Reflections from Rwanda: Accountability for high quality health services in the right places

By Nosipho Gwebu Storer, Technical Director/Deputy Chief of Party, Pact Swaziland

I landed in Kigali just after midnight. I was taken by the colourful lights that welcomed us to the cleanest city in Africa. The DPMI experience to me was one of many levels of learnings. I met graduate students and professionals who were all drawn to the course because of its offerings of contextual insight into development work. In this blog, I will share two insights that have left an imprint with me.

One key reflection that has stayed with me was the model of implementation used by Partners in Health (PIH) in Rwinkwavu, an extremely rural area east of Kigali where the DPMI course was held. Their approach was premised upon bringing all health services offered to the communities in most need, and removing the need for community members to travel to them wherever they were located. The PIH training center, its staff, its students and its central hospital were located in the heart of Rwinkwavu, easily accessible to members of the community. They complemented their services with an outreach arm for hard to reach areas and also linked with other clinical facilities. PIH offered admission services with 400 beds, and over 20 doctors. This is a model I believe can be replicated when approaching interventions for working in local communities. In many African countries in this region, approaches to “bringing services to people most at need,” still entails services providers primarily being located in the main towns and cities, and vehicles then being deployed to reach the patients.  Looking at this modality, many resources are often spent on keeping cars fuelled, and on long distances reaching project recipients.

Another learning was how the leadership of Rwanda instilled a very high level of accountability amongst health professionals. The many anecdotes we hear in this region are often of patients avoiding health services because of negative health worker attitude, and poor levels of accountability. These have been a major deterrent that has seen patients delaying in seeking health services, low levels of retention and high levels of care lost to follow-up. In Rwanda, on the other hand, patients in health facilities had free access to communications to the Minster of Health and to senior health officials to report poor health service delivery or ill treatment when seeking services. The results of these patient reports to the Ministerial officials would include public investigation, reprimand or even redistribution of staffing. The few patient responses that we received during the course reported to be closely engaged with health facility services, proactively requesting comprehensive services; they were very aware of their patient rights and they upheld the medical professionals with high reverence.

As much as this may be a long shot to duplicate, the principle remains- bringing services to the people in a holistic manner demonstrates deeper commitment to services, and easier access to help and support for those in most need. It enhances reach of services and prolongs long term engagement and follow-up. Ultimately, this approach brings great promise of reaching those who most need it.

 

Locus recommends 7 questions to guide decisions on integration

By Ellie Price, Locus Coalition Coordinator & Sia Nowrojee, Program Director at 3D Program for Girls & Women at The UN Foundation

On February 21st, 2018, the Locus Learning Work Group set out to answer a priority question on the Research Agenda for Integrated Development: What key criteria should determine when integration is the most appropriate approach in different contexts and scenarios?

Members convened for a workshop led by Learning Work Group Co-Chairs  Matt Lineal of Nuru International and Sia Nowrojee of the 3D Program for Girls & Women at the UN Foundation.[1] Through a process of personal reflection – and creative depictions of past experiences designing and implementing integrated programs in both development and emergency settings – we surfaced more questions than answers, but did arrive at a consensus: Different contexts and scenarios demand that we establish different sets of key criteria for assessing if integration is appropriate, who should decide, what should be integrated, and when that determination is made.

By definition, an integrated approach requires bringing people together to address an issue or respond to a need. The specific combination of people involved are the ones who determine the suite of resources at the table available to address it. But not all those resources – human capacity, technical expertise in different sectors, social capital, political will – may be necessary or helpful. So what criteria can people use to decide what sectors and resources to leverage to address a community issue?

Ultimately, the key criteria for determining what and when to integrate depend on the relative value stakeholders place on both assumed and emergent needs, risks, costs, and benefits of an intervention. These can be assessed throughout program planning, design and implementation.

