Social Accountability Monitoring in the Health Sector

1
Social Accountability Monitoring in the Health
Sector

• Dr Neil Overy
• Public Service Accountability Monitor
• 29 March 2010

2
Background Context - South Africas Eastern Cape
Province

• South African Constitution contains commitment
  to the progressive realisation of socio-economic
  rights within available resources, has excellent
  enabling legislation to ensure accountable use of
  resources. Yet
• 60 of EC population continue to live in poverty
• 42 of EC citizens are illiterate
• 800 000 EC families are without proper housing

3
Excellent legislative framework but weak
implementation

• Highly centralised executive power, defensive
  ruling elite, weak oversight institutions, poor
  service delivery
• Tendency to treat accountability as personal
  favour not a fundamental human right
• Fragmentation of monitoring by civic actors,
  oversight bodies and officials

4
The Right to Social Accountability

• All persons have a fundamental right to obtain
  justifications and explanations for
• the allocation and use of public resources from
  duty-bearers entrusted with responsibility for
  these resources, (whether intergovernmental
  institutions, government officials or private
  service providers) and
• the performance of duty-bearers in progressively
  realising the human rights of those they serve.
• Conversely, duty-bearers have a duty to
• provide justifications regarding their decisions
  and performance
• take corrective action in instances where public
  resources have not been used effectively to
  realise human rights and capabilities.

5
The Social Accountability System

6
PSAM Impact Health (1)

• Resource/budget allocation
• Data/Evidence Collection of publicly available
  budget information such as the budget speech,
  budget statements, business plans, and strategic
  plans.
• Output Production of a Budget Analysis (BA) and
  ad hoc reports on specific budget related issues.
• Advocacy Targets Distribute the BA and ad hoc
  reports to Eastern Cape Department of Health,
  Treasury, civil society and the media.
• Example of Impact The BA was used by the
  Department of Healths Integrated Budget Planning
  Unit in the development of the 2009/10 and
  2010/11 draft budgets.

7
PSAM Impact Health (2)

• Strategic Planning
• Data/ Evidence Collection of publicly available
  strategic planning documentation (1 year plan, 3
  year plan, 5 year plan and business plans)
• Output Strategic Plans evaluated against
  treasury templates, legislation, policy, and past
  performance. Production of a Strategic Plan
  Evaluation (SPE)
• Advocacy Targets The Eastern Cape Department of
  Health, Treasury, oversight, civil society and
  the media.
• Example of Impact Eastern Cape Department of
  Health Strategic Planning Unit used the SPE in
  the development of the 2009/10 and 2010/11
  strategic plans and consulted with the PSAM on
  the development of the 2009/10 draft strategic
  plans.

8
PSAM Impact Health (3)

• Performance management
• 2003 95 million 5 year outsourcing contract for
  EMS despite this, reports of ambulances
  arriving late or not at all.
• Early 2004 PSAM requests SLA between EC Gov and
  FleetAfrica PAIA used. June 2004 PSAM given
  SLA.
• PSAM publicizes problems - 2000km/equipment
  servicing/excessive costs (25 million) for DoH
  alone for 5 years.
• Jan 2005 EC Gov announces review of contract.
  Mid-2005 contract renegotiated and was now
  beneficial to the government according to EC
  Gov.
• Successful litigation in 2003 for HIV/AIDS
  strategic plans.

9
PSAM Impact Health (4)

• Public Integrity Management
• May 2005 PSAM given information to show that 47
  of trips EMS helicopter Feb April 2005 for
  MECs.
• PSAM press release numerous radio and TV
  interviews undertaken.
• Decision taken by EXCO in EC Gov to ban MECs
  using EMS helicopters.
• Oversight
• The provincial portfolio committee on health used
  the SPE in its evaluation of the Departments
  strategic planning documentation for 2009.
• Pressured SCOPA into recommending disciplinary
  action be taken against HODs for breaches of
  public finance legislation.

10
The PSAM

• Produces evidence-based research outputs /
  opinion pieces / media commentary which empower
  citizens and partner civil society organisations
  to be better able to demand social accountability
  and realise their Constitutional rights to
  healthcare. Enables civil society to participate
  meaningfully in debates around budget priorities.
• Holds EC Gov accountable for the use of public
  resources and assists in entrenching
  transparency and accountability.
• Liaises with government (subject to limitations
  an oversight role) in areas where PSAM expertise
  can be of assistance strategic planning, budget
  analysis etc often speaks to capacity
  limitations within govt.
• Offers training courses in its social
  accountability methodology to civil society
  activists and members of oversight institutions
  via the Centre of Social Accountability.

11
Recent Advocacy Example

• 24 March 2010 Statement released by the PSAM and
  the TAC (example of partnership)
• Occupational Specific Dispensation additional
  salary payment to healthcare professionals to
  retain staff. Payments not properly budgeted for
  or planned for resulting in
• ARV stock-outs in the Free State province
  prolonged shortages of basic drugs.
• Eastern Cape will overspend its 2009/10 budget
  by 213 million because of a 21 overspend on
  staff.
• Eastern Cape budget for 2010/11 - 6 increase in
  salary costs will has result in 13 decrease in
  medical supplies. Similar reductions in
  infrastructure spending.
• Information sharing media networks
  grassroots