This blog was written by So Yoon Sim (@YoonieSim), a graduate student at Johns Hopkins SAIS and Bloomberg School of Public Health and former Global Health Corps fellow. It summarizes Panel 3 from the GHLS 2015 Symposium titled Meaningful Accountability: Rethinking Roles and Responsibilities in the SDG Era.
Accountability has become part of our speech, but how to implement effective accountability mechanism is a whole different story. In the MDG era, voluntary commitments made by individual countries were not legally-binding nor enforceable, and the nature of joint commitments made it difficult to attribute outcomes to specific actors. The Sustainable Development Goals present an even more dynamic and challenging landscape, as they are based on multi-stake holder partnerships in support of 17 SDG goals and 169 targets. There is a goal for everyone, and we are facing a myriad of questions regarding many aspects that determine accountability—what gets done, who decides to do what, and how the impact is measured.
“Meaningful Accountability: Rethinking Roles and Responsibilities in the SDG Era” panel of the Landscape Symposium 2015 presented by the Global Health Council featured four leaders from public, private, and non-profit sectors and asked a critical question: how can we achieve meaningful accountability in the SDG era?
Here are three main takeaways from the panel:
1) Accountability does not mean a lot if we are not reaching the most remote and marginalized communities and improving their health outcomes
According to Jason Taylor Wright, Director of USAID LMG Project, the SDG era is characterized by desegregation of the data that enables decoupling of key populations that the aggregate data often overlooked. The dual role of civil society as a watchdog and implementer ensures that services reach the remote and marginalized communities, and civil society should play a critical role in encouraging conversation between different actors, not merely duplicating the existing power dynamics.
Nancy Wildfeir-Field, President of GBCHealth, said that legal ramifications often cause discomfort with the language of accountability. The private sector should rethink the notion of accountability and be alarmed by the consequences of “non-delivery” of services especially on maternal and child health. The next step is to work closely with civil society for effective delivery and use their core competency to build capacity within the community.
Ariel Frisancho, Country Director of CMMB Peru, said, “we cannot talk about rights-based approach if do not listen to the people.” People who are at the center of the services are often absent from priority settings and review process, and it is important to study multidimensional factors that prevent people from accessing health care and achieving universality in global health.
2) Measuring and addressing corruption is important
The moderator of panel, Jennifer Kates, Vice President and Director of Global Health and HIV Policy, Kaiser Family Foundation, asked a critical question about the reality of corruption. To what extent can we achieve accountability by (or without) looking at corruption?
According to Frisancho, almost 20 percent of public sector resources in Peru were lost because of corruption, and it is often difficult and challenging to address corruption. However, the first step is to recognize the problem and start talking about it, which should be backed by political support from the international community.
Some organizations came up with institutional mechanisms to address corruption issues. For example, The Global Funds to Fight AIDS, Tuberculosis, and Malaria, does not only reinforce the independence of the inspector general, but it also created a position called Chief Risk Officer as well as a fully outlined risk management framework to effectively respond to corruption and risk. In addition to organizational initiatives, collective corporate voice will incentivize many countries to take actions and reduce negative effects of corruption in the business environment.
Despite many challenges, it is also important to measure corruption. The USAID’s LMG project conducted an online Health Sector Corruption (HSC) survey in 2013 with more than 1000 frontline health managers and leaders working in more than 95 countries. Tackling corruption requires multi-sectorial and multidisciplinary approaches, and understanding how people experience corruption in the field will be a critical step to bring people to the process of achieving meaningful accountability.
3) Focus on what is working and capitalize on existing tools that have proved effective
In the past decade, there has been increasing civil society participation in priority settings and review processes. Civil Society Organizations were actively involved in the post-2015 consultation process, and they have become critical actors in the development and implementation of SDGs. The recent development is a succession of many successful examples from the past.
The Global Funds’ grant proposals are developed and overseen by Country Coordinating Mechanism (CCM) comprising representatives from government ministries, non-government organizations, the private sector, international partners, and people with the diseases. Wright said that CCM was symbolic at best in the beginning but it has grown to be an effective tool to strengthen local ownership and participatory decision-making.
Community of Practitioners on Accountability and Social Action in Health (COPASAH) is another example of effective community monitoring for accountability in the health sector. This movement was created by of a group of practitioners who believed that accountability is a missing piece for many of the health systems around the world, and it has expanded its base of community knowledge and capacity to Africa, Asia, and Latin America.
Each sector has a role to play in ensuring accountability, not for accountability’s sake but for accountability for greater impact. On the road to universality, effective accountability will enable the realization of our dreams and promises.