Questions to Ask during Program Planning and Design

  1. Do we have a shared vision? Working across sectors is difficult and complex. Technical experts speak different languages. Without a shared vision and agreement on the outcome people are trying to achieve, things fall apart. As stakeholders come together around common and overlapping issues, it is important to ask not only if they hold a shared vision, but if they hold competing visions. Is a shared vision possible? If so, what is that North Star which keeps us on track?
  2. What are we willing to let go of? Different individuals and organizations will bring their own set of deeply-held values and favored approaches to the table, as well as their own incentives for being there. As the work required to achieve the shared vision is identified, some of those approaches will work, and others will not. Who is willing to step back and when?
  3. Are there resources to do this? While program design and implementation should not be driven by donor mandates, the reality is that without resources – either financial or technical – integration cannot be done. Some Locus members have donors that value an integrated approach. Others have creatively leveraged targeted resources, and still others have walked away when the right resources required to do the job weren’t available.
  4. What platforms exist or should be created to ensure accountability by stakeholders? Locus members shared stories of times the initial risks, costs and benefits of an intervention changed over the course of time. Ongoing evaluation of these, against the shared vision is key – and demands a platform for people to come together and re-assess.

Questions to Ask During Program Design and Implementation

  1. What technical skills exist in our platform-and what is needed vs. what is not? A clear inventory should be done of the technical skills within our platform. However, just because we CAN design an integrated intervention doesn’t mean we SHOULD. There is value in a focused, vertical program that works well. Adding other components without an understanding of how this contributes to a shared vision, and without adding additional resources if they are needed, could derail a well-functioning program.
  2. What are the political economy considerations in the context? Ongoing political economy analysis is a useful tool for re-assessing the risks, costs, benefits and anticipated return on the investment of an intervention. Interventions must consider how local power dynamics and political will shift as an intervention starts to change incentives within systems. In tandem, we should be thinking about our cost/benefit/risk analysis not only of the whole but of each component of the intervention.
  3. Do people have the incentives and the capacity to stay engaged in this process? A shared vision of success is key to reaching it. Collaborators across sectors need to recognize they have to let go of certain assumptions and approaches as needs emerge and fluid contexts change. Integrated, cross-sector work can stretch people in uncomfortable new directions and capacity building may be needed both to build necessary skills and demonstrate the utility of integration. At every stage of implementation, we need to revisit those incentives that keep different stakeholders engaged to see the process through until the vision is achieved. 

[1] The Activity Guide and notes from the workshop are available here. Locus encourages organizations to use the guide and to send feedback to continue to build our understanding and help answer the question: What key criteria should determine when integration is the most appropriate approach in different contexts and scenarios?

Holding a Space for the Hard Conversations: Reflections on UN CSocD56 Panel

By Ellie Price, Locus Coalition Coordinator

Last month, The Hunger Project, The Movement for Community-Led Development and Locus co-hosted a panel titled “Ending Extreme Poverty is Local: community-led, integrated approaches to sustainable development” at the 56th UN Commission on Social Development in New York. Our panelists, Maurice Bloem, Executive Vice President of Church World Service, Ann Hendrix-Jenkins, Global Director of Capacity Development at Pact, and Mary Kate Costello, Senior Policy Analyst and UN Representative at The Hunger Project, gave insightful remarks and made space for a participatory discussion. 

 I was struck by two observations while moderating the discussion:

1) The vastly diverse professional backgrounds of the people in the room: an ACLU community organizer in Brooklyn, NY. A Minister of Labor from the Government of Zimbabwe. A female pastor from Pittsburgh. Several NGO senior leaders from Malawi, Zambia, and Nigeria. A community organizer from Nepal.

Panel Participants

2) Acknowledgment of the multiple layers of power and privilege that existed inside and outside the room regarding community-led development. Importantly, I appreciated that Mary Kate Costello from The Hunger Project began her remarks by stating her deep regrets over the fact that all three panelists and the moderator were Westerners: three white American women and a Dutch man. With these regrets I concurred, recognizing that the nature of these ad-hoc organized side events favor recruitment of the easily accessible and already well-connected U.S.-based professional at the podium. That’s why we tried to limit our remarks and seek answers from the assets all over the room. Still, we recognized, what was said by each panelist and each participant was equally valuable, as we all have something to learn from one another. The discussion eventually revealed another layer of power: which representatives from the Global South were at the table having this discussion, and which ones were not? Who got visas to come to the UN in New York, and who didn’t? 

