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 Local PHC facilities have suffered from outdated procurement processes and delays in budget flows, which slow down repairs and investment in services.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.

 

Budget Trailblazers: Rommel Rodríguez and Jaime López

Budget Trailblazers: Rommel Rodríguez and Jaime López

Each month, we shine a spotlight on partners who are using budget advocacy to bring transformational change to their communities. This month, we talked with Rommel RodríguezMacroeconomics and Development Area Coordinator, and Jaime LópezTransparency Researcher, both from the National Development Foundation (FUNDE) in El Salvador.

Q: What is FUNDE’s area of work and main aims? 

A:  FUNDE has four areas of work: Macroeconomics and Development, Transparency, Citizen Security, and Territorial (urban, rural, and environmental) Development. Our mission is to work for a fair, open, supportive, and sustainable society. Our vision is to generate innovative thinking, proposals, and actions in the field of development. In 2008, we started to work more on fiscal affairs from a macroeconomic lens, and more recently we began to focus more of our work on engaging the broader public in how budgetary matters impact their lives. 

Q: How has been the partnership between FUNDE and the Central American Institute for Fiscal Studies (ICEFI)? 

A: In general, it is a relationship based on mutual consultation. There have also been opportunities to collectively host events or advocacy activities. For example, FUNDE, ICEFI and other organizations recently made a joint statement on the possible loan agreement between the IMF and El Salvador and the use of bitcoin in the country. We also work together to co-lead the Citizen Oversight Committee of the Legislative Assembly of El Salvador, which is playing a critical oversight role in monitoring public spending on COVID relief. 

Both organizations are part of the Global Initiative for Fiscal Transparency, the Latin American and Caribbean Tax Justice Network, and the Central American Tax Justice Network, and share an interest in promoting tax transparency and public participation in tax decisions. Together with eight other organizations from Central America, FUNDE and ICEFI recently created the Center Against Corruption and Impunity in the North of Central America, where we seek to address transparency and corruption in the governments of the Northern Triangle. 

Q: How did El Salvador score on IBP’s COVID study? What are your main impressions?    

A: The COVID study helped us think more systematically about financing for emergencies, in the context of the COVID-19 pandemic, and to use that process to highlight in very clear and discrete ways the processes that were followed as well as the lapses that occurred. For instance, government officials failed to follow the formal processes that exist for administering and authorizing the budget. We were able to highlight positive developments, such as the creation of the Citizen Oversight Committee in the legislature, as well as lapses, such as the fact that the government has not evaluated or published information on the impact of its relief package.  

In fact, to this day the government still has not produced a specific document that accurately details its 2020 spending on COVID-19 relief. A budget expenditure report is available, but not a specific document for pandemic-related spending. The Citizen Oversight Committee has been focused on getting this information. 

Although the creation of the Citizen Oversight Committee was a positive development, in practice some officials have been reluctant to provide timely and substantive information to the committee. This is happening despite the fact that the legislative decree that created the Committee allows for the committee to have unrestricted access to information and indicates that officials who fail to provide information should be sanctioned. 

Q: What recommendations do you have for the government of El Salvador to improve accountability for COVID-related expenses? 

A: After the initial lockdown, the government resumed monthly publications on its online portal, including for information regarding the execution and modification of the budget. The information is relevant but lacks detail; for example, it does not include the objective of specific expenditures. The information published on the government portal also lacks detail about the sources of financing, including tax or other contributions to the treasury, donations, external loans and financing, and the placement of securities, among other things.   

The Ministry of Finance claimed that urgency is the reason it did not introduce loans through the standard budget process, which would have meant requesting that the Legislative Branch approve the additional resources into budget line items. Instead, they introduced new funds into the budget through an Executive Agreement. Nevertheless, executive agreements to allocate funds and/or modify the budgets of public entities through the Official Gazette must also be made public, without exception. To date, several of them are not public.  

The public portal of Comprasal should be updated as soon as possible with information on COVID-related purchases. The Prevention and Mitigation of Disasters Fund and the Trust for the Economic Recovery of Salvadoran Companies, which is administered by the Development Bank of El Salvador, must also provide detailed information on their sources of financing, the distribution of funds, and the execution of expenses, as well as a public list of beneficiaries. This information must be made publicly available online. 

