Dear HDCA member,

Citizen accountability is a central component of human development. When accountability is

lacking, the door is open for public money to end in the pockets of corrupt officials, to be

wasted on projects of benefits to a few elite, or to be spent on areas that are not the priority for

those who lack the most elementary freedoms. Citizens need to able to monitor governments,

what they do and what they spend money on. This issue explores this core development issue,

but still under-researched, of citizen accountability.

We begin by reviewing the works of Harvard Professor of Ethics and Population Health,

Norman Daniels, on citizen accountability in healthy policy reform. He proposes benchmarks

to improve fairness and equity in health. We then look at how social accountability works in

practice in the health sector in Brazil. Monika Dowbor discusses how health has significantly

improved in Brazil through the social movement of healthcare professionals, known as the

sanitário movement, which aimed at increasing citizen accountability in the health sector.

Social accountability in India has also been greatly improved by a citizen initiative, the Right

to Information Act. Arnab Acharya and Suchi Pande document how people who were once

vulnerable to the arbitrariness of local governments are now able to demand information and

hold officials accountable to the public for what they do. They also draw on studies conducted

in Uganda where increased access to information has significantly improved schooling.

Anuradha Joshi explores further these issues of social accountability in the delivery of public

services and examines the different aspects of accountability and mechanisms, individual and

collective, for improving accountability in service delivery, especially towards the poorest.

Araddhya Mehtta offers an example from the ground to demonstrate that accountability

requires local involvement through common purpose that often stems from ongoing

relationship. We conclude with discussing the accountability situation in Africa where

corruption is still rampant. Dereje Alemayehu draws some connections between the nature of

the African state, its relations to foreign powers and accountability.

Maitreyee will from now on be issued twice a year. Our October 2010 Maitreyee will be on

the subject of religion. If you wish to contribute to the topic, or propose topics for further

issues, do not hesitate to contact us. We also welcome proposals for guest editions.

Arnab Acharya and Séverine Deneulin

E-mails: Arnab.Acharya@lshtm.ac.uk, s.deneulin@bath.ac.uk

M a i t r e y e e

E-Bulletin of the Human Development and Capability Association

Number 16, March 2010

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Fairness, efficiency and accountability in health policy reform:

Norman Daniels‘s works

1

Arnab Acharya

London School of Hygiene and Tropical Medicine

In the 1980s and 1990s health sector reforms in developing countries, mostly imposed as a

part of the process of structural adjustment of fiscal and monetary policy strongly promoted

by the International Monetary Fund and the World Bank, were not evidenced-based policy.

They carried important risks and the associated promised benefits were not founded on past

experiences from wide scale implementation or informative piloted experiments.

Untried and unproven policy implementation is analogous to the introduction of a newly

developed drug to a health care environment; and in the case of the policy environment most

likely larger risks indeed are being imposed on populations. Labelling of health system

reforms as ‘operations’ or ‘managerial prerogatives’ is misleading as it hides the experimental

factors of these reforms whose efficacy and safety may entirely be unknown outside of the

theoretical development of such policies, which usually requires the invocation of ceteris

paribus. When implementing health policy it is important to inquire whether the objectives of

the reform have appropriate ethical and scientific rationale. Reformers should make

transparent the ethical commitments that guide the key elements of policy reform. Further, the

moral legitimacy of the commitments must also undergo scrutiny.

Norman Daniels, setting aside the particularities of the process of assessment of scientific

rationale, develops a normative methodology for scrutinising policy, and, in particular, health

reforms. Varied concerns and interests need to be weighed against each other through

application of ethical principles supplemented with notions of efficiency. Efficiency should

be consistent with the larger goal of ensuring equality of opportunity. Daniels, assisted by a

varied set of researchers and public officials at different points in time and in different

countries, develops a set of Benchmarks of Fairness offered as an explicit framework for

assessing the goals and outcomes of reform. The Benchmarks address the fairness of a

system: that would treat some patients differently from others with similar needs, when some

needs are not met because of inefficiency and when people have no say as to how the system

treats them (JH, p. 269).

Importantly going beyond most notions of equity in health care, Daniels stresses that there

must be local weighting and balancing of values within a reform effort. There is further ‘a

range of fair ways to make reasonable trade offs among the central goals of a reform’ (JH, p.

270). When the Benchmarks are examined in detail, we find that they demand: reforms are

examined through an ethical framework; the rules by which trade offs in policy are made

should be fair and transparent; and implementation processes through which reforms are

imposed require democratic oversight. Below we detail the Benchmarks and then report on an

application.

The Benchmarks

The Benchmarks do have some relations to the general notion of accountability used in the

literature where accountability can be understood as oversight of government’s actions and

1

This section is a summary of Chapter 9 of Norman Daniels’ book Just Health: Meeting Health Needs Fairly.

Prof. Daniels, due to unforeseen reasons could not summarise his work on accountability in time for this issue. I

extend sincere apologies to Prof. Daniels and the reader for any misrepresentation and errors in reporting his

work. The book is referred to as JH in the text.

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answers to demands by an affected party in regards to information or justification for a

governmental body’s action. Apropos, these demands can be made on private institutions as

well. However, the Benchmarks proposed by Daniels can be seen as demands that health

reforms answer to certain moral conditions not just those justified through the constitutional

or, where applicable, market regulatory rules.

The Benchmarks should be used as the basis for the ethical and scientific review of social

experiments (or almost all untried and untested policies); the Benchmarks address three key

elements (stated verbatim from JH, p. 245): (1) An examination of the rationale for the goals

of the reform; (2) An assessment of whether the measures it includes are likely to achieve

those goals and what the risks are if they do not; (3) An evidence base emerging out of

ongoing monitoring and evaluation so that the reform can be modified if it does not meet

expectation or imposes unanticipated risks. These, of course, may not appear as greatly

different from most notions of accountability and can easily supplement or even definitionally

replace more clearly many notions of political accountability. One can understand (1) and (3)

as relevance and publicity conditions (see Daniels, 1998). The novelty and the force of

Daniels work perhaps stems from the way element (2) should be understood in terms of the

goals that a healthcare system seeks to achieve. The second element should be understood

through what Daniels develops (or has been involved in developing) as the Benchmarks of

Fairness; within this framework (3) can be seen as expansive form of democratic openness

through citizen monitoring.

The foundation of the Benchmarks of Fairness lies in Daniels notion of social obligation to

protect fair equality of opportunity. This obligation requires protection of normal physical and

mental functioning through societal effort commensurate with resources available to that

society. Both overcoming of illnesses and protection from illnesses are required under this

obligation, as good health is a crucial element in promoting and preserving equality of

opportunity. The Benchmarks can be divided into three groupings: equity, efficiency and

accountability.