It was Macbain, an NGO leader from Malawi, who pushed back on my question, “what recommendations for change should we make to donors and policymakers for supporting the community-led development we’ve discussed today?”

“It is not just the donors who need changing. First, it is ourselves. Before we go to donors, we should be asking ourselves what do we need to change?” He cited an example of nonprofit leaders in Malawi assuming the youth needed money to take forward their initiatives. So they gave them money, and the results did not come. They were wrong. The leaders had to cut their assumptions and double-down on their listening skills, in order to provide the right support the youth mobilizers actually needed. 

In reality, many of the people seated at the table in that room, regardless of nationality, come from elite classes in their own countries. Well-educated, English-speaking, holding positions of power as leaders, NGO directors, and public officials in their communities. 

It is exceedingly difficult to faithfully represent views other than your own. Our discussion reminded me of this truth. 

But the beauty of that diverse room, far different than the typical D.C. development crowd we engage, reminded me that there is a role for everyone to play in international development. Even white westerners like me. I struggle with this a lot. In my mind, it is often easier to say I should just remove myself from the equation altogether. It is a different struggle altogether to figure out how to “hold the space,” as a colleague of mine at Pact puts it, for such dialogue while recognizing their inherent limits. For me, this is how I can live authentically within my own community, as an American, a resident of D.C., and a member of the professional international development community. These identities give me unique platforms to “hold a space” that hopefully invites more of the right voices into the right conversations. Our conversation was a reminder of that.

These “spaces” which Ann, Mary Kate, Maurice and others “hold” for us are the spaces that Locus Partners is dedicated to creating. Given the realities of our world today, while still working towards more just and equitable relationships between all people, we also identified some practical steps we can take to realize the SDGs. Generating evidence for donors on the efficacy of participatory approaches, is one example. Showing investors, companies, donors and public officials the economic cost savings that can result from participatory, community-led work, is another step forward. Collaborating across actors and organizations within systems for collective impact is yet another. In all this we must remember that true transformation, more often than not, takes significant time.

It is easy to get bogged down in the technicalities of our work, or the limitations imposed by global power structures. Yet these moments of dialogue are incredibly important for revealing our assumptions and giving us space to reflect. Only with reflection can we learn and adapt. Locus will continue to facilitate such learning spaces with our partners. 

Decentralization, Health System and Gender Issues in Zambia

The Decentralisation Policy: In 2003, the Government launched the National Decentralisation Policy, which aims at devolving specified functions and authority, with matching resources, to local authorities at a district level. Under this environment, the role of the center would be to provide policy, strategic guidelines, overall coordination, monitoring, and evaluation while implementation and supervision of the programmes would be through the local authorities. The Decentralisation Implementation Plan was approved by the Cabinet in late 2009, and the country is heading towards a full-scale devolution.

Functions:- The new decentralized structure of governance that will be established by the law, through which services will be delivered. The new structure will comprise four levels namely National, provincial, District and sub-district.

Decentralisation will riot necessarily imply that all authority will be transferred to local authorities. The Central Government (including line ministries) will retain a core of functions over essential national matters and ultimately have the authority to redesign the system of government and to discipline or suspend decentralized units that are not performing effectively. Specifically, the Central Government will retain the overall responsibility of:

  1. general and legislative Policy formulation, monitoring and evaluation and provision of advice to Councils on their operations;
  2. setting national performance standards;
  3. controlling arms, ammunition and explosives;
  4. national defense and security;
  5. regulating banks and financial institutions, promissory notes, currency, and exchange;
  6. citizenship, immigration emigration. refugees, deportation, extradition, and designing of passports and national identities;
  7. copyrights, patents, trademarks and all forms of intellectual property, incorporation and regulation of business organizations;
  8. control of state land and minerals;
  9. declaration of public holidays, working and shopping hours;
  10. preservation of national monuments, antiquities, archives and public records;
  11. foreign relations and trade, regulation of trade and commerce;
  12. national and local government elections;
  13. guidelines on national census and statistics;
  14. control of publications of national surveys and mapping;
  15. control and management epidemics, pandemics and disasters;
  16. airports, aerodromes, and airstrips;
  17. national development projects and programmes;
  18. correctional policy and maximum security prisons;
  19. trunk roads and highways;
  20. prosecutorial functions;
  21. high school and tertiary education; and
  22. Any other functions delegated by Parliament.