COVID-19 & Accountability in The Gambia

COVID-19 & Accountability in The Gambia

A public health emergency is testing whether Gambian civil society can keep tabs on the national budget 

The Start of a Change Agent

After decades of dictatorship, The Gambia had its first transfer of power by popular election in December 2016. This election brought hope, but unravelling decades of dictatorial rule has proven difficult. Government funds earmarked for public projects often end up in the hands of individuals with connections to politicians or used to benefit special interests.  

Ahead of the watershed 2016 election, Marr Nyang resigned from his job at a well-regarded law firm to embark on a grassroots voter education and engagement campaign. Following the campaign’s success, he established Gambia Participates as a civil society organization to bolster good governance.       

“I started Gambia Participates because I realized there were no organizations promoting fiscal transparency, doing anti-corruption work, or bringing the public into the fold,” Nyang said. “It was only done at the government level and inconsistently. I decided to start Gambia Participates in 2016 during that toxic political environment. After the change in government, I started pushing for fiscal discipline, transparency, and accountability. Fast forward and we’ve seen great improvements, but also have big challenges when it comes to the mismanagement of public wealth.”  

The organization works to ensure budget transparency and a budget that “reflects the needs and aspirations of the people,” as Marr puts it. They also monitor and hold the government accountable for how it spends the budget. Over time, they have successfully nudged the Gambian government, and the Ministry of Finance in particular, to improve governance standards and budgetary reporting.  

In December 2020, as part of its work to monitor and hold the government accountable, Gambia Participates sued the National Assembly for violating the budget process by forcefully inserting a US$1 million loan scheme for Members of Parliament in the 2021 budget. On 4 May 2021, the Supreme Court declared the move unconstitutional and the loan scheme was consequently removed from the enacted budget.  

 The Open Budget Survey as a Vehicle for Reform

The Open Budget Survey, published by the International Budget Partnership (IBP) in collaboration with partners in close to 120 countries around the world, helps local civil society assess and confer with their government on the reporting and use of public funds. The Gambia took part in the Open Budget Survey for the first time in 2019 thanks to Gambia Participates and its dynamic leader. 

Since the country took part in the survey, the government signalled a willingness to make its budget documents more transparent. For the first time, the Ministry of Finance published the Executive’s Budget Proposal (EBP) on time and well before the enacted budget was approved. The EBP is the national budget that is tabled before parliament and is widely considered to be the government’s most important annual economic policy statement. Timely publication of the EBP is critical, as it can enable the public and CSOs to make submissions on their needs and priorities to their elected representatives before the budget is approved into law. 

Prior to this, the EBP had only been made available in hard copy for the Ministry of Finance and National Assembly. By making the EBP and other such documents available to the public, the Gambia demonstrated its support for informed public debate on the budget. Furthermore, this is one of the key criteria used to assess and rank countries in the Open Budget Survey. The government also published the 2019 budget on the Ministry of Finance website for the first time.  

These are significant wins for the people of The Gambia and for advancing global transparency norms. “I believe the Open Budget Survey was a wake-up call for the government to acknowledge its weaknesses and work towards improving them by collaborating with civil society,” Marr said. “In partnership with IBP we realize it is important for there to be a standard roadmap to ensure increased budget transparency, citizen participation in the budget, and accountability around the budget process.”      

When COVID-19 hit, Gambia Participates leveraged the skills learnt from conducting the Open Budget Survey to analyze how COVID-19 emergency funds were being used and to hold the government accountable.  

 Pivoting during the Pandemic

The COVID-19 pandemic was the ultimate test of good governance in the country since the end of dictatorial rule. As the virus spread, the government created a $10 million emergency response fund to provide the medical sector with the tools to keep the pandemic under control. Gambia Participates leveraged the skills and knowledge obtained from its work on the Open Budget Survey to track where and how the emergency funds were being spent. 

As the investigation into COVID-19 spending unfolded, field workers from Gambia Participates began noticing a lack of personal protective equipment among frontline workers throughout the country. They also discovered hospitals in major population centers lacked basic items, like overhead thermometers. Frontline workers that Gambia Participates interviewed said funds had been mismanaged just as they had been during the Ebola crisis of 2014-16. 

Gambia Participates published an investigation titled “Corona, The Gambia, and the Millions,” in which it detailed the misappropriation of emergency funds. According to the investigation, only $3 million of the $10 million emergency fund had been spent. Moreover, much of the money that was spent had gone to “motor vehicles and hotels while treatment centers and isolation centers are in dilapidated conditions.”  

