A light in the COVID-19 darkness: Social Accountability

By Besinati Mpepo  

The test of COVID-19 commitments and plans made by pharmaceutical companies, donors and governments lies in the successful deployment of vaccines. Vaccination success equals equity and ensuring vaccines end up in the arms of all who need them, leaving no one behind  – rich or poor, visible or marginalised, young or old, differently abled - wherever they are located. Having had my own first dose here in the UK, I have been quick to encourage my elderly mother, family and friends back home in Zambia to get their vaccines when they are offered to them. I have had varying levels of success. 

Like any other public service, the delivery of the COVID-19 vaccines is guided by a plan, in this case the National Deployment and Vaccination Plans (NDVP) and every plan requires monitoring and accountability to ensure satisfactory delivery. Social accountability has much to offer in monitoring of health and other services and puts people at the heart of system. For over 16 years, World Vision has worked with local communities across 600 programmes in 50 countries to apply a social accountability approach called Citizen Voice and Action (CVA) that sees communities provide feedback on their lived experience of the service being monitored -  in created or invited spaces -  for constructive dialogue and collective action. The result has been better services.  

Initial findings from the World Bank NDVP assessment show that the world’s poorest countries are at varying degrees of readiness for the massive undertaking of vaccinating their populations against the deadly COVID-19 disease. The assessments reveal that while 85% of countries have developed national vaccination plans and 68% have vaccine safety systems, only 30% have developed processes to train the large number of vaccinators who will be needed for the campaign and only 27% have created social mobilisation and public engagement strategies to encourage people to get vaccinated.

Given the worrying vaccine hesitancy levels, strategies to generate confidence, acceptance and demand for the vaccine are urgently needed. At the same time, the first panel at this year’s World Bank Global Partnership for Social Accountability (GSPA) partners forum was on the theme of Social Accountability and Covid-19 Vaccination with many practitioners pointing to the value of social accountability in not just improving the vaccine service, but also in its potential to significantly contribute to demand creation and tackling the challenge of vaccine hesitancy – huge challenges in the roll-out in many countries.   

The experience of World Vision throughout the pandemic has been that even when people are struggling with COVID-19 restrictions, previous social accountability experience has proved to be a sound investment. Running CVA programmes during COVID-19 has been really difficult because of lockdown and social distancing. Nevertheless, community groups in places like Zambia, Indonesia and Uganda that have led and facilitated CVA in their communities in the past, are now supporting communities with important safety information and responding to failures in public services in their communities  because of the pandemic.  

In one example, a community Citizen Voice and Action group in one area of Kyankwanzi District of Uganda facilitated community monitoring of maternal and child health, education and child protection services in 2020. Among the insights garnered from this process were that many pregnant mothers could not afford to reach maternal and child health services or give birth at a medical centre because motorcycle taxi drivers charges had spiked because of COVID-19. Many more women than usual therefore opted to deliver at home with the help of traditional birth attendants away from health facilities putting both mum and baby at greater risk of medical complications.  

These insights were presented to the local government and helped inform decisions to provide emergency vehicles for the transportation of health staff and expectant mothers, and for other health emergencies. What's more, this fed into the establishment of district COVID-19 task force to give guidance to the local district government on matters related to health and COVID.  

Recently, World Vision has started to pilot Citizen Voice and Action for vaccine services in a few countries, with the aim of scaling it up. We have discovered that for it to work: 

• National Vaccine Deployment Plans must be more publicly available for use by civil society and communities; 

• Strong approaches to civic education should address vaccine hesitancy, and information regarding people’s entitlements to the vaccine must be shared; 

• Social accountability should be at the heart of the NDVP monitoring and communities must have opportunities to feedback on their lived experience of vaccine services; and, 

• Governments and other stakeholders need to be ready to listen and close the feedback loop.  

As noted in an Open Government Partnership article on the Covid-19 vaccine, applying the pillars of transparency, civic participation, and public accountability throughout the life cycle of vaccines can mitigate corruption risks, achieve value for money, build public trust, and ensure that vaccines are reaching the people who need them most. 

All indications are that the world has a way to go before we emerge from this situation. World Vision’s experience is that adapting social accountability for accountable delivery of the vaccine and other services that are critical to communities during and after the pandemic, can go a long way to improving services, systems and relationships at a time when so much has been lost. 

To learn more about World Vision’s social accountability work visit here 

To read more about Citizen Voice and Action visit here  

Besinati Mpepo is World Vision’s Technical Director, Social Accountability. Follow her on Twitter at @Besinati