Functions at the Provincial level, functions to be performed include:

  1. coordinating and consolidating district plans into provincial development plans for submission to the center;
  2. monitoring the utilization of resources and implementation of development programmes in the province;
  3. coordinating and auditing of local institutions; (d) preparing provincial progress reports for the central
  4. The government on the implementation of development programmes and projects;
  5. ensuring implementation of Central Government policies and regulations;
  6. implementation of National development projects and programmes which cut across sectors;
  7. ensuring proper utilization and maintenance of Government buildings, equipment, plant and other infrastructure; and
  8. any other functions delegated from the center.

The Government shall decentralize with matching resources, some of its function & to the district, which shall perform these functions through democratically elected councils. The Councils will raise part of their own revenue and receive grants from central treasury and line ministries to perform the devolved functions such as’.

  1. coordination of decentralized structures, including Health and Education Boards;
  2. disaster management;
  3. community development;
  4. primary health care;
  5. primary and basic education;
  6. water and sanitation;
  7. rehabilitation, maintenance, and construction of feeder roads;
  8. infrastructure development and maintenance;
  9. planning and implementation of development projects and programmes;
  10. mobilization of local resources;
  11. preparation of progress reports for the province;
  12. management, conservation of natural and wildlife resources;
  13. environmental services;
  14. provision and maintenance of public amenities; land
  15. allocation and utilization;
  16. trade and business licensing;
  17. agriculture extension services;
  18. bye-laws;
  19. community Police Service;
  20. community Prisons Service;
  21. youth and juvenile delinquency; and
  22. any other functions as delegated from the center.

Zambia’s Health System

Zambia’s health policy, created in 1992 and becoming operational with the Health Services Act 1995, is intended to ‘provide people of Zambia with equity of access to cost-effective, quality healthcare as close to the family as possible…’(MOH 2005:1). The aim of the policy was to provide a service that was responsive to local needs by decentralization of decision making to districts and promote peoples’ power through encouraging local representation on health management boards. The Ministry of Health (MOH) was given responsibility for policy, financing, and regulation, and a new organization, the Central Board of Health (CBOH), was tasked with service implementation (ACCA, 2013).

However, following 10 years of implementation, the health policy had become outdated and the Health Services Act was repealed in 2006 leading to the abolition of CBOH structures and creation of a unified four-tier health system under the MOH. The four levels as indicated on National Health Strategic Plan 2011-2015 document include:

  • The MOH Head Office at the Centre, responsible for policy guidance and oversight, regulation and defining standards;
  • The Provincial Health Offices (PHOs), responsible for coordination, monitoring, technical supportive supervision, and quality assurance and performance management at provincial level;
  • The District Health Offices (DHOs) at a district level, as the focal point for services delivery, providing supervision, coordination, planning and management support to Health Posts, Health Centres, and 1st level hospitals; and
  • The health service delivery facilities, which are the backbone of the system, providing “treatment and care services” to the general population at the community level.

In addition, national units were established to oversee specific health programmes, including the National Malaria Control Center, Reproductive Health Unit, Tuberculosis and Leprosy Unit, and National Aids Council.

Health Care is provided by a multitude of providers, including the MOH, church organizations, the private sector (both nonprofit and for-profit) and alternative providers. The vast majority of health facilities (1489) are owned and operated by the public sector. These are supplemented by 122 mission health facilities and 271 private health facilities (ACCA, 2013).

The health services delivery system in Zambia is focused on providing health services as close to the family as possible using a Primary Health Care approach. Zambia operates a pyramid classification structure of health care provision (National Health Policy, 2012):

  • tertiary or specialist care is provided in Level 3 hospitals
  • provincial-level care is provided in Level 2 hospitals
  • district-level care is provided in Level 1 hospitals
  • community-level care is provided through community services, health posts, and health centers.

