality and utilisation of services.
- To review the operation of Hospital Management Committee (HMCs) and adopt a more rigorous approach to monitoring their effectiveness and taking remedial measures when performance is not effective.
- To strengthen the Gender Equity Voice and Accountability Task Group (GEVA-TG) through the inclusion of line directors involved in major initiatives in V&A.To consider how the views of women users can be heard and incorporated into the design of voucher schemes and monitoring of implementation recommendations to DFID and Development Partners (DPs).
Recommendations to DFID and DPs
- To establish through the pooled funds a Community Health Development Fund to provide funding for third-party support to CCMGs and CSGs; block grants to provide for small discretionary expenditure based on Local Level Plan (LLP); and capacity strengthening of local government chairmen and councillors.
- To provide support through the pooled funds for a scheme to revitalise and strengthen schemes for hospital accountability to communities served. This should include technical assistance and capacity strengthening for the operation of HMCs and small grants to recognised hospital user forums and similar bodies.
- To provide financial support to think tank-style organisations proposing and then implementing schemes for providing expert knowledge support to community-level organisations and facilitating the exchange of information and good practices between such organisations.
- To work with the LD-MIS to explore and fund promising innovations in the use of new technologies to strengthen citizen voices.
- To explore options for improving the expert knowledge of health specialising journalists so that they are better informed of best practices and international experience.
Recommendations to NGOs and civil society organisations
- Based on the learning from experiences so far, design low-cost but effective means of providing support to citizen groups.
- To explore means of collaboration, information exchange, and sharing of good practices in citizen participation in health.