Produced by the Indonesia Country Office.
Original story appeared here.
Maumere, Indonesia, October 16, 2015 – The voice of citizens can be a powerful tool to help ensure that public services are meeting standards.
Through the Global Partnership for Social Accountability (GPSA), the World Bank is supporting stronger citizen engagement in developing countries, so that projects live up to their objectives and improve people’s lives.
Striving for improved transparency, innovation, and citizen participation, the GPSA works with civil society groups to strengthen social accountability, by supporting their efforts to monitor outcomes of centrally funded programs such as healthcare services.
In 2013, the GPSA, in their first call of proposal to CSOs in countries including Indonesia, awarded a grant to Wahana Visi Indonesia to implement a program that will improve maternal and child healthcare in a number of areas of Nusa Tenggara Timur in Eastern Indonesia.
The GPSA Secretariat received as many as 216 proposals from all over the globe that year. Wahana Visi’s proposal was one among the dozen awarded to developing countries. The group proposed to look into the cause of the high maternal mortality rate in the Nusa Tenggara Timur province, and ways to solve the problem. The province is among those with the highest maternal mortality rates in the country.
Poor public services were one reason. Experiences like those of Natalia, a mother of three from Riit Village in Maumere, are not uncommon. “There were times when the village midwife was not available, or there were not enough medicine,” she said.
It is crucial for the village midwife to be always available, particularly for villages like Riit: isolated in the highlands with very poor roads. If a midwife is not present, women in labor have to travel hours to get to the nearestclinic, risking their lives and that of their child.
Encouraging citizen feedback for better health services
Wahana Visi’s program is being implemented in three districts of Nusa Tenggara Timur, serving approximately 52,000people. The program uses a method called “citizen voice and action” where community members serve as advocates for better healthcare services for mothers and children.
Lack of awareness has prevented communities from letting their local leaders know when public services are inadequate or unsatisfactory.
“Sometimes not all services offered are available at the health clinics. But most people don’t know that these services should be available, so they accept whatever are provided to them,” said Helianto Duarte Naru, who works as a facilitator for the program at Wuliwutik, a village renowned for their large statue of the Virgin Mary.
So facilitators routinely go out to communities and inform mothers like Natalia about the minimum of services and standards that must be made available at the clinics and health posts, as required by government regulations. These include the minimum number of health workers, their working hours and the types of services that should be provided.
Once communitieshave a better understanding about the standard of services, they fill out score cards to rate their experiences when receiving health-care.
“Sometimes people are reluctant to tell us directly,” said Nita village chief Antonius Luju. “The program’s score card has helped them be honest about how they feel and really show us what’s happening on the ground.”
In addition to inputs from the community’s score cards, facilitators also check each health facility to see whether they meet the minimum service standards. Once the score cards and findings by the facilitators are completed, they be presented to the government at higher levels, in order to advocate for better services.
Stronger voice brings change
The program started in 2014 and remains in its early stages, so the main goals have not yet been achieved. Nonetheless, changes are already visible–from simple results to others with bigger impact.
This is the hope of the GPSA: to give people like Natalia a more articulated voice, and to help local leaders like Antonius listen and act upon the feedback they receive.
Victorianus Suban from Nita Village are among those who have seen improvements in health services. “Health workers at the clinic used to start work at around 10 or 11am. Now, it’s 9am sharp,” said Suban, who often accompanies his wife on her visits to the clinic.
A local village government is allocating more budget for maternal health, following inputs from the community on its urgency. Many communities have complained that they cannot afford the delivery kits needed for safer childbirth. After the complaints, the village government decided to act.
“The village is taking the suggestions very seriously,” said Yasnita Fransiska, a midwife at Nita Village. “Mothers who go into labor have to buy a delivery kit. With inputs from the community, the village now shares half the cost.”
These early results demonstrate the potential of how citizen engagement can help provide better services for the public.