The structuring of the health system suggests that a managed hierarchical referral system is in operation, but owing to undeveloped communication systems and limited availability of ambulances, referral systems between the different levels of care are often poor.

The Zambian health policy stipulates that every Zambian with an income should contribute to the cost of his/her health. However exemptions exist based on age (children under 5 and adults over 65), diseases (TB, HIV/AIDS, Cholera and dysentery; safe motherhood and family planning services; immunization; and treatment of chronic hypertension and diabetes) and other factors. This is aimed at enhancing equitable and appropriate delivery of health services to all Zambians, but in practice is not implemented due to lack of resources (1).

There is inequitable access to basic health services in Zambia between provinces and between urban and rural areas. In urban areas, 99 percent of households are within 5 kilometers of a health facility compared to 50 percent in rural areas. In Zambia, household expenditures on health vary according to location. Poor households spend the highest proportion of their income on health, which can be up to 10% of total expenditure when in-kind costs are included (2).

Many of the key determinants of health are outside the direct scope of the health sector. There is often poor access to safe water and sanitation, malnutrition accounts nearly half (42%) of all deaths in under five children; lack of education, particularly among females; gender discrimination; Climate variability and change. Other key factors include poor road networks (particularly in rainy seasons), an insufficient number of vehicles for transportation, and limited access to electricity (ACCA, 2013).

Organization and management structures;

Since 2005, the health sector has been undergoing a major restructuring process. Through this process, the sector has established a comprehensive organization and management structures at national, provincial, district and community levels, intended to facilitate efficient and effective management of health services. However, the organization and management structures have very weak linkages with the community that existed before the repeal of the NHSA in 2006, over the past two decades decentralization in the health sector has an increasingly familiar theme, commonly linked to a wider public sector and governance reforms. The intent was to bring decision making, responsibility, and accountability, closer to where health care services are provided, in order to realize increased efficiency (National Health Policy, 2012).

Gender situation in Zambia

Zambian Government Policies and Laws on Gender

  • At the policy level, there have been some improvements towards gender equality. In 2012, the Ministry of Gender became an independent ministry and the National Gender Policy was formulated in 2014. This policy lists the strategy and actions to be implemented by government ministries and agencies in 15 different fields to achieve gender equality, although there are no formal commitments in terms of indicators and annual budgets. The Ministry of Gender is in the process of drafting a monitoring report for this policy and there is no clear picture concerning the progress of this policy (JICA, 2016).
  • In 2005, the Penal Code was revised making the punishments for (sexual) violence against women and children stricter, and the Anti-Gender Based Violence Act was enacted in 2011. However, the actual enforcement of these laws and policies has been slow and acceleration of their enforcement is sought.
  • At present, deliberations on the Gender Equity and Equality Rights Bill are in progress along with those to revise the Constitution. The intended revision of the Constitution includes (i) revision of the text in line with the Convention on the Elimination of all forms of Discrimination Against Women (CEDAW) and other human rights-related documents, and (ii) rectification of the dual structure of statutory law and customary law to realize gender equality. The bill in question aims at (i) incorporating the spirit of the human rights-related documents in national laws and policies, and (ii) establishing the Gender Equity and Equality Commission as an organization to supervise the implementation of gender equality

Population (UNDP, 2016)

  • The total population of Zambia is 16.2 million
  • Females account for 50.7% of the total population and males accounting for 49.3 percent.
  • 77.5 percent of households were headed by males while 22.5 percent were headed by females

Gender inequality index (UNDP GII, HDR 2016) 

  • The UNDP Gender Inequality Index (GII) reflects gender-based inequalities in three dimensions namely reproductive health, empowerment and economic activity. Zambia has a GII value of 0.526 ranking 139 out of 188 countries in the 2016 index assessment. This high level of gender inequalities arises because only 12.7 percent of parliamentary seats are held by women. However, the number of women who have reached at least a secondary level education account for 52.3 percent of adult Zambian women compared to 48.9 percent of Zambian men, this is the area where Zambia showed significant improvement in the last five years.  For every 100,000 live births, 224 women die from pregnancy-related causes; and the adolescent birth rate is 90.4 births per 1000 live births. Female participation in the labor market is 69.8 percent compared to 80.9 percent for men (1).