The Gambian Ministry of Health cooperated with the investigation and publicly reported that  the emergency funds had been spent on the procurement of medical equipment, the refurbishment of health facilities, as well as vehicles, training, and hotel accommodations for quarantined individuals. Field workers from Gambia Participates, however, painted a very different picture.  

Everywhere they visited, health workers and stakeholders complained of a lack of training on COVID-19 protocols; unfurnished isolation centers; inadequate sanitary materials; fraudulent names on the list of frontline workers eligible for hardship allowances; and, above all, a lack of preparedness. In the initial phases of the emergency response, there was no plan or budget in place to determine the actual expenditure of funds.  

Using the findings as a springboard, Gambia Participates offered policy reforms designed to prevent public sector corruption and strengthen the public finance sector and health facilities. While the Ministry of Health acknowledged the accusations of corruption and misuse of funds, it is yet to present solutions. 

Hard Work Remains

In January 2021, Gambia Participates, with support from IBP, held a workshop with key stakeholders from the Ministry of Finance, the National Assembly, civil society organizations, and the media to identify opportunities for improving fiscal transparency, budget oversight, and public participation in the national budget. Participants reviewed recommendations from the 2019 Open Budget Survey and reflected on gaps in the budget process that hindered the country’s performance.  

The outcome was a detailed roadmap that included a budget calendar to facilitate predictability and planning for the fiscal year. “When we designed the roadmap, each institution and stakeholder presented their challenges and opportunities, and then we discussed how to advocate for the roadmap to be part of the budget process,” Marr said. Gambia Participates sent the roadmap to the Ministry of Finance and the national audit office to ensure officials included it in their budget plans. All three stakeholders will hold discussions about how the government can start implementing the roadmap to fill in the gaps it has in budget transparency and public participation, and how Gambia Participates can collaborate with the government to implement the roadmap’s recommendations.  

The tide is starting to shift in The Gambia when it comes to public access to and scrutiny of budget decisions. Between Gambia Participates’ scrupulous work and the government’s willingness to improve, attention is focused on building long-term budget practices that will prepare the country for the next public health or other crisis.  

“The national budget is central to the socio-economic development of a country,” Nyang notes. “It is crucial for citizens to have a say in the budget process and to mainstream their priorities, which we continue to do at Gambia Participates by facilitating discussion between government officials and the electorate before and after the budget is approved.”  

With IBP’s support, the work carried out by Gambia Participates demonstrates that when civil society is properly equipped, open budget practices can be championed even during the immensely challenging conditions of a pandemic. When community-led organizations galvanize citizens to hold their governments accountable, the voices of those most in need are centered.  

This work forms part of IBP’s COAB initiative and is supported by the European Commission. 

Budget Trailblazers: Elena Calistru

Budget Trailblazers: Elena Calistru

In this section, we shine a spotlight on partners who are using budget advocacy to bring transformational change to their communities. This month, we talk with Elena Calistru, chair and founder of Funky Citizens, a Romanian-based NGO that builds research-based, data-driven advocacy tools. Funky Citizens was one of our research partners on the COVID-19 assessment.

Q: What inspired you to start working with budgets?

A: It was 2011 and I got a letter from the tax authorities demanding I pay extra money. And despite being a highly educated person who works in civil society, monitoring issues related to transparency, I couldn’t understand why I couldn’t find any publicly available information to help me understand why I owed this money. I ended up paying the tax without knowing why and promised myself that it would never happen to me again.

Together with people from various sectors, we started looking into government budgets. We went through thousands of tables, hundreds of PDFs, and made hundreds of public officials hate us with all the FOIA requests. But we managed to visualize data related to public budgets, sometimes did cooking shows just to explain budgets for the average citizens and worked with journalists to investigate government expenditures. Essentially, I took my vulnerability in the face of authority and decided to empower myself and others to understand where our tax money goes.

Q: What is Funky Citizens’ primary goals and mission?

A: Founded in 2012, Funky Citizens promotes active citizenship and encourages citizens to get involved in initiatives meant to make the state institutions more responsible. We often collaborate with investigative journalists, given our expertise on topics such as the judiciary, public administration and, of course, public budgets. We are well-versed in data-based advocacy, communication and civic education.

Q: What was the process you used for conducting research for the Open Budget Survey COVID study?

