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Social Accountability Monitoring in the Health Sector

Social Accountability Monitoring in the Health Sector. Dr Neil Overy Public Service Accountability Monitor 29 March 2010. Background Context - South Africa’s Eastern Cape Province.

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Social Accountability Monitoring in the Health Sector

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  1. Social Accountability Monitoring in the Health Sector Dr Neil Overy Public Service Accountability Monitor 29 March 2010

  2. Background Context - South Africa’s Eastern Cape Province South African Constitution contains commitment to the progressive realisation of socio-economic rights within available resources, has excellent enabling legislation to ensure accountable use of resources. Yet: • 60% of EC population continue to live in poverty • 42 % of EC citizens are illiterate • 800 000 EC families are without proper housing

  3. Excellent legislative framework – but weak implementation • Highly centralised executive power, defensive ruling elite, weak oversight institutions, poor service delivery • Tendency to treat accountability as personal favour not a fundamental human right • Fragmentation of monitoring by civic actors, oversight bodies and officials

  4. The Right to Social Accountability • All persons have a fundamental right to obtain justifications and explanations for: • the allocation and use of public resources from duty-bearers entrusted with responsibility for these resources, (whether intergovernmental institutions, government officials or private service providers) and • the performance of duty-bearers in progressively realising the human rights of those they serve. • Conversely, duty-bearers have a duty to: • provide justifications regarding their decisions and performance • take corrective action in instances where public resources have not been used effectively to realise human rights and capabilities.

  5. The Social Accountability System

  6. PSAM Impact: Health (1) • Resource/budget allocation • Data/Evidence: Collection of publicly available budget information such as the budget speech, budget statements, business plans, and strategic plans. • Output: Production of a Budget Analysis (BA) and ad hoc reports on specific budget related issues. • Advocacy Targets: Distribute the BA and ad hoc reports to Eastern Cape Department of Health, Treasury, civil society and the media. • Example of Impact: The BA was used by the Department of Health’s Integrated Budget Planning Unit in the development of the 2009/10 and 2010/11 draft budgets.

  7. PSAM Impact: Health (2) • Strategic Planning • Data/ Evidence: Collection of publicly available strategic planning documentation (1 year plan, 3 year plan, 5 year plan and business plans) • Output: Strategic Plans evaluated against treasury templates, legislation, policy, and past performance. Production of a Strategic Plan Evaluation (SPE) • Advocacy Targets: The Eastern Cape Department of Health, Treasury, oversight, civil society and the media. • Example of Impact: Eastern Cape Department of Health Strategic Planning Unit used the SPE in the development of the 2009/10 and 2010/11 strategic plans and consulted with the PSAM on the development of the 2009/10 draft strategic plans.

  8. PSAM Impact: Health (3) Performance management 2003 $95 million 5 year outsourcing contract for EMS – despite this, reports of ambulances arriving late or not at all. Early 2004 PSAM requests SLA between EC Gov and FleetAfrica – PAIA used. June 2004 PSAM given SLA. PSAM publicizes problems - 2000km/equipment servicing/excessive costs ($25 million) for DoH alone for 5 years. Jan 2005 EC Gov announces review of contract. Mid-2005 contract renegotiated and was now ‘beneficial to the government’ according to EC Gov. Successful litigation in 2003 for HIV/AIDS strategic plans.

  9. PSAM Impact: Health (4) Public Integrity Management May 2005 PSAM given information to show that 47% of trips EMS helicopter Feb – April 2005 for MECs. PSAM press release – numerous radio and TV interviews undertaken. Decision taken by EXCO in EC Gov to ban MECs using EMS helicopters. Oversight The provincial portfolio committee on health used the SPE in its evaluation of the Department’s strategic planning documentation for 2009. Pressured SCOPA into recommending disciplinary action be taken against HODs for breaches of public finance legislation.

  10. The PSAM: • Produces evidence-based research outputs / opinion pieces / media commentary which empower citizens and partner civil society organisations to be better able to demand social accountability and realise their Constitutional rights to healthcare. Enables civil society to participate meaningfully in debates around budget priorities. • Holds EC Gov accountable for the use of public resources – and assists in entrenching transparency and accountability. • Liaises with government (subject to limitations – an oversight role) in areas where PSAM expertise can be of assistance – strategic planning, budget analysis etc – often speaks to capacity limitations within govt. • Offers training courses in its social accountability methodology to civil society activists and members of oversight institutions via the Centre of Social Accountability.

  11. Recent Advocacy Example 24 March 2010 Statement released by the PSAM and the TAC –(example of partnership) Occupational Specific Dispensation – additional salary payment to healthcare professionals to retain staff. Payments not properly budgeted for or planned for resulting in: ARV stock-outs in the Free State province – prolonged shortages of basic drugs. Eastern Cape – will overspend its 2009/10 budget by $213 million because of a 21% overspend on staff. Eastern Cape budget for 2010/11 - 6% increase in salary costs will has result in 13% decrease in medical supplies. Similar reductions in infrastructure spending. Information sharing – media – networks – grassroots …

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