Employment

Statistics show that employment in Zambia is dominated by the informal sector with females being the majority. There has been an increase in the percentage of persons in formal employment from 11.0 percent in 2008 to 15.4 percent in 2012 (1).

  • The percentage of females in the formal sector increased from 6.0 percent in 2008 to 8.7 percent in 2012 while that of males increased from 15.0 percent to 22.3 percent.
  • There are more females (52 percent) than males (48 percent) employed in the Agriculture, forestry & fisheries industry (2).

In the Republic of Zambia, there exists a deep-rooted concept of an unequal gender relationship in which men are considered to be superior to women. This biased view regarding gender equality originates from not only traditional cultural and social norms but also from the dual structure of statutory law and customary law. Rights, which are supposed to be protected under statutory law, are not necessarily observed and women endure unfair treatment in terms of child marriage, unequal distribution of property, etc. Meanwhile, there have been some positive developments at the policy level, including the establishment of an independent Ministry of Gender, the introduction of specific gender policies and revision of certain provisions of the Constitution, which epitomize gender inequality (currently being deliberated) (Jica, 2016).  

According to a report published in 2015, Zambia ranks as low as 11th of 15 countries surveyed among Southern African Development Community (SADC) members in the areas of women’s participation in politics. In terms of political empowerment as a global gender gap indicator, Zambia ranks 102nd of 145 countries.  

While the net enrollment rate for girls in primary education is similar to that for boys, the dropout ratio for girls increases as they advance to higher grades (especially 7th grade and thereafter), mainly due to pregnancy (JICA, 2016)  

As 78% of women are engaged in agriculture, women constitute an important labor force for agriculture. However, their role is often to assist men in family farming or production for home consumption due to (i) their little access to production equipment and land compared to men and (ii) their prominent role in household work and child-rearing. Outside the agricultural sector, many women are employed in the informal sector (JICA, 2016)

Marriage at a young age, teenage pregnancy, and violence against women are quite common and the prevalence of HIV/AIDS is higher for women than for men. Because of women’s limited decision-making power, women are negatively affected regarding their sexuality and health.  The Zambia Demographic and Health Survey (ZDHS) for 2013-14 reported that 43% of women in the age bracket of 15 to 49 have experienced violence at the age of 15 or older (JICA, 2016)

Gender Index

In Zambia, marriage, child custody, property rights, and inheritance are governed by a dual legal system statutory and customary laws. The marriage act provides the minimum age of marriage at 16 for both men and women, with parental consent needed under the age of 21. These rules, however, apply to statutory and not customary marriages; under customary law, it is legal to marry a girl child who has attained puberty.

Regarding parental authority, there are no legal restrictions on women becoming heads of households and equally the new draft constitution grants women equality in marriage.

According to  ZDHS 2013-14,  

  • One in three currently married women who earn cash for their work makes independent decisions about how to spend their earnings.
  • Fifty-nine percent of currently married women whose husband receives cash earnings say that they decide jointly with their husband about the use of his earnings.
  • Seventy-four percent of women participate in decisions regarding their own health, as compared with 89 percent of men.
  • One in two (53%) women participate in four specified decisions pertaining to their own health, major household purchases, purchases for daily household needs, and visits to their family or relatives.
  • Empowerment is strongest among women who participate in all four specified decisions, who agree that wife beating is not justified for any reason, and who agree that a woman can refuse sexual intercourse with her husband for any reason.
  • Contraceptive use is positively associated with all three empowerment indices measured in the 2013-14 ZDHS.

Women Empowerment

  • According to the ZDHS 2013-14, 8.4 percent of women aged 15-49 years compared to 3.7 percent of men of the same age group had never attended any level of formal Education.
  • More males compared to females were literate, 82.7 percent and 67.5 percent, respectively.
  • 48.8 percent of the total number of women aged 15-49 years were currently employed compared to 72 percent of men in the same age category.
  • 34.7 percent of married women with Cash earnings decided how their earnings were used, 49 percent decided jointly with their husbands, 16 percent said that their husbands decided how their earnings were used.
  • The men (22.5 percent) were more likely than women (9.4 percent) to have sole ownership a house. 30.4 percent of women-owned assets jointly. 58.0 percent of men and 53.8 percent of women did not own a house (ZDHS, 2013-14).