There are nine elements to benchmarks and each serves to gauge the justness of the reform;

elements either centre on equity or serve to protect and promote equity. We discuss the list by

the above grouping and then discuss as to how they might be applied through some examples

that Daniels offers.

Health care must not be seen in isolation; the etiology of many illnesses may not always be

biological when social structures are taken into account. Reduction in poverty, gender and

other types of discriminations may reduce the incidence of many illnesses; intersectoral

features of governance such as just taxation, transportation, education and judicial structure

will impact health needs and therefore health status. The sectors should have, among the other

aims applicable to those sectors, the aim of promoting and protecting good health equitably.

More direct aspects regarding equity are those that concern access to health care. The

intersectoral Benchmarks and those associated with access directly protect equity in health

care delivery. The other Benchmarks, although they may serve some intrinsic aspects of

wellbeing, are necessary to ensure the Benchmarks necessary to guarantee equity in delivery.

Equity in access to care is realized when needs determine who gains access to health care.

Thus equity is achieved when income, social structure and even characteristics of the health

system such as availability of physicians are not the determining factors in obtaining care. An

instance of unavailability of physician that could entail unfairness in access would be the lack

of presence of female physicians in societies where women only wish to be seen by female

physicians. Equity in access entails the removal of financial and non-financial barriers. The

opportunity protecting motivation for health functioning gives guidance in defining needs,

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which in turn shape what the health system will view as health needs in order to guarantee

equity in access to health care. A comprehensive list of care, to be delivered through a basic

tier of health services, must protect normal health functioning.

Efficiency is achieved when a system does not waste resources and accommodates health

functioning as much as possible given a set of resources. With the duality of an optimization

process applicable, a health system with comparable resource inputs is more efficient if it

achieves a fair distribution (commensurate with equality of opportunity) of a better set of

health outcomes.

Definition of needs can conflict among people; such conflicts are to be resolved through

appeal to accountability for reasonableness in resource allocation decisions. Health care

provisioning will require fair process in limit setting as to what can be delivered. The process

must assure reasonableness in reaching agreements about limit setting. Four conditions are

required for accountability of reasonableness (Daniels, 1998): (1) publicity condition: the

rationale for a decision must be publically known; (2) Relevance condition: These rationales

must rest on evidence, reasons, and principles that all fair minded parties can agree are

relevant to deciding how to meet the needs of the affected population; (3) Appeals condition:

A mechanism of challenging the decision must be in place; (4) Enforcement Condition: There

is a regulatory process that ensures that the above three conditions are met.

Perhaps a broader justification of accountability is also applicable. It stems from the fact

health care affects any population in a fundamental way and those affected by it must

understand and have ultimate control over that system. Such control requires accountability of

reasonableness in the decision making process. ‘Ultimately, the [accountability] criteria

require a strengthening of civil society, so that people understand the problems and are

empowered to improve the health sector’ (JH, p261).

An application and concluding remarks

As already stated, the Benchmarks appearing in Just Health were developed with

collaborations from health professional in developing countries. Daniels and colleagues have

applied the Benchmarks to assess specific health system reform. The claims as to how well

they can be applied are although modest, they show that the Benchmarks can be applied. The

Benchmarks can serve to become a checklist for assessing equity, part of which involves

assessing citizen ownership of reform. A group of government officials and academics

focused on the Guatemalan decentralization of financing and policies toward improving

access to maternal health services. The group, through their analysis, identified as concerns:

non-financial barriers based on language; regional short falls in availability of health

professionals; and lack of matching of resources to needs. The problem of mismatch of

resource and needs was addressed through use of community volunteers who would be

trained to be the first point of contact for patients in the health service. The community

volunteers would assess community needs. The analysis found that the communities with

worse resource gaps were those that also had worse community involvement and were served

by fewer community-based health workers.

Norman Daniels’ approach advocates ethical concerns that can be incorporated into the

accountability process. It is also true that accountability itself is seen as part of the ethical

process through which we must deliver public service in an equitable way.

References

Daniels, Norman (2008). Just Health: Meeting Health Needs Fairly, New York: Cambridge University Press.

______ and Sabin, J. (1998) ‘The ethics of accountability in managed care reform’, Health Affairs, 17(3): 50-64.

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Introducing social accountability in the health sector in Brazil

Monika Dowbor

Brazilian Center of Analysis and Planning (CEBRAP), São Paulo

Democratic innovations through which representatives of diverse segments of civil society are

able to exercise social accountability over the executive power are part of the everyday life of

public policy in Brazil today. Present in most sectors, the most recurring institutional form to

be found are councils, which are installed within governmental agencies at the three federal

levels. The health sector pioneered this trend during the 70s and 80s. The motto at the time

was ‘participation of the community’ in the policy-making and implementation of services

and was, in principle, sponsored by the social movement of healthcare professionals, known

as the sanitário movement.

In 1988 community participation was included in the constitutional design of the sector,

which had just been reformulated, promoting free and universalized access to healthcare. In

the following decades this was institutionalised and the real power of social accountability

mechanisms in policy making continues to be an object of research. This article traces the

path of the sanitário movement, highlighting stance and actions which sought to increase

what we call today social accountability of healthcare policy.

The sanitário movement in Brazil was established during the 1970s, within Preventive

Medicine Departments. It gradually encompassed several healthcare professionals, organised

doctors, academics and the medical students – forming a movement of doctors and

intellectuals of liberal, socialist and communist backgrounds (Escorel et al. 2005; Barros

2002). This was guided by medical-social ideals and was defined by strong criticism of the

military regime’s health model seen as centralised, exclusionary, institutionally fragmented

and hospital-centric, with the private sector as the main provider of hospital-based medical

care. The movement participated in some projects and programmes of limited scope,

accumulating experience and widening membership. These actions were precursors for

reformist action in public health institutions.

The movement grew and strengthened around certain spaces and institutions. The first

significant common forum was the Community Health Studies Week held annually since

1975. The studies were not censored by the military regime and, thus it enabled discussion

and debate. From 1979, these activities of new research institutions became stronger. Among

these was the Brazilian Centre of Health Studies (Centro Brasileiro de Estudos da Saúde,

CEBES), established in 1976. CEBES played a key role in disseminating proposals and

promoting debate through its journal Saúde em Debate (Debating Health). By opening

regional cells throughout Brazil, CEBES became more broadly based. The Brasília cell, for

instance, worked closely with congressmen, which led, among others, to the National Health

Policy Symposia, where the movement presented and debated its reform proposals. Among

academic fora were the Brazilian Post-graduate Associations for Collective Health

(Associação Brasileira de Pós-graduação em Saúde Coletiva, ABRASCO), which was

founded in 1979 and was an important partner of CEBES, and the Social Medicine Institute at

the State University of Rio de Janeiro. In addition, the medical union movement became

active in organising professionals (Lima et al. 2005).

