COMEN: Communities achieve much-needed investments in Primary Health Care

COMEN: Communities achieve much-needed investments in Primary Health Care

 

The Primary Health Care (PHC) sector in Nigeria has suffered from chronic underinvestment since the 1980s, when primary health care was decentralized and handed over to local governments. Local PHC facilities have suffered from outdated procurement processes and delays in budget flows, which slow down repairs and investment in services. There has also been weak oversight and little opportunity for citizens to participate in decision-making about resourcing these facilities. Although many Nigerians rely on their local PHC facility for care, only 20% of the 30,000 facilities across the country are in working order.

 

With our support, Community Empowerment Network (COMEN) built the skills and coalition to get the Anambra state government to increase its 2020 budget health allocations by 6.4%. Their 2021 budget also centralized and increased allocations to the State Primary Healthcare Development Agency from 26.4 million in 2020 to 757.6 million naira. State officials also disbursed their 20% share (the federal government matches with the other 80%) of the Basic Health Care Provision Fund (BHCPF)1 to 175 PHC facilities for the first time. Anambra is now the leading state in Nigeria in accessing the BHCPF.

 

Background

 

Charity primary health care facility at Ezinifite community, Nnewi South Local Government Area, with worn-out mosquito nets.

COMEN is a large organization that helps 181 communities— over 6 million residents— to identify and prioritize development needs. SPARK’s strategy is to seek out groups that are already organizing and mobilizing around a service delivery issue. COMEN had been trying to influence community development priorities in Anambra state for a few years and in 2015 had managed to get community demands reflected in the budget but tangible changes in services were slow to materialize. We felt that by applying more rigorous budget analysis and advocacy tactics, COMEN could make further inroads in building the community’s influence over resource decisions.

 

Anambra has a poor track record of primary health care service delivery, as is the prevalent norm across Nigeria. Providers lack the capacity to provide basic care and clean water and basic sanitation to residents. PHC facilities are poorly staffed, have ageing infrastructure and equipment and lack supplies of essential drugs. We focused on what the community said was their top priority—access to clean water and sanitation— as our “entry point” to drive broader conversations around the need to invest in PHC facilities.

 

In 2015, Anambra’s State Government launched a program to rehabilitate 63 out of 326 PHC facilities annually. However, COMEN’s budget tracking with IBP revealed that PHC facilities had not received any funding from the federal health budget, state health budget or local government budgets in the 2020 and 2021 fiscal years. This underinvestment was not due to lack of revenue but poor budget execution (see graph 1). The state government succeeded in mobilizing and collecting 99.51% of its targeted revenue between 2015 and 2019. The problem was that these revenues were not allocated and spent effectively by the government to make good on its promises.

 

 

 

 

Path to COMEN’s results

We and our technical partners—Justice, Development and Peace Caritas, Nnewi (JDPC) and the African Centre for Leadership, Strategy and Development (Centre LSD)—helped COMEN to build budget analysis skills and forge relationships with local officials to demand that Anambra’s government adequately prioritize the PHC sector.

 

Joining of technical and political power

 
COMEN’s political influence as a well-organized network was already significant. What they lacked were budget and advocacy skills to address the bottlenecks that were keeping revenues from reaching their intended purpose. It was important for them to understand and map the actors, roles, institutions and contexts that influence budget decisions in the primary health care sector. COMEN had to be able to answer this question: If governments consistently made allocations for the PHC program, then why were the facilities in such a poor state?

 

We helped COMEN make the connection between public budgets and service delivery by understanding how resources flow to PHC facilities and how such resources are used to deliver services across facilities. Unpacking this process allowed us to identify what was keeping repairs and other services from being met. We leveraged our convening power to help COMEN build relationships with local and state officials that had a say in how PHC facilities were resourced. By understanding the political economy, and how to navigate it, COMEN was able to design more purposeful and focused campaigns.

 

 

Strengthening formal budget spaces

 

Strategic training on Charters of Demands in Idemili South community.

Many of Nigeria’s rural areas have town unions that convene community members and local officials to address needs and improve services. They do not, however, exist in all communities and, for the most part, have failed to help communities achieve the improvements they seek. Many communities had grown apathetic about the value of engaging with government because they were not seeing tangible results. They were organized but struggled to have the power and voice to seek change.

 

We had to counter this apathy and help communities understand how they could turn things around. We worked with COMEN to host participatory workshops through the town union structure. We educated residents about how to interpret and monitor budgets that matter most to them. With their newfound skills, these residents were able to speak up about their needs and to speak out against the failures of budget implementation. As a result, town unions transformed from spaces of tired apathy to ones of hope and action.

 

 

 

Generating and leveraging data to make demands

 

To gather data on the state of the PHC sector, COMEN visited and inspected 21 facilities late in 2019, with a specific focus on water and sanitation. They interviewed frontline workers and held discussions with community members to form an all-round view of what was needed both by patients and workers. We supported COMEN to research, analyze, package and use these facility assessments, and budget information, to drive change. By arming themselves with facts about the conditions of facilities and budget implications – facts which the government did not have – COMEN grew its reputation as a knowledgeable, credible and legitimate partner for local and state government. These new dynamics renewed hope in COMEN and community members after years of being ignored.