 

References

ACCA. (2013, April). Key Health Challenges for Zambia. Retrieved from http://www.accaglobal.com/content/dam/acca/global/PDF-technical/health-sector/tech-tp-khcz.pdf

The Republic of Zambia. (2012, August). National Health Policy

The Republic of Zambia. Ministry of Health. National Health Strategic Plan 2011-2015. Retrieved from http://www.moh.gov.zm/docs/nhsp.pdf

Zambia Health System. Retrieved from. http://www.access2insulin.org/zambias-health-system.html

Zambia Demographic and Health Survey. 2013-14. Retrieved from https://www.dhsprogram.com/pubs/pdf/FR304/FR304.pdf

Zambia 2002. The National Decentralization Policy ‘’Towards Empowering People’’ Retrieved from https://theredddesk.org/sites/default/files/zambia_national_decentralisation_policy_1.pdf

Zambia Central statistics office. Gender Status Report 2012-14. Retrieved from https://www.zamstats.gov.zm/phocadownload/Gender/Gender%20Status%20Report%202012-2014%20290616.pdf

JICA. JDS. 2016. Country Gender Profile: Zambia Final Report. Retrieved from http://open_jicareport.jica.go.jp/pdf/1000026840.pdf

 

Community-Led Development and Its Rationale

 

Patriarchy and ‘’top-down’’ development approaches have resulted in little or no change to the poor in the bottom. Instead of focusing on what strengths, assets, and capacities the communities possess, the approach solely has been trying to address the gaps and vulnerabilities without working to utilize or build upon the strengths. As a result, the existing indigenous skills and knowledge that are appropriate to the context were often ignored and less valued. Since the design, planning, and implementation of these projects didn’t consider the needs and wishes of the communities it usually becomes impossible to ensure sustainability upon their phase-out. As a result, dependency, lack of ownership and little or no impact have been the common features of many short-term, ‘’top-down’’, quick-fix development programs.

The most important issue with international development is delivering required resources to the right place at the right time and ensuring those resources are being integrated in a sustainable manner. The greatest failure of international development to this day is the wasting of resources due to lack of proper understanding of the contextual factors and its realities. It is this lack of accountability and meaningful investment—“the tragedy of aid”—that William Easterly criticizes in his book The White Man’s Burden (Easterly, 2006). He argues that while a significant amount of resource was allocated for the projects in developing countries, there is “shockingly little” growth to show for it. This can occur when bureaucratic interventions by governments, non-governmental organizations, or transnational conglomerates impose “top-down” solutions that fail to take into account both the needs and wishes of the bottom. Conversely, if solutions to community issues are identified and rectified by community-developed remedies—ones that better understand the delicate intricacies of local issues—success and sustainability are much more likely.

According to the Voices of the Poor study (Narayan and others 2000), based on interviews with 60,000 poor people in 60 countries, poor people demand a development process driven by their communities. When the poor were asked to indicate what might make the greatest difference in their lives, they responded: (a) organizations of their own so they can negotiate with government, traders, and NGOs; (b) direct assistance through community-driven programs so they can shape their own destinies; and (c) local ownership of funds, so they can end corruption. They want NGOs and governments to be accountable to them (Gillespie, 2004).

Based on this evidence and lessons from its many years of working with developing countries, the World Bank initiated community-driven development (CDD) and currently supports approximately 400 projects in 94 countries valued at almost $30 billion (Wong, 2012). CDD programs operate on the principles of ‘’transparency, participation, demand-responsiveness, greater downward accountability, and enhanced local capacity’’. The World Bank recognizes that CDD approaches and actions are important elements of an effective poverty-reduction and sustainable development strategy (World Bank, 2017).

The CDD and community-led development (CLD) have enormous overlaps, commonalities and share similar principles however the former approach is mainly project focused whereas the community-led development focuses on improving systems by changing mindsets, building capacity, ensuring self-reliance to achieve sustainable development.

What is Community-led Development?