The choice for reformist action within state institutions driven by the military regime was not

the only trend in the sanitário movement, but it grew in importance when social issues were

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prioritised in 1975 by the government. The military regime created new institutions and

programmes, but lacked adequate personnel to fill these new spaces, which opened doors for

professionals committed to a public, universal and free access to health care (Escorel et al.

2005). A mutually helpful relationship was formed: progressive-minded professionals took on

government proposals in order to advance their own, contradicting the main model. The

regime itself took advantage of the development of progressive proposals, for its own

legitimisation or to implement administrative rationalisation measures (Arretche 2005). State

and municipal elections at the time were part legitimate and provided another mechanism

making it possible for reform-minded professionals to become leaders in the sector.

The movement’s members worked first in specific programs. By the end of the 1970s, its five

projects had been widely publicized among members as successful examples of implemented

healthcare services for the general population. The mobilisation and participation of the

community, which were fostered by the movement, was a distinctive aspect of these

initiatives. The action of santitaristas in São Paulo exemplifies the double strategy of the

movement. On the one hand, these doctors took on administrative leadership positions in the

regional healthcare units and on the other, they promoted the organisation of users and opened

communication channels at the highest levels of the sectorial leadership. Their work with the

communities resulted in the proposal to create community health councils, which was sent for

approval by the governor of São Paulo, passed and put into practice in 1979.

The implementation of the nationwide reformist program, in which participation was one of

the structuring axes, became possible when a financial crisis rocked the sector and questioned

the system of private providers. In order to interfere, the military regime, through the

President of the Republic, established the National Council of Social Security Health

Administration (Conselho Nacional de Administração da Saúde Previdenciária, CONASP),

comprised of representatives of the main sectoral actors: private health sector, techno-

bureaucracy and reformists (Cordeiro 1991). The Council prepared the Reorientation Plan for

Healthcare within Social Security. Known as the CONASP Plan, it acknowledged the

distortions in the health organisation model and set out 17 administrative rationalisation

measures aiming at remedying the situation by reducing costs (Barros 2002).

The CONASP Plan’s most important and lasting measures, however, were the Integrated

Health Actions (Ações Integradas de Saúde, AIS), which most clearly expressed the sanitário

movement’s proposals. In 1983, the AIS announced a complete reorganisation to healthcare,

with principles of universal access, decentralisation, community participation, regionalization,

the hierarchy of actions and greater participation by public providers (Escorel et al. 2005).

Implementation of the AIS was enabled by the 1982 election outcomes in municipal and state

governments, which brought to power parties opposing the military government. This led the

sanitário movement to intensify its strategy of occupying spaces in public institutions.

The AIS had already demonstrated the sanitário movement’s capacity to influence sectoral

policy, but Integrated Health Actions’ staggering growth occurred in the democratic transition

government that succeeded the military regime in 1985. For the health sector, the new

government’s policy was prepared in the 5

th

National Health Policy Symposium, based on

CEBES documents and reinforced the AIS strategy. In this phase, representatives from the

sanitário movement took key positions in the institutions in charge of health policy in the

country. This led to an increase in AIS’s implementation and to strengthening the actions’

guiding principles (Cohn and Elias 2005).

In terms of participation, the implementation of the AIS from 1983 to 1988 meant the

installation of levels of planning and administration in which different actors were united with

the objective of coordinating actions and redefining healthcare policies in their sphere of

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action. Federal and state commissions, the inter-ministerial Planning Commission and the

inter-institutional Health Commissions, respectively, had state representatives among their

members. Nonetheless regions and municipalities, the Regional and inter - institutional Health

Commissions and the Local and/or Municipal Health Commissions, included representatives

of the municipal secretaries of health, as well as contracted institutions, community

organizations and unions, representing the population (Tanaka et. al. 1992).

In addition to promoting the participation of the community as a principle and important

element of the programmatic actions implemented in the state, the movement's strategies

transcended state levels. Its operations consisted in the establishing and maintenance of

alliances among different branches of the movement and with other social movements and

political parties. On the one hand, the alliances had specific objectives that were linked to the

policy process. On the other hand, they mobilised actors around the sectoral policies, turning

them into potential participants of future spaces for social accountability. At the federal level,

the sanitário movement aggregated more and more local and regional actors to its project.

The 8

th

National Health Conference of 1986, a space that traditionally involved specialists of

the sector, brought users together for the first time and increased the number of participants.

The National Health Plenary, a pressure platform put into place by the sanitário movement in

Brasilia in 1987 during the process of formulating the new constitution, made use of the

strategy of mobilising popular healthcare movements, unions, local health councils,

universities, and political parties. For each strategic action, letters were sent to the members

of the Plenary in states and municipalities, indicating the agenda to be presented to the

political representatives

‘Participation of the community’ was passed in the Constitution in 1988 as one of the four

principles of the new healthcare system, along with universalization, being free of charge and

decentralization, and it was institutionalized in the form of councils. Its regulation in the

Organic Law was vetoed by the President of the Republic in 1991. However, this veto was

overturned through the broad mobilisation of the health movement, showing its robustness

and ability to mobilise. The setting up of the councils received a push in 1993 when a norm

issued by the Ministry of Health conditioned the transferring of resources to states and

municipalities to the councils being put into place. Three years later, nearly 63% of the

municipalities had adopted the new system, which meant the existence of councils, where the

representatives of civil society had at their disposal mechanism to hold accountable and

sanction the policy makers. By 2002, almost all of municipalities were part of the national

system (Arretche 2003).

The article has succinctly demonstrated the introduction of the spaces of social accountability

in the health sector in Brazil. The greatest advocate was the sanitário movement which,

through its reformist experiences across the nation while still under military rule, put

community participation into practice and provided institutionalized norms. The movement’s

organisational strategies and mobilisation activities also encouraged the participation of

diverse actors in the sectoral policy, who became involved in formal and nationally instituted

spaces of social accountability in the sector throughout the 1990s.

References

Arretche, M. (2005) ‘A Política da Política de Saúde no Brasil’, in N. Lima, S. Gerschman, F. Edler and J. M.