 

 

Building alliances

 

We also realized that data was not enough—we had to help COMEN navigate and transform relationships with officials and community leaders who had to take this data to drive constructive action. When COMEN initially tried to engage frontline service providers at PHC facilities they found resistance and they ultimately realized this was due to pressure providers were receiving from the Anambra State Primary Health Care Development Agency (ASPHCDA) to not share data. These efforts also strained the relationship between communities and frontline health workers who felt victimized.

 

COMEN worked to build trust and form coalitions with local actors, including traditional leaders, religious formations and civil society organizations—like the Idikacho Women in Governance (I-WIG) and the Anambra State Associations of Town Unions (ASATU)—who helped amplify community reach. They also forged ties with local officials like Ward Development Committees (WDCs), Water Sanitation and Hygiene Committees (WASHCOM), officers in charge of PHC facilities and local government health departments who helped them analyse service gaps across facilities and recommend strategies to improve them.

 

 

I am proud of leading members to advocate for Primary Health Care Centers, championing and defending civil society space and the formation of a partner network. Our partnership with the Justice Development and Peace Caritas helped us influence and improve Primary Health Care Center’s service delivery and provide the evidence needed for the #FixmyPHC campaign, which directly led to governments increasing money spent in Primary Health Care Centers.

 

– Ubagu Martha Amuche
A member of COMEN in the Ojoto community.

 

 

Formal and informal engagement and participation

 
We saw an opportunity to leverage the PHC assessments, and the inroads we had made through the town union structure to impact change. The Anambra State Government had created a Community Charters of Demands Desk within its Ministry of Economic Planning, Budget and Development, for communities to submit Charters of Demands on services and other community development priorities. This channel had not been utilized effectively because communities had lacked the skills to draft effective Charters. With support from us and our technical partners, COMEN worked with 12 focus communities to submit Community Charters of Demands. They also encouraged other communities to do so through the Anambra State Associations of Town Unions. In total, 57 communities submitted Community Charters of Demands for the 2020 fiscal year.

 

 

Communities should come together in their townhall meetings to prioritize what they would like to have in the annual budget, so it can be pushed to make sure that what they want is accommodated financially.

 

Mr. Arthur Iweanya
Director, Ministry of Economic Planning, Budget and Development Partners

 

 

Through the new alliances built and with clear community demands in hand, COMEN reached key government offices such as the ASPHCDA, the Anambra State Government Commissioner for Health, the Senior Special Assistant, the COVID response task force and the Ministry of Budget and Economic Planning. These officials could influence budget systems at PHC facilities and effectively monitor their service delivery. Increasingly, local officials are more willing to provide valuable information about PHC facilities. Through dialogue, frontline health workers also now understand the crucial role they play in strengthening the performance and accountability of local health care systems. As a result, they have applied pressure on ASPHCDA to improve health workers’ conditions.

 

COMEN’s engagement with relevant government institutions has given them access to decision-making spaces previously closed to them. COMEN are now part of annual budget bilateral forums in Anambra, where the executive presents budget proposals to civil society for feedback before they submit them to the legislature for appropriation.

 

Working with oversight institutions

 

At the height of the pandemic, COMEN tried to link their state campaign to a national health budget cut campaign. They sent position papers to National Assembly health committee members and Anambra state legislators. They participated in donor-led advocacy, such as an event organized by the UK Department for International Development. Though no concrete outcomes emerged, these efforts helped connect COMEN’s coalition to the national health budget debate. COMEN’s work with oversight institutions has been mostly reactive and represents an area for further investment.

 

 

Amplifying COMEN’s voice

 

Radio Program for COVID -19 Awareness at Anambra state Broadcasting Services Awka.

COMEN and partners embarked on two media campaigns to garner public and political attention. The first of the media campaigns was a 3-week series of radio and TV phone-in programs, featuring a representative from the ASPHCDA. These programs raised awareness about preventing the spread of COVID-19 and tied in the poor conditions of PHC facilities across Anambra leveraging the facility assessments. By putting government “on the spot,” COMEN and partners made a strong case to prioritize PHC facilities during the pandemic. This campaign was effective because the Anambra State Governor wanted to be seen to be a “champion of good health” during the pandemic.

 

 

 

 

 

COMEN’s main successes to date

 

As a result of COMEN’s budget advocacy and coalition-building, the Anambra State Government revised the 2020 health budget upwards from 4.7 billion to 5 billion naira (an increase of 6.4%) and reiterated its commitment to implement the program to rehabilitate PHC facilities and improve health services.

 

Anambra state officials also heeded COMEN’s and our recommendation to strategically centralize all allocations for PHC facilities to the agency that is best suited to manage the funds. In its draft 2021 budget, state officials moved all monies for repairing the facilities under the ASPHCDA, increasing its allocation from 26.4 million to 757.6 million naira. Because the funds are under the direct supervision of the agency responsible for repairing facilities, there are less opportunities for delayed funds, political patronage and waste to sidetrack these monies from being spent on what they were allocated for.

 

Finally, the state government yielded to pressure from COMEN and partners to disburse the BHCPF to PHC facilities. 175 out of 326 facilities in Anambra have successfully accessed the first disbursement tranche. 17 are from the campaign’s 21 focus facilities serving an estimated 91,000 people. Out of those 17, 15 have commenced renovation work, such as fixing taps and water systems. Because of our partnership, this is the first time the Anambra State Government has met the criteria for accessing the BHCPF and provided its 20% share of the Fund (the federal state provides the other 80%). Anambra State is now the leading state in Nigeria accessing the BHCPF.

