World Vision’s social accountability approach:

Citizen Voice and Action

Citizen Voice and Action (CVA) is a social accountability approach that promotes engagement between communities and government to improve health, education and other services. CVA has improved key social indicators and helped to strengthen health and education systems.

Key results

A 2011 Oxford University randomized control trial[1]of the CVA approach, which was applied in 100 Ugandan primary schools, found:

 o   A .19 standard deviation increase in test scores in the treatment communities using the CVA scorecard. This increase would move the average student from the 50th to the 58th percentile.

o   An 8-10% increase in pupil attendance in the treatment communities using the CVA scorecard.

o   A 13% reduction in teacher absenteeism

o   A 16% higher likelihood that communities would solve collective action problems.

o   The intervention was estimated to cost just $1.50 per student.

A similar randomized control trial of community monitoring of health clinics in 50 communities in Uganda[2] studied the impact of a methodology similar to CVA found:

o   a 33% drop in under-five mortality

o   a 20% increase in the utilization of outpatient services;

o   a 58% increase in the number of deliveries by skilled birth attendant deliveries;

o   The cost was estimated at roughly $300 per under-five death prevented.

How does Citizen Voice and Action work?

Citizen Voice and Action combines several elements of social accountability into one package.  This includes civic education, a community score card, a social audit, and an interface meeting which brings all stakeholders together, and community driven advocacy.

Civic education is provided about tangible rights to services under local law.  For example, communities learn about what the teacher-pupil ratio should be in their primary school, or how many midwives should be employed at their local clinic. Next, communities compare reality against these national government commitments.  Communities are also introduced to a scorecard that allows them to qualitatively rate the services of their local clinic or school against criteria that they themselves generate.  The results of these activities form the basis of an evidence-based dialogue meeting between communities, government, and service providers.  At this meeting, stakeholders commit to an action plan designed to improve the facilities, and monitor the implementation of this plan over time.

By ensuring the participation of all stakeholders, including local politicians and bureaucrats, CVA has acted, in the words of one chief medical officer, as a “quality audit system”. [3] This has helped the community, service staff, politicians and bureaucrats to respond to critical issues such as understaffing, absenteeism, lack of equipment and poor attitudes, which especially deter women seeking health services.

A critical success factor is the collective action CVA encourages.  CVA tends to broker partnerships among communities, local government, and service providers.  These actors unite to press sub-national government to perform better. District officials have conceded the collective pressure has influenced their decisions to recruit more staff, monitor equipment or ensure drug supplies do not run out. This collective pressure has been identified by the World Bank and others as one of the strongest determinants of effective service delivery. [4]

CVA local data used to influence sub national and national policy

As more communities implement CVA, the data generated through the process is aggregated and patterns identified.   This data provides an evidence base for civil society to advocate for changes to sub-national and national government policy and practice. For example, communities in Kenya came together to help reform the law governing local government’s use of MP discretionary funds. In Uganda, communities successfully lobbied for more teachers for an entire district. In Armenia, community lobbying led to reform of the pay structure of doctors to ensure mandated visits to rural clinics were undertaken. In response to CVA activities, the Zambian Government has promised to introduce a ban on cheap local alcohol affecting educational outcomes among both teachers and students.

CVA is a replicable approach used in 229 of World Vision’s long term development programmes in 34 countries in Asia, Africa and Latin America. Through research partnerships with the UK Department for International Development, Oxford University, Georgetown University, Columbia University, 3ie, AusAID, and independent academics, World Vision is expanding its understanding of social accountability’s impact on development outcomes.

For more information, please contact: cva@wvi.org