Suárez (eds), Saúde e Democracia: História e Perspectivas do SUS, Rio de Janeiro: Fiocruz

Arretche, Marta (2003) ‘Financiamento federal e gestão local de políticas sociais: o difícil equilíbrio entre

regulação, responsabilidade e autonomia’ Ciência e Saúde Coletiva 8(2)

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Barros, M. E. (2002) ‘Financiamento do Sistema de Saúde no Brasil: Marco Legal e Comportamento do Gasto’,

Projeto de Desenvolvimento de Sistemas e Serviços de Saúde 4, Brasília: Pan-American Health

Organization, Health Care Secretariat

Cohn, A. and P. Elias (eds) (2005) Descentralização e Saúde no Estado de São Paulo. As Articulações Entre as

Esferas do Governo, São Paulo: CEDEC

Escorel, S., D. Nascimento and F. Edler (2005) ‘As Origens da Reforma Sanitária’, in N. Lima, S. Gerschman,

F. Coelho Edler and J. M. Suárez (eds), Saúde e Democracia: História e Perspectivas do SUS, Rio de

Janeiro: Fiocruz

Lima, N., C. Fonseca and G. Hochman (2005) ‘A Saúde na Construção do Estado Nacional no Brasil: Reforma

Sanitária em Perspectiva Histórica’, in Nísia Trinidade Lima, Silvia Gerschman, Flavio Coelho Edler and

Julio Manuel

_ _ _ _ _ _ _ _ _ _ _ _

Information and demand-making by citizens

Arnab Acharya and Suchi Pande

London Institute for Hygiene and Tropical Medicine

Institute of Development Studies, Sussex

In the now classic study on causes of famine, Sen shows that democracies have not suffered

in the modern times from famine deaths. Information spread through free press about famine

deaths had been a vital part in preventing famine. In his recent work, Sen (2009) notes that

lack of information may have misled the government, so intent in hearing the rosy picture of

its successes, into engendering the catastrophic famine that China faced in the 1950s.

We highlight through examples some ways that information can be used to secure vital

services to the poor. We explain the role of the right to information law enacted in India, and

report results from two experiments to promote the use of information in ensuring educational

and health services to under-served groups.

The Right to Information Act

In October 2005, the Indian government, formed by United Progressive Alliance (UPA) and

led by Dr. Manmohan Singh as the prime minister, through the passage of the Right to

Information Act (RTI) made it obligatory for public officials to provide information and

public documents to any citizen who demands them at a nominal charge within a reasonable

period of time. Unusually, the Act has strong sanctions for non-compliance, including the

fining of public officials who fail to provide information on time. The RTI Act was welcomed

as ‘historic’ legislation - the first of its kind in independent India.

The Campaign for the RTI Act in India shows how innovative actions created spaces of

pressure in different areas of India’s federal system. The judiciary in the 1970s attempted to

harness the ‘right to know’ to the legally enforceable Fundamental Right to freedom of

speech and expression’. Gradually through the activities of environmental campaigners and

grassroots activists in the state of Rajasthan, the ‘right to information’ became a powerful

focus of a popular movement. The idea of information was successfully linked to livelihoods,

as well as to the ideal of a more substantial form of democracy which was far from the lived

experience of many poor, especially those living in the rural areas. Given the federalism

inherent in the Indian governance structure, critically for provisioning of basic goods, many

state governments took the initiatives to introduce transparency legislation which brought

about considerable leeway for individuals as well as organisations in being able to access

public documents that affected funding appropriations for public services.

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The passage in 2005 followed a decade long activism known as the RTI movement that

sought to make public document accessible to the public. The RTI movement had put a

number of activists in a position to seize a new moment of openness at the central government

by a party which professed a pro-poor manifesto. The result was the Right to Information Act,

one of the more robust pieces of transparency legislation in the world. The Act allows

individual and organisations to examine what legislations may have mandated in terms of

public services. Of course, not all exercises of this right would serve the poor as not all

legislation is pro-poor such as many zoning laws regarding housing.

There are growing areas for concern around bureaucratic and judicial foot-dragging, as well

as areas for optimism with the RTI Act being used for a variety of individual and collective

issues. However, with the continuation of UPA in power since the 2009 election, the

environment for making claims on this right is likely to be enabling until the next election

cycle. The challenge for the future is to make the legislation work, even if the space for

coordination between government and social activists changes or recedes at the central

government.

Two Experiments

Activities such as public expenditure review and expenditure tracking reveal what

governments allocate for different public provisions; such activities are a first step in ensuring

that funds are used for the purpose intended. Often these activities can be dated and much of

the information provided is highly aggregated making it difficult to ascertain who might be

the recipient of the funding allocation. It may be that greater scrutiny is needed in developing

countries where many of the recipients of public services are poor and service is delivered by

poorly paid bureaucrats who may lack proper incentives to provide quality service. Citizen

monitoring can enhance the access to public services by those who have little individual

power and lack access to alternatives to government services. Information provided to the

public is likely to be the first step in scrutinising the activities of public official. The

regulatory aspect of information can be stresses as evinced through two experiments in

information dissemination. We report on two such experiments from Uganda, conducted with

the help of World Bank.

Improve schooling through newspaper campaign

Capturing of public funds, aimed for service delivery, by bureaucrats is a persistent problem

in nearly all countries and imposes more severe consequences in developing countries. Free

press, when so permitted, can play an essential role in exposing neglect or malfeasance of

both public and private sectors. Public sector response is likely to be more precipitous than

that of the private sector, as reputation can affect the popularity and legitimacy of

governments. Reinkka and Svensson (2004) report on a newspaper campaign. A newspaper

campaign in Uganda aimed at reducing capture was put in place to report to parents and local

schools information regarding educational grants per pupil for supporting non-wage

expenditure within the schools. It was known that poorer communities suffered more from

capture of resources away from school usage than did the richer communities.

The campaign was a bottom up approach as the newspapers fed the information to the poor

themselves of the grants to which their schools were entitled. Under the newspaper campaign,

the public access to information was a powerful deterrent to capture funds at the local level.

Reinikka and Svensson (2004) showed that head teachers in schools nearer to newspaper

outlets (which engender greater newspaper circulation) had greater knowledge regarding their

entitlements. The correlation between non-wage spending and knowledge regarding funding

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accessed through newspapers was positive and statistically significant. School enrolment and

pupil test scores, which could be related to school quality, was positively correlated to

nearness to newspaper outlets.

Community-based monitoring

Bjorkman and Svensson (2009) again report from Uganda on a field experiment that

introduced community-based monitoring of health centres again. Researchers from

Stockholm University and the World Bank in cooperation with eighteen Ugandan community

based organisations (CBOs) designed and implanted a program to strengthen the availability

of information on community entitlements to health services and the status of its delivery.

In many developing countries local committees are supposed to be the link between facilities

that deliver essential services and the community. Such committees often are not functional

for various reasons, which include financial and local and broader political factors. The

intervention in Uganda involved CBOs making functional the already existing health unit

management committee (HUMC). The task of the HUMC is to monitor drug supply and other

facility activities and report to the community its entitlement along with helping to determine

what are reasonable demands to make from government providers who should deliver care

without charging patient fees. The intervention started with the assessment of the condition of

facilities at the baseline. It then focused in encouraging the community to make the HUMC

more functional and further helped develop a community plan that could be thought of as a

community contract to monitoring service at the facility. The community was more or less left

to organising its own method of monitoring. The researchers randomised this program into 25

sites and also studied 25 other sites that did not receive this particular assistantship. The

CBOs carried out their usual activities in both the intervention and the control districts.