 

 

Conclusion

 

Score card process in Charity PHC Nnewi South local government area.

By building mutual understanding and trust with health officials and budget decision-makers, we are finally seeing much-needed repairs to PHC facilities in Anambra. Beyond the immediate improvements, COMEN and the communities’ skills and government relationships have been permanently transformed. These transformations will prove invaluable going forward. They also provide lessons learned we are applying to scale up results beyond Anambra to Oyo state in 2021.

 

In 2021, COMEN and their civil society networks will monitor the implementation of the BHCPF and the 2020 Anambra state revised health budget allocations to the PHC sub-sector. They will collate this information to address budget implementation bottlenecks. They will also monitor the conditions of the PHC facilities every quarter through a community scorecard to document service improvements. This information will be used to engage relevant government actors at national and subnational level, who, in turn, will commit to keep improving PHC service delivery.

 

 

 

Footnotes:

Asivikelane: Helping South Africa’s informal settlement residents’ voices be heard

Asivikelane: Helping South Africa’s informal settlement residents’ voices be heard

 

The Asivikelane campaign was founded in early 2020 through a coalition formed by IBP South Africa and its partners – Afesis-corplan, CORC and Planact – in the face of the global COVID-19 pandemic. The coalition feared that the conditions in which informal residents live – very close quarters, with failures in adequate water, sanitation and refuse removal provision – were not being sufficiently addressed by the government and municipalities. While the government in general, and metropolitan governments in particular, have enough money available in their budgets to reduce poor service delivery in informal settlements, they do not allocate enough of this money to improving services and infrastructure in these poverty-stricken areas. IBP and coalition partners had worked together since 2018 to hold metropolitan governments accountable for improved service provision in five metropolitan municipalities using the power of evidence-informed advocacy with local governments. As the COVID-19 pandemic set in, Asivikelane was designed to mobilize informal settlement residents to monitor failures in the delivery of critical water, sanitation and refuse removal services; report those findings, notably through the media; and engage metro governments on the challenges and potential short-term and long-term solutions.

 

Asivikelane – which means “let’s protect one another” in Zulu – asks informal settlement volunteers to respond to questions regarding the quality of water, sanitation and waste management services over a seven-day recall. IBP South Africa then consolidates the answers and disseminates monthly results to bring problem areas to the attention of the relevant city agency and the public.

 

Since the campaign’s inception a little more than a year ago, the number of partners in the coalition has grown from three to 141; the number of municipalities monitored has increased from an initial five metro municipalities to eight metros and seven smaller municipalities; and the number of informal settlements represented through citizen monitoring has grown from an initial 65 to 275.

 

Through consistent monitoring of service delivery and holding the relevant municipalities and governments accountable, Asivikelane has contributed to large-scale improvements in informal settlement communities since its implementation in March 2020: 30 settlements (400,000 people) have access to improved water taps and tanks; 36 settlements (500,000 people) have access to safer and more hygienic sanitation facilities; and 18 settlements (250,000 people) have more regular refuse removal.

 

Furthermore, Asivikelane has built a network of 79 community leaders in participating informal settlements who have been empowered to campaign and advocate for improved service provision, armed with service failure information and insights, and connections to local decision-makers.

 

In late 2020 and early 2021, Asivikelane conducted budget analyses on the City of Cape Town, City of Johannesburg, Ekurhuleni, and eThekwini. In addition, the team wrote a general analysis with suggestions about how these municipalities can improve services to their informal settlements without breaking the bank. These types of analyses serve to underpin the Asivikelane campaign with evidence-informed budget advocacy for improved allocations to water and sanitation services in informal settlements.

 

 

Background

 

More than 5 million South Africans live in informal settlements. These sprawling, crowded communities frequently lack even the most basic of public services, such as clean toilets, running water and refuse removal. In fact, it is estimated that 43% of the total population of South Africa does not have access to clean water. In addition, within informal settlements communal toilets are often neglected and not regularly cleaned. Broken taps and blocked or broken toilets are the norm, and metros are generally slow to repair these. As a result, residents are left with fewer working taps and toilets, or in some cases none at all.

 

Most metros indicate that maintenance and repairs of basic services infrastructure is a “priority”, but recent comparative research has found that only six out of the 257 municipalities have spent adequately on repairs and maintenance over the 2016/17 – 2018/19 period. The lack of detailed budget information makes it difficult to evaluate whether the maintenance of taps and toilets in informal settlements is indeed being treated as important. This opaqueness makes it very difficult for the public and oversight actors to participate meaningfully in the local government budget process. What is clear is that the informal settlement share of budget allocations for the maintenance of taps and toilets is not sufficient, and more than 70% of residents reporting to Asivikelane have noted that it takes more than three months for anything to be fixed. Moreover, budget allocations currently prioritize slow, high-cost upgrades that only benefit a few settlements. Scaled interventions that also meet the basic services needs of a larger number of residents in the short term would be far better.

 

Prior to Asivikelane, IBP’s work focused on building the collective agency of informal settlement residents by promoting their participation in the planning and implementation of budgets for basic services. This work was done with support from its partners, Afesis-corplan, CORC and Planact. Planact has a solid reputation and base in the City of Johannesburg and Ekurhuleni; while Afesis-corplan is active in the Eastern Cape province, which covers metros like Nelson Mandela Bay. Meanwhile, CORC is an important partner that has prioritized mobilizing networks of informal settlement residents around issues such as land, evictions, informal settlement upgrading and basic services. By working together, this coalition can have a far wider reach across the nation and build on relationships with officials in certain target areas.

