Health & Fitness

Social accountability evaluations key to effective health intervention programmes

Last week at the invitation of a coalition representing healthcare Civil Society Organisations, CSOs ,some health sector players in my county met.

Through the support of a local health NGO and the county health department we held deliberations on the need for social engagement by health programme implementers. What appears to arise from the meeting is that civil society organisations and advocacy groups sometimes feel sidelined as oversight partners.

This together with inadequate public engagement is a missing component in delivering aid funded health programme interventions.

Healthcare as a component of social services ranks amongst some of the highest aid recipients. HIV/AIDs, tuberculosis, water and sanitation as well as the emerging Health Systems Strengthening projects are some of the favourite funding areas.

The aid comes either as direct allocations of inter-governmental funds transfers, indirect grants or loans. But a significant chunk is outside these three classes and falls within grants to private entities and NGOs that competitively bid for them.

Most of the funds in this last group go to programme specific project interventions dictated by the granting body.

The supervisory oversight role for most of these channels is minimal once funds are released and seems to be part of the reason health CSOs are asking for some say on behalf of intended programme beneficiaries.

Perhaps due to the nature of the grant award conditions this may not always be possible because awardees are straight jacketed by award rules and conditions.

The operational independence is both good and bad. Good because it allows implementers to run projects independently and take responsibility for failures.

It is also bad because it sometimes means even those with unrealistic operational goals can still continue operating.

In support of grantees’ wishes to have as much independence as possible, are the hiccups arising from engaging with CSOs. Allowing too much external players’ roles can cause a project to become a cropper from the beginning.

Examples abound where CSOs create obstacles and sometimes introduce vested personal interests into the projects.

However the demand for more accountability by implementers of health systems is not without merit. Doctors on behalf of patients are also pressing for more details from the technocrats crafting and implementing these programmes. Do the target programmes work? How can we tell?

The need for participation of citizens from the project drafting, to implementation and exit is a necessary component of a good program. This engagement must also be across the entire project’s life cycle and not just one or two meetings.

At the root of the issue is distinction between who the “employer” is and whether grant funders are more important than the intended beneficiaries. The big question ought to be “Who are we working for?”.

A look across the scene suggests that more emphasis is placed at the funders wishes as opposed to the needs of the intended beneficiaries.

CSOs in particular can play a big role in the monitoring and evaluation of programs’ impact. Unfortunately many monitoring and evaluation (M &E) consultants have become infected with the accountants’ disease cooking financial books and painting rosy pictures even for institutions on their death beds.

For the right price it seems, your project will now get the exit report you desire from evaluation consultants. Maybe this is the reason why credible evaluation on impact assessment by CSOs is becoming more and more important for health intervention programmes and NGOs.

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