The program results were assessed a year later. Data was collected to determine how the

community viewed the quality and efficacy of service delivery and impact in changes in care

as well as some health outcome. This small study showed that community participation in

oversight and monitoring of health centre performance, even without the ability to impose

punitive measures, can bring about improvement in public services. This field trial

demonstrated that lack of relevant information and opportunities of communities to come

together to agree upon reasonable demand making regarding service delivery may be holding

back more successful delivery of public services.

Both experiments exemplify that when allowed and encouraged citizens can exercise voice

and accountability to enhance the performance of the public sector and are able to access

essential services such as health and education.

Some observations

The present authors along with a team of researchers working in the slum regions of Sao

Paulo and Delhi have found presence of community-based organisations serving to address

problems that citizens in poor communities face in accessing mandated services. We observed

that in many instances when citizens do not receive legally mandated goods they do turn to

organisations that can follow up on bureaucratic failures or even bring legal actions where

failures may be purposeful or simply illegal. The authors did not have observations in time to

note improvements that can be attributed to activities of participatory community action. Most

likely cross-sectional observational studies will not confirm that in the areas where

participatory community action is observed are better served. In fact, it may be that under-

served communities may have the impetus to seek out avenues that engenders community

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action. Only longitudinal studies would yield information that can assess the performance of

community action.

Effective long lasting community activity is likely to be more organic than that could be

generated through simple five-day community intervention that is reported in the Ugandan

health centre study. The impact may disappear in time. CBOs played a role in kick-starting

the local activities. They may need continuous interventions along with some self-

mobilization.

Local community may need assistance from larger community of CBOs. The enabling

environment that is likely to aid the precipitation of community action is crucial. This

environment may have to be composed of activities at a national level to promote vigilance to

assure that pro-poor legislations are adopted. Such environment may require creation of

greater democratic space, if replicated across a county at a large scale may threaten repressive

governments; thus, one needs to go beyond local democracy. The Ugandan example of ability

of newspapers to report freely shortfalls in flows in appropriation of mandated resources

illustrates that when free to scrutinise government officials press can come to considerable aid

of the people to make demands even within the prescribed set of rules and regulation. The

acts such as RTI broaden the scope of scrutiny to a much larger scale. The deepening of

democracy to the sphere of citizen regulatory framework is central to making governments

accountable to upholding its own laws.

References

Bjorkman, M. and J. Svensson, (2009), ‘Power to the People: Evidence from a Randomized Experiment on

Community-Based Monitoring in Uganda’, Quarterly Journal of Economics, 124:2: 735-769.

Reinikka, R. and J. Svensson, (2009), ‘When is Community-Based Monitoring Effective? Evidence from a

Randomized Experiment in Primary Health in Uganda’, Journal of European Economic Association,

forthcoming.

Sen, Amartya, (2009), The Idea of Justice, London: Penguin Books.

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Social accountability in service delivery

Anuradha Joshi

Institute for Development Studies at Sussex

In recent years, accountability failures have been diagnosed as the key reason why public

services in developing countries continue to be poor. The World Development Report 2004

on Making Services Work for the Poor focussed exemplifies this focus on accountability. The

central argument is that accountability relationships between key stakeholders in service

delivery—citizens, policy makers and providers—are not transparent, formalised or effective.

This results in a whole host of problems that plague public services—inadequate spending,

skewing towards the rich, inadequate coverage for the poorest people, lack of resources at the

point of delivery, corruption, absenteeism of staff and ultimately, poor quality of services.

This focus on accountability is welcome. For improving basic services that meet the needs of

poor people, we need to ensure that their voices are taken into consideration in policy making

and implementation, and that providers of public services are accountable for the extent,

accessibility and quality of the services they provide. In this article we attempt to synthesise

the prevailing thinking.

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The central problem of accountability is an old one: how can we ensure that democratically

elected governments use resources they raise to provide appropriate basic services for the

poor? How can those who exercise public authority be made accountable to the people who

have granted them the power to act on their behalf? To place the issues in context, it is useful

to revisit how accountability is defined.

Foremost, accountability is a relationship between two parties: one who has granted authority

(accountee) to the other (account-holder) to act on their behalf. Literature identifies four parts

to the accountability relationship (Schedler 1999, Grant and Keohane 2005). First,

standards—form the content or substance of accountability—what is being accounted for.

Second, information is essential to establish how authority was exercised. Third, justification

by the account-provider is necessary to evaluate whether authority was used in a desired

manner. Finally, sanctions are essential if accountability is to have any teeth, i.e. make the

account provider likely to act in accordance with the wishes of the accountee.

Three accountability relationships are at issue (WDR 2004). First, governments need to adopt

policies that meet the needs of their citizens. Second, policy makers need to ensure that

providers of services (whether public agencies or non-state providers) are accountable for the

services they provide. Finally, citizens could hold providers directly accountable for services.

The first two relationships combined form the ‘long route’ of accountability between citizens

and providers, the third one forms the ‘short route’.

We know from the widespread failure of public services to deliver for the poor in the

developing world that the long route of accountability has not worked. Politicians have few

incentives to take service delivery outcomes into account in their political calculations.

Politicians do not take the state of service delivery into account in their political calculations.

There appear to be at least three reasons for this a) voters lack information of performance

and ability to attribute service delivery outcomes to particular politicians; b) continued

potential for mobilizing the electorate around identity based politics (e.g ethnicity, caste,

religion etc.) and; c) lack of credibility among the populace regarding political promises

(Keefer and Khemani 2003).

State-supported providers themselves have few incentives to respond to the constituency of

the poor. When states themselves are providers of services, the accountability relationship

breaks down, as the state is required to account to itself. Within state bureaucracies,

accountability relationships are focussed on processes rather than outcomes. Lack of

resources, combined with the relative power of the rich to skew resources in their favour leads

to low accountability. When the state supports non-state providers, it often does not have the

capacity or resources to monitor or sanction them for failures, particularly when non-state

providers are politically well connected. And non-state providers who are independent of the

state often operate in an unregulated environment, leading to the poor often paying more for

worse services.

As a result, recent literature has emphasised the ‘short route’ of accountability—making

service providers directly accountable to groups of poor people. Yet thinking on this issue has

taken two directions—those who emphasize accountability mechanisms inspired by New

Public Management that focus on the individual consumer and those that have emerged

through social movements and focus on collective action and citizens.

Individual consumer focussed mechanisms such as customer complaint hotlines, citizen

charters and single window cells are problematic for three reasons (Joshi 2008). First, by

focussing on people as consumers, they do not leave space for the claims of those that are not

served at all by providers. Second, despite the creation of direct mechanisms for reaching

providers, it is not clear why people would use them if they lack any mechanism for

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sanctioning non-responsiveness. Finally, we know that the poor in particular, are unlikely to

confront service providers as individuals, given the power differentials that exist between

them.