 

 

Path to Asivikelane’s results

 

Joining of technical and political power

 

Asivikelane builds on work carried out in 2018, when IBP South Africa and the Social Audit Network (SAN) partnered with Planact and 13 informal settlement communities in Ekurhuleni to conduct a social audit on the provision and maintenance of portable toilets. The audit mobilized the community as a whole, involving 20 000 residents as respondents, 157 community volunteers and seven ward councilors. The audit contributed substantial improvements to one of the city’s new contracts for the provision of good quality sanitation services.

 

In the same way that previous work by IBP and partners focused on mobilizing the collective power of informal settlement communities, Asivikelane also relies on informal settlement community volunteers to report and monitor sanitary conditions in the informal settlements in which they live on behalf of the communities they represent (between 1.5 million and 3 million people, as reliable informal settlement population estimates are hard to come by).

 

To reinforce this network of community members, Asivikelane developed a network of 63 community facilitators, of which half are women. The core function of these community facilitators is to help partners build the budget collective agency of informal settlement residents through a number of ways. They mobilize communities, particularly women and the differently-abled; assist in the identification of stakeholders in the communities; brief communities about who in government is responsible for basic services and how they may be reached; inform communities about what level of basic services should be provided to them; report to our partners about the state of basic services and improvements that have been made; liaise with and rally communities around formal participation processes like Integrated Development Plans and budget submissions; participate in and provide feedback to communities about the outcomes of engagements with the government; and coordinate the collection of stories (sometimes writing them up), videos or photos from the community in order to gather more evidence of the sanitation challenges faced in the community.

 

The number of residents and informal settlements taking part in Asivikelane’s service monitoring is constantly increasing (from an initial 65 to 258 informal settlements at the peak of the campaign in 2020). This is in large part due to excellent collaboration with partner CSOs and the reach they have in these communities. By mobilizing members of the community to become engaged in the process of holding the government accountable for its failures in providing adequate basic services, Asivikelane has helped informal settlement residents find their voice and achieve real change that has affected the lives of millions of individuals. Within the first weeks of Asivikelane’s launch, metros committed to improving water, sanitation and waste management service delivery and quickly acted on their commitments, installing new water tanks and taps and addressing water shortages in cities such as Cape Town, Tshwane, Ekurhuleni, eThekwini, or Buffalo City. In addition, some residents reported that more regular cleaning of communal toilets was taking place at their settlements and that protective gear was being distributed to janitors.

 

 

Building budget and political advocacy skills

 

Since the beginning of SPARK implementation, IBP South Africa has provided 160 instances of training, technical assistance and mentoring to seven partner organizations on SPARK strategy development and implementation, SPARK monitoring and evaluation, and engagements in relevant decision-making processes etc. Partners then further imparted knowledge and built the capacity of 876 informal settlement community members (including community facilitators) on budget and political advocacy.

 

In addition, two important learning events took place. The first occurred in July 2020 and was entitled ‘Building residents’ voice in Asivikelane: what have we learnt to date about deepening connections with communities and residents?’ The discussion brought to the surface several results from, and learning points about, what is working well in Asivikelane. We were able to determine that Asivikelane has strengthened connections between residents and community leaders within and across communities by providing accessible platforms for remote engagement; it has obtained and secured commitment from community respondents to stay engaged; it has given residents voice, which has raised hope and allowed space to raise other issues; and there are emerging signs that Asivikelane has helped create a dialogue between municipalities and informal settlements. This is significant as Asivikelane provides information that municipalities do not have and which they have no other means of accessing. It was also determined that in some cities the campaign is still viewed with suspicion and that traction is disappointing, a reminder that acceptance by residents is not automatic or necessarily continued. Asivikelane needs to up the ante in engaging residents in their responses and in closing the information loop back to them. It is crucial for residents to feel that they own the results and not that they are cogs in a wheel over which they have no control.

 

The second important learning event was on the subject of community engagement and occurred in October 2020. This event’s main function was to serve as an opportunity for partners to share their approach to community engagement and their strategies for building agency. Again, partners reflected on lessons learnt from the Asivikelane experience. They also discussed what would come next in terms of engagement and agency-building after COVID and a return to the ‘new normal’. Particular attention was given to the value of community facilitators and the impact their assistance has had so far on communities and the success of the project. Liaisons with individual informal settlement residents who volunteer their time, and sometimes their resources, to assist us in interacting with the communities in question form a core part of our partners’ activities. These community facilitators play a vital role in helping CSO partners build the budget collective agency of informal settlement residents.

 

 

Generating and leveraging data to support demands

 

As indicated above, a primary part of the campaign is collecting data from informal settlement volunteers regarding water, sanitation and refuse removal. At present, 1296 residents from 275 informal settlements are monitoring service delivery across eight metropolitan municipalities and seven smaller municipalities, and reporting these results back to Asivikelane. This data collection is vital in giving residents a voice. Data is published in the form of Asivikelane monthly releases, which are used to hold governments and municipalities to account by showing where they have fallen short, or alternately, where they have improved.