The Hunger Project and many other organizations came together and have initiated a movement of 32 like-minded organizations committed to the success of the SDGs-called ‘’the movement for community-led development.’’ Calling for enhanced power and capacity of communities to take charge of their own development.  The movement has its own conceptual framework with each member organizations having developed their methodologies based on its principles. But what’s community-led development?

Researchers and organizations have defined community-led development in various ways however they all agree in the principles and that the approach puts the communities on the driving seat as agents of their own development with some external support from CSOs or government. Inspiring Communities which is an organization that catalyzes locally-led change in New Zealand defined the movement for community-led development (CLD) as ‘’the process of working together to create and achieve locally owned visions and goals. It is a planning and development approach that’s based on a set of core principles that (at a minimum) set vision and priorities by the people who live in that geographic community, put local voices in the lead, build on local strengths (rather than focus on problems), collaborate across sectors, is intentional and adaptable, and works to achieve systemic change rather than short-term projects (Inspiring Communities, 2013).’’

Torjman & Makhoul (2012) defined ‘’CLD as a unique approach to tackling local problems and building on local strengths which are guided by several core principles.’’ Some of the guiding principles are it ensures the voice and views of citizens, seeks to empower community members, co-creates a governance process, sets aspirational goals or visions. Despite their differences, community-led development approaches are bound together by a set of guiding principles, assumes that all communities and their members have strengths, skills, and resources on which to build, frameworks for change and translation of aspirational goals into specific steps. Community-led development is not a straight pathway. It is a process of continual learning and checking of progress against objectives (Torjman & Makhoul, 2012).

Community-led development focuses on step by step process of empowering communities to take charge of their own development. Evidence shows that community building, capacity building, ownership building, creating impact and ensuring self-reliance to bring sustainable development can best be addressed through community-led development. The community-led development allows people to participate in and feel ownership for their own development, gives an opportunity to the communities to prioritize urgent needs specific to their own community and builds trusting relationships, positively impacting perceptions regarding the capability of actors and the impact of their efforts (Mercy Corps, 2010).

John Coonrod (2015) says ‘’Community-led development is more than participatory projects. It requires a long-term process that empowers citizens and local authorities to transform entrenched patriarchal mindsets and take effective action.’’ The movement is inspired by SDG #16 calls for building participatory, effective, accountable institutions “at all levels” – which must start at the level closest to the people.

CLD is a social innovation as it intends to address the development related social issues of the society in a new bottom-up approach which is a gender-focused and transformative process. Community-led development has strong relevance to good governance, peace and security, and humanitarian response, as well as to urban and rural social and economic development. As a result, it’s crucial to allocate funding and other resources for long-term development programs that are integrated and focus on empowering the local communities through community-led initiatives. The external forces such as CSOs and central government should acknowledge the capacities and strengths of the indigenous people. Thus, they should focus on supporting the processes by listening to the needs and wishes of the communities until and after the communities ensure their local self-governance, resilience, and self-reliance.

 

References

Coonrod, J. Development (2015) 58: 333. https://doi.org/10.1057/s41301-016-0008-2

Narayan-Parker, D., & Patel, R. (2000). Voices of the poor: can anyone hear us? (Vol. 1). World Bank Publications.

Mercy Corps. (2010, June). The Benefits of Community-Led Development Programming in Insecure Environments: Findings from Iraq and Afghanistan. LEAPP

Gillespie, S. (2004). Scaling up community-driven development: A synthesis of experience. International Food Policy Research Institute, Food Consumption and Nutrition Division, FCND Discussion Papers, (181).

Inspiring Communities. (2013). Learning by Doing: community-led change in Aotearoa NZ. Publisher: Inspiring Communities Trust, New Zealand.

Torjman, S., & Makhoul, A. (2012). Community-led development. Caledon Institute of Social Policy.

The World Bank. (2017, Sept 22). Community-Driven Development. Retrieved from http://www.worldbank.org/en/topic/communitydrivendevelopment

Wong, S. (2012). What have been the impacts of World Bank Community-Driven Development Programs? CDD impact evaluation review and operational and research implications. World Bank, Washington, DC.