Collective action focussed accountability mechanisms, more generally called ‘social

accountability’ are more likely to be used by groups of poor people because they do not

require formalized structures; they operate on demand and are relatively accessible. Social

accountability essentially works by making state failures in meeting service obligations

public—thus imposing political and reputational costs on policy makers and providers. Three

strategies are often at the heart of social accountability efforts—social mobilization, media

exposure and public interest litigation (Perzzotti and Smulovitz 2006). Pressures generated

through social accountability can often trigger traditional accountability mechanisms.

Social accountability mechanisms are increasingly being used by groups representing poor

people to challenge poor services and make claims on states based on socio-economic rights.

For example, the use of citizen report cards in the use of public services is intended to shame

public agencies that score poorly. Social audits, and public hearings, that are informal audits

of how public money has been used, have been a tool for exposing corruption. Media

campaigns against hunger and starvation challenge policy makers to re-evaluate their policies

based on outcomes rather than processes.

What is interesting about social accountability mechanisms is that they often question the

‘public standards’ that are set by public policies. In this, they highlight frustration against not

simply implementation failures, but failures of public policies to be responsive to the needs of

citizens. For example, the Right to Food case in India, brought against the state by the

People’s Union for Civil Liberties, questioned the ‘morality’ of a policy that allowed

starvation of its citizens while it had tonnes of food grains stored in its go-downs (references).

Most formal accountability mechanisms do not tackle the ‘standard setting’ part of

accountability—they take them for granted as they are decided through other process—most

often in the legislature. However, by their very nature, social accountability mechanisms lack

implementable sanctions, or teeth. Those who are targets of social accountability strategies

are not required to act; it is assumed that the force of the media, public debate, reputational

damage and the triggering of social accountability mechanisms will have the intended effects.

In many countries where formal accountability mechanisms—voting, auditing, legislative

oversight, reporting systems—are weak, social accountability mechanisms represent an

important tool for activists and organizations interested in improving service delivery for the

poor. If we place faith in social accountability mechanisms to have impacts on public service

quality, then we need to understand the conditions under which groups representing the poor

emerge, gain capacity and engage in social accountability.

References

Schedler, A., (1999) ‘Conceptualising Accountability’, in A. Schedler, L. Diamond & M. F. Plattner (eds.), The

Self-Restraining State: Power and Accountability in New Democracies, London: Lynne Reinner.

Grant, Ruth and Keohane, Robert. (2005) ‘Accountability and Abuses of Power in World Politics’, American

Political Science Review, Vol. 99, No. 1: 29-43.

Keefer, P. and Khemani, S. (2004), ‘Why do the Poor Receive Poor Services?’, Economic and Political Weekly.

39(9).

Peruzzotti, E. and Smulovitz, C. (2006), ‘Social Accountability: An Introduction’, in E. Peruzotti and C.

Smulovitz (eds.), Enforcing the Rule of Law: Social Accountabilty in the new Latin American

Democracies. Pittsburg: University of Pittsburg Press.

Joshi, A. (2008), ‘Producing Social Accountability: The Impact of Service Delivery Reforms’, IDS Bulletin

38(6): 10-17.

Responsive governments and responsible citizens:

Accountability in the midday meal programme in Delhi

1

Araddhya Mehtta

Oxford Hub

This article briefly examines accountability issues in the midday meal (MDM) scheme in

Delhi, a key part of the central Government of India’s attempts to address children’s

malnourishment. The MDM scheme aims to deliver daily cooked meals to every child in

every Indian government primary school, and is currently the largest school-feeding

programme in the world (Mathur et al 2008). Despite variations in the design of the scheme,

the MDM is feted as an excellent programme for tackling problems of child nutrition and

school attendance throughout India (Focus Report 2006, Drèze et al 2003). However,

although the MDM’s overall effects are positive, implementation remains varied. For

example, within Delhi, children in some schools receive regular meals of a good quality,

while others receive meals irregularly, if at all, and quality varies widely (Samson et al 2005).

The Right to Food Campaign (RTFC) in India has been using a range of strategies to

pressurize for better implementation—however a full discussion of these is beyond the scope

of this article. Here, my discussion of the MDM in Delhi focuses on the question: How can

variations in the implementation of the midday meal scheme between schools be explained?

In Delhi, as elsewhere, there are problems in both delivery and distribution, which may or

may not be alleviated by increasing the MDM scheme’s budget. Why do these problems

exist? Caterers, unsurprisingly, often argue that the government is not paying the caterers

enough. The suggestion is that if the government, increased spending and provided adequate

funds for better kitchens, extra ingredients, transport facilities, and staff, delivery problems

could be eliminated (Samson et al 2005). Doubtless, more resources for caterers would

improve meal delivery. However, this alone will not ensure perfect implementation

everywhere. First, deliveries may still be late, inadequate, poor quality, or absent, as at

present (Jha 2005). Second, once food has been delivered to schools, not all the food is

always distributed to children.

My research in two schools in Delhi suggests that instead of increasing the programme’s

budget, improving accountability at many different levels is required to make significant

improvements in the functioning of the MDM scheme. Most attention to date has been at the

macro level—in the relationship between providers, government and citizens. At the macro

level, caterers need to be accountable to the government for delivering meals, and the

government needs to be accountable to citizens for managing the caterers. ‘Accountable’ in

the MDM scheme means that if caterers do not deliver adequate quantities and qualities of

food on time, the government and the people will be aware of this and can punish the caterers

in some way, or seek compensation. As client, the government should impose sanctions on

caterers. But as the government is ultimately responsible to its citizens for the scheme, the

government is accountable to citizens for imposing sanctions and managing the caterers. Most

approaches to accountability have focused on this three-way relationship. No exception, the

Right to Food Campaign seeks to improve MDM implementation primarily by holding the

government accountable for the scheme and by pressurising the government to further

improve MDM delivery.

1

This paper is based on an MPhil Dissertation in Development Studies titled: “Responsive Governments and

Responsible Citizens: An integrated approach to exploring accountability in a school-feeding programme in

Delhi.” Oxford: Queen Elizabeth House.

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However, my research in two schools in Delhi, suggests that ‘micro-level’ accountability

relationships are equally important. In one of the two schools studied, the MDM scheme

worked well (i.e. children typically received food on a daily basis, either directly from the

MDM scheme or from replacement sources organised by parents and teachers). In the other,

the MDM scheme worked very poorly (i.e. delivery was erratic and there were no

replacement sources). Based on focus group discussions and interviews with teachers,

students and parents, the effectiveness of the MDM scheme seems not to depend solely on the

accountability relationships between the government and citizens. Rather, good

implementation depends very significantly on the level of (historically generated) social

cohesion (such as notions of trust and reciprocity) between parents, and between parents and

teachers. Fieldwork showed that the parent participation necessary to generate ‘micro-level’

accountability does not occur everywhere. Where such parent participation occurs, the MDM

scheme functions well, and where it does not, the scheme delivers poorer results.