 

In addition, Asivikelane has also engaged in diagnostic work regarding the weaknesses in public finance management systems that cause the poor quality and quantity of services in informal settlements. This has primarily taken the form of budget analysis work that shows which budget shifts could help the government respond to the service delivery problems reported by Asivikelane. In the latter half of 2020, Asivikelane carried out budget analyses of the City of Johannesburg, City of Cape Town, eThekwini, and Ekurhuleni.

 

 

Multi-level engagement with government

 

The Asivikelane campaign was careful to take a multi-level approach to form affiliations with as many decision-makers and influential organizations as possible to build a strong network that could assist in bringing about change. These engagements were both formal and informal.

A particularly valuable aspect of Asivikelane’s formal engagements with the government has been the solidifying of their working relationship with the Auditor General of South Africa (AGSA). In 2018, IBP South Africa developed a Memorandum of Understanding with AGSA that is now being fully implemented through sending social audits and Asivikelane reports to AGSA once a month. They are then able to use this information to decide which aspects of municipal budgets and service delivery to audit. Asivikelane also meets regularly with senior managers of AGSA to discuss how the findings can be used.

 

Asivikelane’s work builds on a significant relationship that IBP South Africa developed with with the Extended Public Works Programme (EPWP) of the Department of Public Works. In 2019, the EPWP completed a strategy development process for Phase IV of their EPWP programme, of which social audits form a central part. After the department requested IBP South Africa’s support with developing an implementation plan, it accompanied IBP South Africa on site visits during the Kameeldrift social audit, and IBP South Africa provided the department with background documents and materials to help with its thinking. Subsequently, EPWP contracted IBP South Africa’s partner organization, Planact, to conduct social audits of EPWP projects at four sites.

 

 

I was previously afraid to talk to the municipality about the issues in my community. Asivikelane has encouraged me to not be lazy to engage and as a result, we have water and toilets in our community.

 

– Interviewee no. 3: Kanele Gova
Buffalo City Metropolitan Municipality – Emibhobheni, Dice Etwatwa

 

In fact, the responses from the government have been very positive, with the national Minister of Human Settlements requesting a briefing. In addition, many city governments have undertaken to fix the issues that have been identified by Asivikelane’s findings. They have requested that Asivikelane bring them these problems on a regular basis.

 

On an informal level, through careful and consistent relationship-building and by using the networks of all partners in the coalition, Asivikelane has been able to engage policy-makers to the point that the government has now become more receptive to engaging with civic organizations working on the plight of informal settlement residents. IBP South Africa and its partners went from having to work for months to obtain a meeting with the government to weekly meetings with various national and local governments. At present, Asivikelane is meeting regularly with metro and national government departments to facilitate government responses to Asivikelane results. In line with our goal of engaging residents in government budget decisions, we have worked with CSO partners to include residents in these meetings.

 

 

Engagement with the media

 

When the COVID-19 pandemic hit South Africa in March 2020, Asivikelane’s first response was to start working with a team of health professionals to identify hygiene practices that would help informal settlement residents avoid contracting the coronavirus. Asivikelane produced posters about these hygiene practices, distributing and displaying them widely, including via social media and WhatsApp. The immediate response to the posters was overwhelming. National, provincial and city government agencies endorsed and reprinted the poster – often asking to add their own logos. After many requests from CSOs and community members, Asivikelane translated the poster into 11 languages. In addition, Wagtale, the film production company with whom they collaborate, also turned English, isiZulu, Tshivenda, Xitsonga and isiXhosa versions of the pamphlet into film animations as part of their pro bono support of Asivikelane’s work. Such films are particularly helpful in spreading the message since online and social media content is often preferred in this format by younger generations, as well as by those with low levels of literacy.

 

In addition, Asivikelane and Wagtale have produced several short films about service delivery issues in informal settlements and budget allocation failures. These films, which were distributed through Asivikelane’s mailing list and social media, were also extremely successful in giving voice to informal settlement residents themselves and making their daily circumstances visible. Many metro and national government engagements came in the aftermath of the release of these films. Asivikelane also made small bandwidth versions available so their community network partners could distribute them amongst community members.

Asivikelane also shares its monthly results releases via social media and its mailing lists. Their social media strategy is to share a mix of the good and the bad. They identify hotspots and tag the relevant municipality, which has helped to put pressure on municipalities to address those problems. However, Asivikelane makes a point of posting good news stories too. This shows that they are not only focusing on the negative but also praising municipalities when there is progress. Municipalities have started to respond to these posts and taps and/or toilets have been fixed after social media posts were made.

 

Because of the impact that the Asivikelane campaign is having, it has also been reported on regularly in newspapers and on radio and television. Every time the campaign is mentioned, it reminds the wider public about the issues being faced by their informal settlement neighbors and helps to keep the importance of the campaign in the collective conscience of South Africans.

 

 

Asivikelane’s main successes to date

 

The vast extent of the impact that Asivikelane has had on the lives of informal settlement residents is evident. Seven metropolitan councils took action in response to CSO campaigns for improved services. Not only did access to water improve in at least 30 settlements, positively affecting the lives of at least 400 000 people, but sanitation also saw an improvement in 36 settlements, with the result that 500 000 people have better toilet facilities. Moreover, refuse removal was either introduced or increased in 18 settlements, impacting 250 000 people.

