Description

Accompanying photographs - 1. The Batnes community now records basic community health and service indicators in the waiting room of the clinic. 2. CVA Facilitator with her children and the village head.

In the Indonesian village of Batnes, just a few miles from the border with East Timor, villagers are using Citizen Voice and Action to transform their local clinic. Community members monitor the performance of their health services, and press their government to fulfill its commitment to children's health.

But it wasn't always that way.

From 1966 until 1997, Indonesia was an authoritarian state, ruled by the government of (name) Suharto. "Challenging government was forbidden. Civic engagement simply did not exist. Even after the dictatorship ended, the low level of civic engagement has persisted." says Yuliana Opat. New, elected leaders and civil servants remained immune to the opinion of citizens. Even when government solicited the opinions of citizens, people were reluctant to respond.

Today, Citizen Voice and Action is helping to challenge this lack of accountability. The services at the Oeolo clinic in Batnes have dramatically improved – so much so that the clinic won a prize for the best service in the province. Oeolo clinic is now in the running for national recognition.

"Now people understand their rights and can remind government of their responsibilities," says Yuliana, a CVA facilitator from Batnes.

Using the "Citizen Voice and Action" approach, citizens begin by learning about their basic human rights, like the right to health. But they also learn how these abstract rights are articulated under their own local law. For example, under Indonesian law, each village is entitled to have a midwife at their clinic.

Next, communities work with government to measure whether their clinic is complies with these government standards. Communities also have the opportunity to generate their own criteria for good health services, and compare reality against that ideal. Finally, with this evidence in hand, communities convene a collaborative, town-hall style meeting where citizens have the opportunity to engage their governments, identify problems, and design a plan of action to improve their health services.

The community in Batnes followed this process. They also reinvigorated a local planning process called "Musrenbang". In Indonesia, the Musrenbang is a forum designed to solicit community input for government planning. In Batnes, the Musrenbang existed, but had little effect, because citizens did not have an organised way to present their petitions and challenge government's shortcomings.

Using "Citizen Voice and Action" the people of Batnes leveraged the Musrenbang process to greatly improve the quality of health care in their village. Through CVA, community members discovered that, under local law, their clinic should have a midwife, a doctor, and village ambulance service for patients. But these staff and services were absent prior to the CVA exercise. Equipment (such as scales, office supplies, notice boards, height measuring tools, chairs, desks) was also absent. The Batnes “clinic” was really no more than a couple of empty buildings. The community brought this evidence, and its impact upon them, to the attention of the government, using the Musrenbang forum.

A transformed clinic:

Today, after advocacy by the community, the government has fulfilled its commitments. A new doctor and midwife now serve children and their families. The clinic equipment has been delivered, and the ambulance delivers patients to the clinic from far flung rural areas. And, in response to a grave problem under weight and undernourished children, Community Health Workers now provide advice to parents to help them use local products to improve the nutrition of mothers and children.

Thanks to improved services, the community reports just 2 under-nourished children, down from 25 just 2 years ago.

The impact on children:

CVA facilitator Yuliana Opat has two children. Her oldest, Yova (now 7), was a baby, she needed regular treatment because of a rare infection. Because the clinic in Batnes was not functioning, Yuliana had to travel more than an hour from the nearest functional medical facilities, “We had to spend a lot of money just on accommodation and transportation,” says Yuliana. Prompted by this experience, and equipped with the CVA tools, Yuliana’s children can now count on local medical services just a short walk away. Yova says she wants to be a midwife when she grows up – perhaps inspired by the friendly staff at the Oeolo clinic.

Government supportive:

When asked, local government officials attribute the changes in Batnes to the "action plan" that the community developed during the Citizen Voice and Action process.

"Citizen Voice and Action has added value to our government system, especially health care," says Thomas Laka, head of the Oeolo clinic. "Community input provides a good control mechanism. Now, we have a better idea about what people need and where gaps exist".

Government officials and citizens may disagree on many things. But they are often united by a desire to see their children thrive. As in many other places where World Vision supports the Citizen Voice and Action approach, local government officials and community members often depend upon the same health services for the well-being of their children. In Batnes, the positive changes at Oeolo clinic benefit everyone.