A: We had been following COVID-19 allocations even before we started working with IBP on the COVID module of the Open Budget Survey. IBP’s call for transparency in the COVID-19 response and relief expenditures hit close home for us and prompted us to look early on at what was happening on the legislative front. This made it relatively easy to have a good understanding of the larger context, but also to choose the package that was most relevant as a case study for how the Romanian authorities responded to the pandemic.

In the end, even though there are numerous measures that could have been analyzed, we decided on the package that was passed relatively early (a budget revision with numerous measures ranging from fiscal stimulus to unemployment benefits or social assistance to rapid funds allocation for hospitals to the wider healthcare response). Starting from that package, we investigated follow-up to these measures, complementary resources and any changes to the initial package.

Q: What challenges did you face in the research process?

A: As in most countries that were assessed in the study, Romania suffered from a lack of transparency in the emergency response. For example, as part of the state of emergency regulations, FOIA response times were doubled, and given the fact that the Romanian authorities did not provide any regular updates on COVID-19-related spending, these restrictions made data collection difficult.

Q: Why should the average citizen care about budgets?

A: In an ideal world, the average citizen shouldn’t care about budgets. They would get good public services, decent infrastructure and a great quality of life from their tax money. But I think it is obvious for everyone that we live in a far from ideal world so monitoring what is happening with the budgets is necessary in the face of misspending and sometimes rampant corruption, even during times of crisis. But what we should have is an awareness that the transparency of the budgets is essential. Citizens should be sensitive to any attempt to hide any information related to public expenditures, even if that means that the data released about such expenditures will only be “consumed” by some activist data geeks or investigative reporters. Citizens should be the allies of people engaged in this work that can “translate” for the wider public, so they understand what is happening with the taxes that they are paying.

Budget Trailblazers: Dr. Sandra Guzmán

Budget Trailblazers: Dr. Sandra Guzmán

In this section, we shine a spotlight on partners who are using budget advocacy to bring transformational change to their communities. This month, we talk with Dr. Sandra Guzmán, founder and global agenda coordinator at the Climate Finance Group for Latin America and the Caribbean. 

Q: How did you get involved in the environmental sector and climate change work? 

A: I studied international relationships to understand the best ways to collaborate among countries to face a global crisis such as hunger and poverty. However, while I was studying, I identified a significant threat for all of humanity related to the environment: climate change. I understood that climate change was a problem caused by human activities, especially in developed countries. I realized that while developing countries may not be the major emitters of greenhouse gases that caused climate change, these countries are following production patterns and consumption patterns that threaten the environment.  

Q: How did you come to realize the importance and intersection of climate change and budget work? 

A: After focusing my work on what is necessary to take developing countries down an alternative development path, I realized that the key problem is not always the existence of the necessary policies, but the lack of resources to implement them. This led me to start analyzing public budgets to understand to what extent these budgets were aligned to climate action. I concluded that there will not be a successful transition toward low carbon development if countries do not mainstream climate change in their planning and budgeting processes.  

Q: How was the Climate Finance Group for Latin America and the Caribbean started and what are you currently working on? 

A: In collaboration with friends and colleagues, we created the Climate Finance Group for Latin America and the Caribbean in 2012. After many years of work, including my doctoral studies, we launched a campaign called “Sustainable Finance for the Future: putting life at the center of investments and created the Sustainable Finance Index – a tool that tracks budget allocations related to climate change, as well as allocations to activities that are carbon-intense, to identify the gaps that exist between these two. Simultaneously, the tool also measures the type of sustainable revenue that comes to these countries from international sources and those revenues that are also carbon intense.  

Q: What are some of the findings you’ve discovered as a result of the Sustainable Finance Index? 

A: We applied this index to the 21 major greenhouse gases emitters in Latin America and the Caribbean and found that none of these countries spent more than 1% of their budgets on sustainable matters in 2019. We also learned that they spent 6.5% of their budget in the energy sector, with 60.3% of that budget going to the production of hydrocarbons, while only spending 0.3% on renewable energy. While this is not good news, this information allows us to highlight these gaps and provide recommendations to structurally transform these governments and get them on a path to incorporating climate change in their planning and budgets. 

Q: Why should the average citizen care about climate finance? 

A: There is no topic more relevant to citizens than public finance. We’re seeking greater public participation related to climate and sustainable finance, including public and private resources. We call on people to engage in this conversation toward transforming the financial system to ensure that present and future investments protect the environment and human rights.