 

In addition, Asivikelane successfully assisted communities in metropolitan municipalities in obtaining relevant budget information, such as service delivery schedules and the names and numbers of government contact people during COVID-19. In 2020, four communities (BCM, City of Cape Town, eThekwini and Ekurhuleni) were able to access relevant budget information. Specifically, eThekwini provided Asivikelane with the names and numbers of their sanitation area engineers and BCM regularly gave their monthly COVID reports to Asivikelane partner, Afesis-corplan. These reports laid out their service delivery plans in response to the pandemic. Asivikelane received similar delivery schedules from the City of Cape Town, Ekurhuleni and eThekwini. In addition, the City of Cape Town made its entire COVID response available to Asivikelane partner, SASDI.

 

The metropolitan councils of the City of Cape Town, eThekwini, the City of Johannesburg, BCM, Tshwane, Nelson Mandela Bay and Ekurhuleni worked together with CSOs to improve service delivery. During the lockdown, IBP South Africa and its partners met with the metros multiple times per month to facilitate government responses to the Asivikelane campaign. Of particular significance is the fact that Asivikelane results have become a standing agenda item in the weekly COVID-19 meeting between metros, the National Treasury and the National Department of Human Settlements, and also in the weekly management meeting of the City of Cape Town’s Water and Sanitation Department. Asivikelane’s partner, Afesis-corplan, was also invited onto the COVID-19 command councils of the Eastern Cape Province and BCM.

 

Perhaps most significantly, Asivikelane has mobilized informal settlement residents so that there is now a firm cadre of community budget facilitators that is ever growing. These leaders have the potential to have long-lasting impacts on citizen mobilization in bringing about improved service delivery, as well as wide-reaching participatory budgeting processes.

 

 

Conclusion

 

While the COVID-19 pandemic will hopefully soon start to subside, the long-standing difficulties experienced by residents of informal settlements when it comes to the delivery of water, sanitation and refuse removal are bound to persist. So far, the effects of Asivikelane have been positive. Relationships between the coalition and decision-makers have improved, and those in positions of power are taking more time to listen to the requests of residents and to implement real changes. As long as residents continue to be mobilized and empowered to speak in an informed way about their needs, change will continue to improve the lives of millions of South African citizens who are so often forgotten.

 

Managing Covid Funds: the accountability gap

Managing Covid Funds: the accountability gap

Background

When the Covid pandemic broke in early 2020, there was near unanimous consent that a crisis of this magnitude required governments to act boldly and swiftly to meet the needs of their people. By the end of 2020, governments mobilized a staggering $14 trillion in fiscal policy responses of different types.

While welcoming these responses, a chorus of voices, including ours, urged governments to put in place the transparency and accountability arrangements necessary to ensure that the massive resources being mobilized did not go to waste. Responding to the crisis in an open and accountable manner was a way for governments to restore public trust and build back better.

Working with civil society researchers in 120 countries, we documented the introduction of almost 400 emergency fiscal policy packages from March to September 2020 and assessed the largest or most important of these packages in each country.

Findings

Our assessment shows that more than two-thirds of surveyed governments are falling short of managing their fiscal responses in a transparent and accountable manner, thereby jeopardizing the effectiveness and impact of their responses to the crisis (Table of Results).

These shortcuts and limitations are neither necessary nor inevitable. Many countries across regions and incomes have chosen a different path. An urgent and speedy response does not have to come at the expense of accountability. There are three key findings in our COVID accountability report.

1. Governments have failed to adopt key measures to enhance accountability that many voices had demanded when governments began to announce their relief packages.

  • Only in about a quarter of countries assessed were auditors able to produce and publish audit reports on Covid fiscal packages before the end of 2020.
  • About half of the governments surveyed published little information on the implementation of policy initiatives.
  • Approximately two thirds of surveyed countries failed to follow transparent procurement procedures.

Despite this, some countries have shown a different way is possible. For example:

  • Paraguay has a one-stop-shop site that publishes information on all pandemic-related procurement.
  • In Jamaica, the Auditor General published three concurrent audit reviews of the government’s cash transfer program, and the Ministry of Finance worked closely with the national audit office to follow up on audit recommendations.
  • Recognizing the disproportionate impact of the pandemic on women, Canada, the Philippines and Sweden published a Gender Impact Assessment of their COVID-19 response. And in Togo, in a short period of 10 days, the government established a transparent platform for a cash transfer program that prioritized women.

2. The role of legislatures has been limited during the pandemic.

In almost half the countries in our assessment, governments introduced fiscal policy measures through executive decrees, side-stepping normal legislative and approval processes and preventing public debate. Not surprisingly, countries that bypassed their legislatures were also generally less transparent in their Covid-related spending.

Again, some countries showed that a better way is possible. For example:

  • In Nepal, the Parliamentary Accounts Committee investigated irregularities in procuring medical equipment and supplies to hold to account those responsible for these failures.
  • In the Philippines, weekly reports on COVID-19 response actions are sent to a Joint Congressional Oversight Committee that oversees implementation.

3. Public participation in the formulation and execution of COVID policy responses is virtually non-existent.

This has not only excluded the public from having a voice in decisions on priority-setting during the pandemic but it has also deprived governments of inputs which could greatly improve the effectiveness of their actions. Only 10 out of 120 countries made any meaningful efforts at engaging with their populations in the design and oversight of relief monies.