Such participation prevailed in one of the schools studied: the Municipal Corporation of Delhi

school, where the parent community was cohesive, with established informal codes of

conduct that guided them to be responsible and accountable monitors. The school had two

distinct enabling features that created a sense of duty and joint responsibility among the

parents for the delivery of the meals. First, the parents shared a common history of collective

action while protesting against the demolition of their slums, which provided a foundation for

them to build a sense of togetherness. Second, most parents lived in the same geographical

area and therefore had opportunities to build sustainable relationships of trust and inter-

dependence. These factors enabled them to create their own norms of self-governance, to be

responsible monitors and to exemplify transformative accountability while monitoring the

delivery of the meals.

The other school—the New Delhi Municipal Corporation school—in contrast, had a number

of local accountability based problems that hampered the delivery of the meals to the

schoolchildren, despite the caterers delivering the meals to the school. Often the parents were

involved in selling ‘surplus’ meals and a large number of the parents refrained from engaging

in the monitoring committees for reasons ranging from a) unequal power dynamics among the

parents and between the teachers and the parents b) self-exclusion due to apathy and the lack

of a vision for a ‘common good’ and c) individualised notions of well-being where a majority

of the parents had devised individualised methods for coping with poor meal delivery. The

general lack of ‘togetherness’ and ‘citizen-citizen’ accountability was exacerbated by

dispersed living arrangements and a lack of a collective historical experience that could have

potentially brought the parents together.

Therefore, in order for ‘co-governance for accountability’ to work, citizens not only have to

participate but participate in a specific way: to participate to not only hold providers

accountable but also each other. The two school based case studies explored the centrality of

citizen-citizen accountability in delivering the meals. Citizen-citizen accountability implies

answerability and (informal) enforcement mechanism among the parent community. I

proposed that exercising such accountability is aided by a sense of ‘togetherness’ or ‘social

cohesion’ among the parent community, where informal codes of conduct guide parents’ roles

as responsible monitors.

Thus, I suggest that accountability at the macro-level needs to be reinforced by accountability

at the local, or micro level, where providers are held accountable by individual citizens/

recipients and where citizens (school parents) engage positively with the scheme. Parents

must participate actively in the monitoring committees, composed of teachers, parents,

community members and a local government official, that were set up by a 2006 Government

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Order to monitor the delivery and distribution of the food, and register complaints to the

government and caterers when food is below standard. I argue that scholars and practitioners

should pay more attention to these micro-level actions, to explain why parents engage

actively in holding caterers accountable only in some schools. The level of accountability

among citizens (parents) determines the extent of their participation and, to a large degree, the

success of the scheme. A notion of ‘citizen-citizen accountability’ could therefore usefully be

incorporated into current approaches to state and provider accountability. Building on the idea

of social cohesion (referring to reciprocity, trusteeship, obligation, solidarity and inter-

dependence), citizen-citizen accountability implies parents’ mutual answerability in fulfilling

obligations, and the imposition of (informal) sanctions in case of non-participation or

participation for private gain.

The focus on enhancing provider accountability therefore needs to be combined with efforts

to enhance citizen-citizen accountability; especially under the context of good governance,

with the changing role of the state – where ordinary citizens (along with NGOs and private

players) are being invited to shape the development processes that directly affect them

(Chandhoke 2003). For such new accountability and governance approaches, a re-

conceptualisation of accountability is required with a greater focus on citizen-citizen

accountability – which implies an increased emphasis on citizens’ duties, and not just their

rights. This argument warns against unquestioning approaches to ‘transferring the stick’ to

communities – not only because of unequal local power dynamics or problems of co-option

but because citizens – just as governments – can also act self-interestedly and not for their

shared benefit.

Although the focus of the research was on the MDM scheme, we can make some broad

generalizations about how the delivery of basic services can be improved through the creation

of stronger and more chains of accountability. I make two broad points on the role of ‘voice’

based accountability mechanisms. First, the ‘voice’ based social accountability mechanisms

have been successful in enhancing the delivery of the MDM scheme. Second, analysis of ‘co-

governance for accountability’ approaches highlight absences of citizen-citizen

accountability. These new approaches to accountability are crucial in bringing citizens to the

centre-stage of their own developments as agents of change as opposed to silent beneficiaries.

These new approaches to social accountability have thrown up new questions – who needs to

be accountable to whom in order for more effective delivery of services? I propose that a

greater emphasis needs to be given to accountability relationships among citizens while

monitoring the delivery of services. The nature of local relationships (whether citizens are

accountable to each other or not) has a profound impact on enhancing or obstructing the

delivery of basic services – including midday meals.

Accountability among citizens is crucial for a decentralised system of food production and

delivery to function effectively. Cultivating accountability between citizens is a historical

process, which requires communities to build norms of trust, solidarity and reciprocity

between them. Local norms of conduct are mechanisms for ensuring answerability and

enforcing sanctions when citizens violate codes of conduct. The question then arises how can

these local norms of conduct be built? What can policymakers do? How can policymakers

generate citizen-citizen accountability? Is it even their place to intervene?

These questions require further research and careful thought. Further research would reveal a

richer picture of processes that lead to the creation of citizen-citizen accountability. However,

it is clear that strengthening communities internally cannot be achieved simply through

specific policies. These processes evolve over time and reconfigure constantly depending

upon the local context and micro-relationships that form these local contexts. In this respect,

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development intervention can be more responsive to approaches that bolster the community

internally in order to create the social base for both self-governance and government

accountability. Perhaps a more allied approach is needed – one that includes government-

targeted social accountability along with citizen-citizen accountability.

References

Chandoke, N. 2003. Governance and the Pluralisation of the State: Implications for Democratic Citizenship.

Economic and Political Weekly. Vol. 38, No. 28. Pp. 2957-2968.

Drèze, J. and A. Goyal. 2003. “Future of Mid-day Meals.” Economic and Political Weekly. 1

st

November.

Focus Report, 2006. http://www.righttofoodindia.org/data/rtf06focusreportabridged.pdf.

Jha, P. 2005. “Guaranteeing Elementary Education.” Journal of South Asian Development. Vol. 2, No. 1. Pp.

75-105.

Mathur, P., S. Thomas and R. Chadha. 2008. “Third Party Evaluation of Mid-day Meal Programme in Delhi

Report.” Department of Food and Nutrition, Lady Irwin College, New Delhi.

Samson, M., A. De and C. Noronha. 2005. “Towards more Benefits from Delhi’s Mid-day Meal Scheme.”

CORD, October.

