Description

The Lori Region of Armenia sits in the mountainous north of the country. Lori is known for its breathtaking medieval churches, stunning landscapes, and several famous poets and musicians. But Lori is also home to some of the most devastating poverty in the post-Soviet world, and is the Armenian region with the highest rate of child poverty.

Since 2008, World Vision Armenia has used the Citizen Voice and Action (CVA) approach to mobilize communities and monitor local services in its two Area Development Programmes (ADPs) in Lori and elsewhere.

CVA is a local level advocacy methodology that transforms and strengthens dialogue between communities and government in order to improve services like health and education that impact the daily lives of children and their families. Using a simple set of tools, citizens (children included) monitor the facilities in their communities, and measure the reality against government commitments. They join in solidarity with sympathetic civil servants and local government officials, and take action to improve crucial facilities like schools and clinics.

In Lori, the methodology has often exceeded expectations. For example, in Alaverdi ADP, the community had to identify new targets just two years into their implementation phase because they had already achieved all their objectives. Staff credit CVA.

Recently, ADP communities have begun to look beyond the services that exist at the local level. Using the data collected through the CVA process, World Vision staff, in collaboration with local Community Based Organizations (CBO) and ordinary citizens, formed a network. Together, they began to identify patterns of failure at clinics throughout Lori Region.

Perhaps the most pressing issue identified by the community network was the failure of family doctors to visit remote communities. The community’s CVA-driven research on entitlements had revealed that the doctors were required by law to visit each community each month. Steep mountains and the lack of transportation made doctors’ visits a matter of life or death at times.

World Vision worked with its partners to call a meeting among key stakeholders, including mayors, regional government representatives, central government representatives, clinic directors, several Ministry of Health representatives, and the media. Because CVA had already created a collaborative atmosphere, government participation levels were high. In total, approximately 60 to 70 people attended from across the region.

Many of the citizens who attended were very poor, yet made the long trip to the regional capital on their own account, motivated by the opportunity to solve problems collectively with their government. Few, if any, citizens had ever participated in a meeting like this before. The legacy of the Soviet system continues to discourage dialogue based on transparency, but CVA helps to challenge the past.

In September of last year, World Vision staff facilitated a review of the CVA process and revealed the communities’ findings. The first issue to be discussed was the rather delicate issue of rural medical care and the failure of doctors to visit the most remote communities. The regional representative of the Ministry of Health spoke up to challenge the community’s assertion. But a community network member stood up, rather nervously at first, and then explained exactly what the community had found as part of its monitoring process, and how it had come to the conclusion that this was a pattern. An employee of a local clinic stood and supported the community’s claim, and the Regional representative agreed to look into the problem and correct it.

Critically, it was the evidence base created by CVA that eventually defined the debate, and empowered the community to be persuasive in this forum.

After the meeting, the Regional Health Representative made good on his promise. He took two crucial steps that dramatically improved the primary health services throughout the rural villages of Lori region. First, the Regional Representative personally called each doctor and insisted that he or she make the required visits. Second, and perhaps more importantly, doctors’ pay is now directly correlated to the distances they travel, providing an incentive to visit the most distant (and often most impoverished) places.

Several other community concerns were advanced that day. For example,

• Despite community research which showed that the mortuary was required to pick up the deceased free of charge, this service was absent throughout Lori. The community network is collaborating with regional government to seek redress directly from the national Ministry of Health;

• The community network requested that ambulance services be provided, even to the most distant villages, in accordance with the law. The Regional Ministry of Health acknowledged the entitlement, and has committed to solving the problem;

• The Regional Health Ministry agreed to provide a nurse in the tiny, remote village of Small Ayram, in accordance with demographic requirements.

The community network’s advocacy continues. Inspired by their own success, the villages of Lori region continue to press for better government services. Their results go beyond health care, as well. Alaverdi ADP members recently successfully acquired a new kindergarten for their children as a result of the CVA process (see article “Schooling for the Future”). Now, the community network is working to persuade government to subsidize kindergartens across Lori region.