Even as governments largely kept the public at bay, civil society groups have been active in mobilizing local communities and amplifying their needs to government. One of the most successful examples of civil society and government collaboration is the Asivikelane initiative in South Africa which is giving an active voice to informal settlement residents in major cities who are faced with severe basic service shortages during the crisis. Through targeted advocacy and campaigns, the initiative has already secured improved access to water, sanitation and waste removal services from municipal governments affecting more than one million people.

Going Forward

There are practical steps governments and donors can take to bolster accountability as part of the ongoing response and to build back better.

  • Governments can adopt reforms now such as publishing monthly progress report and disclosing procurement details in open formats. They can plus up resources for national auditors to conduct expedited audits and take remedial measures in response to their reports. They can take actions to restore legislative oversight. Further, they can also leverage existing mechanisms in the executive, legislatures and within national audit offices to facilitate citizen participation in the formulation, approval and execution of new Covid-related packages.
  • Over the long-term, governments can strengthen systems in the annual budget cycle to be better prepared for future crises. These include reforming legal and regulatory frameworks to clarify roles and responsibilities in areas such as procurement, oversight and participation. They can also integrate innovations that emerged from this crisis, such as providing user-centered information.
  • The international donor community can play an important role in advancing accountability norms in emergency spending. As part of their assistance, donors should urge and support country-led efforts to publish more information about what governments are spending and its impacts and to facilitate oversight by legislatures, auditors and citizens.

The COVID crisis is far from over. We must keep mobilizing resources for the global COVID response, including filling the funding gap for COVAX to ensure everyone has equitable access to vaccines. But if we are serious about equity and justice, we must simultaneously get serious about accountability. This is about ensuring assistance reaches those who need it most. When governments do not deliver as promised, underserved communities bear the brunt.

Budget Trailblazers: Rongai Leakwara

Budget Trailblazers: Rongai Leakwara

In this section, we shine a spotlight on partners who are using budget advocacy to bring transformational change to their communities. This month, we talked with Rongai Leakwara, a budget champion from one of the smallest and marginalized ethnic minority communities in Kenya, known as the Ilchamus community. 

Q: What inspired you to start working with budgets? 

A: I became involved in budget work to help my community better organize and engage in county budget making processes. As a person with a disability from the Ilchamus community, I became an active member of a support group for people with disabilities. It was through them that I was introduced to the Centre for Enhancing Democracy and Good Governance (CEDGG), a civil society group that works to empower vulnerable and marginalized citizens to engage with development and governance processes. CEDGG has truly played a big role in making me who I am today. Through CEDGG, I was able to learn about and engage in county budget processes to push for our community needs to be included in the county annual budgets.  

Q: What skills and tools have you learned from your partnership with IBP that has helped your budget work? 

A: I have learned about the county budget process such as the decisions that are being made, important dates in the process, the people involved and the role of citizens. I have also gained skills in analyzing budget documents, community organizing and facilitation of budget deliberations at the community level and engagement with government officials. More importantly, I have gained advocacy skills that have enabled me to engage government officials and follow up on their commitments to hold them accountable.  

Q: How has becoming a budget champion in your community changed your life? 

A: Being a community budget champion has raised my social status in the community and I am now recognized and respected in my community as a resource. Even men, who had previously looked down on women and people with disabilities, now call on me to educate them. For example, the Ilchamus Council of Elders has invited me to consult on their decision-making regarding development in our ward. In addition, government officials, media and research institutions reach out to me for my opinion on various development concerns within the Ilchamus community. In 2019, I was recognized and rewarded by the Baringo County government as a community heroine for championing for the rights of people with disabilities, women and the Ilchamus Community. However, what pleases me the most is when I see my community members accessing water, health and other services as a result of the budget advocacy work that I and my fellow budget champions have done.   

The Iingarua health center that Rongai has been advocating for more budget allocations to improve service delivery.

Q: Why is it important for women to have a voice in budget processes? 

 A: Women play key social roles at the family level ranging from overseeing health care for the family to ensuring water is available for the household. Women end up shouldering the many costs that come with health care needs such as travelling to health care clinics and the purchase of medicine. Therefore, if only men participate, they may not remember to prioritize water projects or health services since they do not appreciate the struggles we go through. When men and women participate, budget decisions are likely to be balanced. 

Q: Why should the average citizen care about budgets? 

A: We expect the government to implement development projects and improve services such as water and health services in our communities. But as a budget champion, I have come to learn that it is only through the budget that the government brings development to our community. We may continue complaining about poor services but unless they are factored in the budget, we may never see the improvements we want and need. Citizens also pay taxes which finance government activities, so we should care because it is about our money. 

In case you missed it: high-level panel on promoting equity and accountability in the COVID-19 response

In case you missed it: high-level panel on promoting equity and accountability in the COVID-19 response

On Dec. 16, 2020, the Finance Ministry of the Republic of Indonesia and IBP held a high-level, virtual panel, “Getting it Right: Promoting Equity and Accountability in the COVID-19 Response,” which focused on equity and accountability in emergency public spending and how we can strengthen the role of civil society in monitoring these expenditures. The event garnered international media coverage from major outlets in Indonesia and Kenya and more than 3,300 viewers from across Canada, Ghana, India, Indonesia, Italy, Mexico, Senegal, South Africa, Tajikistan, United Kingdom and the United States​.