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General issues of accountability in Africa

Dereje Alemayehu

Christian Aid and Tax Justice Network

Accountability is a relational concept; in a broader sense it is about state-society relationship,

about relationship between duty bearers and right holders. For duty bearers, at the institutional

level it has a legal, political and ethical dimension. Legal: is dereliction of duty sanctioned?

Political: is there a political price to pay for omissions and commissions that impinge on

accountability? Finally ethical: do the prevailing norms and sense of duty within the

institution fulfil acceptable moral standards.

Enforcement of checks and balances, the incentive mechanism, the professional ethos of

individuals within the institutions determines ‘horizontal accountability’. Ensuring ‘vertical

accountability’ is more complex. On the side of right holders, the basic (but not necessarily

the simple) requirement is the awareness of the public about its right to hold duty bearers to

account. But awareness alone is not enough. It requires legal and organisational means to

make effective use of their entitlement.

The lack of accountability signifies impunity on the side of duty bearers and disempowerment

on the part of right holders. In the African context, at the risk of gross generalisation it can be

stated that the state-society relationship is still more characterised by the ‘impunity –

disempowerment’ equation rather than by accountability of duty bearers to right holders.

Most African societies were at different ‘pre-capitalist’ stages at the advent of colonialism.

Hardly any of the communities were engaged in surplus production, so there were no ‘ruling

classes’ to organise society with functionally differentiated institutions to facilitate continuous

production of surplus. Most of the countries in Sub-Saharan Africa thus had no experience in

statehood and nationhood before colonialism, thus, social organisation was not based on

universal principles of accountability.

The origin of most African states is colonialism; the sate machinery was created to subjugate,

and not to serve society. Even municipalities were created not to collect garbage but to

conscript and oversee forced labour. Decolonisation and post-independence development has

more or less failed to fundamentally change the role and functions of change. The lack of

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indigenous roots at independence was by itself a formidable hindrance. The post

independence leadership was not able to transform the oppressive machinery into an

institution that serves society and subjugated population into citizens.

The short-lived post-independence euphoria was coupled with social development policies

with the state taking an active role not only to overcome underdevelopment, but also to

reduce poverty through social service provision. Significant, but as it proved to be, ephemeral,

achievements were also attained in some cases. However, the inherited colonial machinery

was more apt to serve the minority at the helm of power rather than society. The lack of

downward accountability made the state ‘privatisable’ such that the ruling elite could utilise it

to pursue its ‘collective strategy of private enrichment’ within an entrenched and pervasive

pyramidal patronage structure. Optimism of the population changed into disenchantment.

Euphoria of independence degenerated to rhetoric; idealistic leaders were replaced by/mutated

into self-seeking rulers.

The unravelling internal contradiction was compounded by the intervention of the neo-liberal

paradigm, which under the guise of ‘structural adjustment programmes’ dominated

development policy in Africa for two long decades. It based its policy recommendations on

the dogma that ‘state failure is worse than market failure’. In effect, it denied that the

direction of development is determined by politics and not by economics; by states and not by

markets. Its ‘getting prices right’ thus got politics wrong It virtually wanted to get rid of the

state as if it is a disposable gadget to be thrown away if it does not fulfil its duty. It

contributed to weakening already weak states; further de-legitimised states which already

lacked legitimacy; made undemocratic regimes more authoritarian. Additional sufferings of

the poor population, political legitimacy and accountability of states were the causalities of

this policy misadventure. Africa has yet to recover from the damage caused by this policy.

Since the end of the cold war Africa also ushered into the era of ‘multiparty democracy.

NGOs and CSO mushroomed. Structural Adjustment Programmes were by and large

discredited and replaced by ‘participatory poverty reduction strategies. Have all these

improved the situation of accountability? Unfortunately not much. For example, corruption

may be considered a major indicator of impunity. It is maybe the number one topic of

discussion in Kenya. It is also widely considered by many as the number one obstacle in the

fight against poverty and injustice. Yet the ruling elite with its ‘collective strategy of private

enrichment’ appears to be unimpressed by this. The patent public outrage has not yet matured

into a systematic struggle to combat and put an end to this systemic evil, or even ensure that it

is not practiced with impunity.

‘Electoral democracy’ has so far mostly meant ‘voting without choosing’. Usually ‘recycled’

potentates of old unique ruling parties have created their own political formations based on

patronage (usually ethnical) structures to compete for power. The ‘winner takes all’ outcome

of these ‘democratic elections’ has aggravated the inter-elite bickering; it has increased

instability by encouraging shifting alliances and changing sign-posts. It has led to a

permanent ‘election campaigning’ and thus ‘politicisation of society’ which very often leads

to polarisation of society (usually along ethnic lines); and not to ‘socialisation of politics’,

which would have implied issues-based debate and political competition based on societal

vision and programmes. Participation in policy processes is still formal; ownership of

development processes is still largely rhetoric. Donor conditionality still prevails. The erosion

of social capital is not yet checked: people look at the state with disdain. They refuse to

internalise norms, rules and regulations and abide by them. Obviously, this is not a conducive

political and social environment for accountability to prevail.

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Accountability cannot be taken out of the social context and addressed as an issue of

bureaucratic and technocratic efficiency. It should not be conceived as an outcome of

‘targeted interventions’ but as a societal norm that governs the relationship between rulers and

the ruled. The state and its institutions can rule accountably only if state – society relation is

based on a rights holder – duty bearer relationship. If this is not achieved in Africa, nothing

will be achieved. Trying to achieve any positive accountability change without transforming

the state-society relation is comparable to wasteful effort of painting a house on shaky

foundations which could collapse anytime.

As much as it requires the mobilisation of citizens to hold leaders to rule accountably,

accountability needs the commitment of the national leadership. Without a joint effort from

below and from above, it will remain an uphill struggle if at least part of the national

leadership is not committed to it, not only as a moral principle of governance, but also as a

means to ‘reconstruct’ state-society relationship which is a sin qua non to eradicate poverty.

Accountability should be perceived as part of an aspiration of the national leadership to

ensure an acceptable threshold of well-being for all sections of the population. The history of

all late developers shows that successful development has basically been a politically induced

process propelled by nationalism. Thus, the commitment of a national leadership for the

emergence of a responsible and responsive state is the other precondition for the prevalence

of accountability in Africa.

Civil society organisations can and should play a key role to bring about this change in state-

society relationship. Especially the so-called ‘developmental’ NGOs play an ambiguous role

in terms of the process of shaping a democratised state-society relationship. In their

developmental role they tend to replace the ‘failing state’ by engaging in service delivery. But

they need to recognise that CSO cannot replace the state. They can only de-responsibilise it.

In their advocacy role they tend to ‘represent’ society. This could also undermine the

emergence of legitimised representative structures in society (articulating the ‘voice of the

voiceless’ is another thing). Civil society organisations would play a better role if they

conceive themselves as facilitators of negotiations between society and state in the process of

making the latter more accountable.