Mesfin Tekleab and Jessica Sinclair Taylor look at a Mwananchi case study from Ethiopia, and draw out some lessons for improving demand-side accountability at the local level.
Admitting a problem is the first step towards accountability and change. Developing countries face a number of challenges in delivering core services and the gap between policy and practice can leave communities ignored and marginalised.
This story comes from a Mwananchi project in Ethiopia, where a radio station used its status as an independent organisation to help create the space for health officials to acknowledge challenges in how health services are delivered and reduce conflict between health workers and local women.
The Mwananchi Lem Limat programme in Ethiopia is supporting Wolkite 89.2 FM Radio (WFMR), which aims to bridge the information communication gap between citizens and local government on public policies. As a media organization, WFMR was in a unique position to mediate between state officials and marginalized citizens to help create honest dialogue. When a disagreement between local women and health workers revealed shortcomings in the standard of care provided in the district, the radio station escalated the problem to the health department by inviting them to participate in a series of online forums.
WFMR focused on a core government initiative, the Health Extension (HE) programme of the prevention-based health policy, primarily aimed at rural women. The radio station wanted to investigate the extent to which the progamme was transparent to the media and to ordinary citizens, provide basic information to the target group, and provide opportunities for the groups to express their concerns.
WFMR began by gathering the opinions of local health extension workers and local women on the HE programme. In theory, the HE programme constitutes a package of 16 types of healthcare services that should be offered in a Kebele (the smallest spatial unit of formal administration in Ethiopia) by a Health Extension Worker at health post supplied with basic equipment and drugs.
The interviews revealed discrepancies between the health workers’ views on the delivery of services and those of the women interviewed. The health workers said basic services were in place and pointed to more advanced services such as birth delivery, child pneumonia and malaria. Local women, on the other hand, complained that they have never seen these services in their Kebeles, that there were drug shortages or that a health post is not yet constructed in their Kebeles at all. After the broadcasts, some women got in touch anonymously to complain of conflict with the health workers who blamed them for undermining their position.
The disagreements drew the attention of the Health Department, who contacted WFMR to demand that that radio programme was stopped because it was disrupting the HE programme, as well as complaining that it had been broadcast at all without the prior knowledge of the health department. The station manager responded firmly, saying the station was an independent institution meant to serve the public, with or without prior notification. To give the Health Department the opportunity to answer questions and explain the situation and the challenges facing health services in the district, WFMR decided to organise live forums between the department, the health workers and local women.
The officials attempted to stop the radio forum through the highest body of local government – the office of Guraghe Zone Administration. However, the administration office told the health department that WFMR is accountable directly to the regional state which is beyond its control. Hence, the department couldn’t avoid the media forum, and the discussion was recorded and aired to the public.
Prior to broadcasting the discussion, WFMR notified the public about the programme and the phone numbers available for audiences to express opinions and inquiries to the health department. When the discussion with the department was aired in three sessions, the department head was in the studio responding to public inquiries live.
The health department admitted the challenges facing the health extension programme and promised to rectify problems in the service delivery and implementation as soon as possible. Challenges acknowledged included a lack of knowledge and skills among health workers to deliver some of the more complex services, shortages of basic facilities and drugs across the entire region and shortages of ambulances meant to be kept on standby to transport women in labour to a health centre or hospital.
These discussions helped clear controversy about what the needs of the health service were, which the health workers had been trying to hide to defend themselves and the health department from accountability. By acknowledging the challenges, the health department also made itself responsible for addressing them and showed that it valued ordinary women’s voices just as highly as those of paid health workers.
What can we learn?
- Ongoing conversations allow more scope for development than one off forums: by gathering the perspectives of the health workers, women and health department officials over a period of several weeks, WFMR allowed time for debate to germinate and for people to feel they had an opportunity to express their views, which were then put to the head of the health department over three sessions.
- Political context is important: the radio station was in a unique position as a body which was not controlled at a local level, and so was able to avoid being suppressed by local officials, unlike local civil society organisations which would have been more easily controlled.
- Acknowledgement is the first step towards accountability: with the health department acknowledgment of critical issues facing the implementation of the health extension programme, WFMR and other civil society groups have the leverage they need to lobby for improvements.