Moderator Beena Pallical, General Secretary, National Campaign on Dalit Human Rights was joined by Gene Dodaro, Comptroller General, United States of America, Kristalina Georgieva, Managing Director, International Monetary Fund, Sri Mulyani Indrawati, Minister of Finance, Republic of Indonesia and Warren Krafchik, Executive Director, International Budget Partnership for a conversation on the choices governments make while channeling public resources to combat COVID-19 – choices that will determine how many lives are saved and how many people fall into poverty.

Understanding the role of citizens in promoting equitable taxation: A peek at upcoming IBP publications

Understanding the role of citizens in promoting equitable taxation: A peek at upcoming IBP publications

Even before the global pandemic, the international community was increasingly focused on domestic resource mobilization, as aid budgets were set to shrink while countries had affirmed ambitious targets in the Sustainable Development Goals. COVID has brought into even sharper relief the need to resource emergency responses and support aggregate demand. The fiscal costs of the current crisis require a mix of revenue sources, but ultimately will be paid for mainly with taxes.

Alongside the growing attention to taxation in general, interest in the role of civic actors in tax reform in low- and middle-income countries has also grown. This is due in part to a recognition that without a strong grass-roots voice in tax, some of the goals of progressive tax reform—such as equitable tax systems that are based on strong reciprocal ties between taxpayers and the state—may not be met. Civic actors have a vital role to play to ensure that tax systems are redistributive, and that tax compliance is part of a bargain in which citizens demand state performance and services in exchange. This is no easy task, as it means mobilizing the public to take on powerful interests that oppose progressive tax reform.

As part of IBP’s new Tax Equity Initiative, we have developed some resources to help civic actors deepen their engagement with tax reform and learn from each other.  We spent most of 2020 working on three exciting new projects:

  • A review that explores lessons for civic actors from the academic literature on the politics of tax reform. This project resulted in two publications: an extensive literature review paper and a much shorter guide for civic actors to reflect on the main findings from the literature review. Both were released Friday, October 9.
  • A global scan of the civil society tax field, in which we catalogued the major civil society organizations around the globe that are working on tax, the topics they are working on, their main approaches and the constraints that they face, among other things. Products include a summary paper with a broad overview of our findings, as well as a searchable online database that will be available to everyone, which will be published in early November.
  • The first ever set of in-depth case studies on how civic actors have engaged in tax reform, covering seven cases of CSO-led tax reform campaigns in Latin America, Africa and Asia. A synthesis of these cases, and short summaries of each, will be available later this year. In addition to highlighting emerging findings from across the case studies, this project will generate lessons for other civic actors interested in engaging with tax reforms.

Taken together, we think these products will fill a gap in our understanding of how civic actors can and do engage in tax reform.

Our review of the academic literature on the politics of tax reform surveys the literature on the political economy of domestic tax reform, with a focus on low- and middle-income countries. The review looks at the main players involved in the politics of tax reform, the way in which the substance of tax reform shapes political forces, and the process by which taxes are eventually reformed, including how the reforms are framed and understood.

Tax reform is fundamentally political. It is about governments and the bargains that governments strike with taxpayers over how much will be paid and in exchange for what. Of course, states do not bargain with an undifferentiated mass of taxpayers, but with an array of interests, including powerful business interests, donors and creditors, civic actors and individual taxpayers that may or may not be organized. These actors may react to tax reform in different ways depending on their interests and perceptions, including their views not only about the taxes themselves, but what those taxes will be used for.

The literature review demonstrates that while states may generally seek revenue, and business and other elites generally seek to avoid shouldering the burden of paying tax, there are important divisions within these actors and groups. For example, ministries of finance may seek greater revenues to support expenditure, manage debt repayment, and ensure overall fiscal balance. But they may also promote foreign investment and other specific economic activities. This can lead to the pursuit of tax exemptions or tax treaties that reduce revenue, bringing ministries of finance into potential conflict with revenue authorities.  Thus different parts of the state have divergent views on how much revenue to collect and how to use tax policy and administration to further their goals.

While business associations frequently oppose tax increases, they are also often divided over their interests. For example, formal sector business generally likes to see informal businesses enter into the tax net because they believe this leads to fairer competition. In Ghana, larger traders that were part of the Ghana Union of Traders’ Associations supported a turnover tax that brought smaller and more informal business into the tax net because it ensured fairer competition between these larger and smaller traders. Smaller firms may wish to see incentives or exemptions removed for larger firms for the same reason. These examples point to strategic opportunities for civic actors to exploit: opportunities to create alliances with state actors or powerful interests that may not typically be friendly to citizen agendas.

Tax reform is not only about fixed interests or incentives, but also about the way in which such reforms are structured and framed. Different ways of designing and talking about reform also matter. For example, when taxes are closely linked to popular expenditure programs, and when taxpayers trust the government to collect taxes fairly and use them for spending in the public interest, there may be more support for tax reform even from those who have to pay more. This suggests the importance of sound tax administration for tax policy: where there is high trust in tax authorities, there is likely to be more willingness to support progressive tax reform.

These points are just a taste of what is covered in the literature review paper. The shorter reflection paper is organized around guiding questions that civic actors can use to reflect on their strategies. We hope this is a useful starting point for supporting more and better civic engagement with tax, but we also want to hear from you! We know we are only beginning to scratch the surface of this exciting and dynamic field, and we want to keep improving the materials we are developing to make them more accurate, insightful and useful. So please: read and reflect, and also share your thoughts with us.