Building Accountable and Accessible Health Systems for Better Pandemic Response
On October 20th, we sat down to talk with three civil society experts involved in the COVID-19 Transparency and Accountability Project (CTAP) about their experiences implementing innovative approaches in to strengthen health systems in African countries: Nancy Saiboh the Program Lead at Actions for Development and Empowerment (ADE) from Cameroon; Dr. Angela Benson is the Deputy CEO and Co-Founder of the Benson Hospital in Monrovia, from Liberia; and Elhadj Amadou the BudgIT Senegal Country Lead (see their profiles at the end of the blog).
Courtney Tolmie – Senior Fellow from Results for Development – facilitated the conversation and shared more context on the recently launched report “Strengthening Pandemic Governance”. And a collaboration related to Global Integrity’s work with Transparency, Accountability Initiative (TAI) to evaluate COVID-19 trackers and tools, and reveal many lessons that can led to better service delivery in both emergency and non-emergency settings, here in this report and blog.
At the opening of the fireside chat, Courtney pointed out an inspiring message for all that it is forth to mentioning. “We’re able to use the pandemic as a catalyst to create mechanisms for accountability that will far outlast the pandemic and look at larger health systems that carry the potential to have impact outside of just the confines of COVID-19.”
The conversation focused on efforts to improve health outcomes and the undermining challenge of two embedded governance issues: widespread corruption and lack of trust in health institutions. Without a doubt, the emergence of COVID-19 revealed a myriad of ways in which governments, global health institutions, and the public were unprepared to fund and respond to a health emergency of such magnitude. This blog summarizes key lessons highlighted by the experts during the conversation on how to improve government response and enable advocacy by local communities.
Dealing with government response to health crises
The first part of the conversation focused on access to information and participation in public procurement. Since Ebola hit Liberia in 2014 and cholera broke out in Cameroon in 2018, Civil Society Organizations (CSOs) have observed highly centralized and bureaucratic government responses marred by corruption issues. COVID-19 was no exception. The response plans for social resilience to maintain jobs, allocate food, and roll out COVID-19 tests came out on time but the procurement information systems were not easy to use, lacked relevant information, and made it hard to track spending in the health sector.
In Senegal, after multi-actor coalition meetings and research on healthcare facilities and services, CSOs faced challenges of accessing information and highlighted that there was no instrument dedicated to track the spending within the health system. To address this challenge, they launched an observatory with health professionals, CSOs, union leaders, and journalists, to access more information, propose improvements, and demand accountability for health service delivery. Currently, 15 organizations, including grassroots ones, are focusing on transparency and advocacy strategies to engage with the President and the Commission of Health in the National Assembly to improve transparency and accountability.
“COVID-19 has shown some challenges. We have noticed that the health care system was not taken into account by our governors. It has shown all the problems that we had in the healthcare system. The research showed us the lack of accountability instruments in the health sector.” – Elhadj Amadou (Senegal)
In Senegal, after multi-actor coalition meetings and research on healthcare facilities and services, CSOs faced challenges of accessing information and highlighted that there was no instrument dedicated to track the spending within the health system. To address this challenge, they launched an observatory with health professionals, CSOs, union leaders, and journalists, to access more information, propose improvements, and demand accountability for health service delivery. Currently, 15 organizations, including grassroots ones, are focusing on transparency and advocacy strategies to engage with the President and the Commission of Health in the National Assembly to improve transparency and accountability.
The case of Liberia is similar. Access to health procurement information is limited, the system is highly centralized, and there has been poor accountability and participation. Budgit Liberia has used a bottom-up approach to address this situation, supporting town hall meetings across six counties and sharing recommendations from those meetings to improve health sector accountability and responsive service delivery.
“Community taking matters into their own hands at the onset of the pandemic when resources were scarce.” She also mentioned that the complexity of procurement systems decreases transparency and should be decentralized to be more transparent and have a “bottom-up” approach. “(…) There has to be more collaboration, more listening to each other.” – Dr. Angela Benson (Liberia)
The experience in Cameroon has been slightly different. The government learned from the previous cholera outbreak and created a multi-sector response to COVID-19, which included active resource mobilization that prioritized identified needs that help improve responsiveness. However, information about how the money of the Special National Solidarity Fund is being used has not been enough. To address this challenge, a collaborative approach has been used, similar to other partners. CTAP Cameroon has relied on multi-stakeholder research and oversight of resource utilization to propose recommendations to improve transparency and accountability and increase government responsiveness to the needs of the citizens. Some changes have occurred in purchasing decisions from district levels and in the reactivation of incident management systems, but there is still a long way to go until these changes work and bring improvements to service delivery.
“We (Civil Society Organizations) are advocating for the Information Act because we feel like it’s a better tool for our work. Constituents can contribute to advancing a better health agenda.” – Nancy Saiboh (Cameroon)
Lessons for pandemic response and preparedness
In the second part of the conversation, panelists discussed how their strategies are helping address some of the issues that undermine health systems and shared recommendations to improve countries’ preparedness for future health crises:
- More training spaces and sensibilization campaigns on the use of data to hold decision-makers accountable for the use of health resources.
- Bottom-up approaches to decentralize the procurement system all the way down. Participation can empower access to information and provide the government with feedback. Government can look at critical areas in the health system. This is why a commission on transparency, accountability, and participation can motivate more investigations.
- A multi-stakeholder platform can have a role in the enforcement of access to information law. This initiative will enable claims and push authorities to inform the general public.
- A multi-actor observatory can enable more investigation of the public health system. CSOs commit to looking into the management and financing of health centers, and their inputs about primary healthcare centers’ service delivery will be useful for advocacy.
- Countries’ National Preparedness Plans can help simulate activities to handle the next emergency. The plans can build a proper response to strengthen health systems and the delivery of services.
These lessons can be part of advocacy efforts aimed to decentralize procurement processes. Adaptive management can improve procurement policies, as well as develop inclusive approaches to consider stakeholders’ demands, including a more robust information center with an effective communication and feedback mechanism where the government, the constituents, and civic leaders can contribute to prevent current and future crises.
