Integrity Watch’s Community-Based Monitoring-Health program promoted social accountability through community mobilization and audits.
Problems and Purpose
Integrity Watch’s Community-Based Monitoring-Health program promoted social accountability through community mobilization and audits. The program empowered communities to monitor health facilities implemented in their area. This program aimed to empower citizens to hold authorities and aid entities accountable and to create active and responsible citizenship. Communities engaged in local monitoring became more autonomous in solving their problems through this monitoring and continuous dialogue.[i][1]
[i] Integrity Watch Afghanistan. Community Based Monitoring – Health. 2021. https://integritywatch.org/community-based-monitoring-health/
Background History and Context
Integrity Watch is a civil society organization in Afghanistan dedicated to promoting transparency, accountability, and integrity. It was founded in October 2005 and became an independent organization the following year. The main office is located in Kabul, but they also have programs in Balkh, Herat, Kabul, Kapisa, and Nangarhar provinces and partnerships with local organizations in other provinces. Over the past ten years, their work has centred on community monitoring, research, and advocacy.[i][4]
The program started in 2018 with health facilities in 10 Kabul Province of Afghanistan communities. It has expanded over the years due to its success in actively empowering citizens to promote integrity and accountability. Since 2018, 70 Integrity volunteers have monitored around 70 health facilities in Kabul, Kapisa, Nangarhar, Herat, and Balkh Provinces.[ii][1]
[i] Integrity Watch Afghanistan Official webpage: https://integritywatch.org/blog/slideshow/community-based-monitoring-of-trial-cbm-t/
[ii] Integrity Watch Afghanistan. Community Based Monitoring – Health. 2021. https://integritywatch.org/community-based-monitoring-health/
Organizing, Supporting, and Funding Entities
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Integrity Watch Afghanistan implemented the program with financial support from donors. [i][3]
[i] Integrity Watch Afghanistan. Corruption and Conflict. IWA.Kabul.2010 : https://www.usip.org/sites/default/files/Amanda%20Mayoral/Lorenzo%20Delesgues%20Presentation%20November%208%202010%20(00019540).PDF
Participant Recruitment and Selection
Integrity Watch Afghanistan worked with communities to identify Integrity Volunteers who volunteer to monitor health facilities on behalf of their communities. The Volunteers were trained and supported by Integrity Watch, which built up years of knowledge and experience in community-based monitoring. Integrity Watch uses carefully designed customized monitoring tools to monitor a series of metrics and phenomena related to health services delivery, illustrating the quality of health facilities and their impact on the targeted communities. These illustrations were based on the clinics' adequacy, consistency, and sustainability.
Integrity Volunteers could file complaints by establishing a Sectorial Monitoring Group (SMG) composed of line ministry representatives, Integrity Volunteers, Provincial Council members, media, and aid actors. The SMGs trigger the accountability role of local institutions. Furthermore, monitoring clinics helps ensure that health facilities positively impact the community.[i][1]
[i] Integrity Watch Afghanistan. Community Based Monitoring – Health. 2021. https://integritywatch.org/community-based-monitoring-health/
Methods and Tools Used
Selecting Communities: Like other Integrity Watch initiatives, the Community-Based Monitoring of Health (CBM-H) program draws on community participation to establish the legitimacy of its objectives. For this program, "community" was defined by Community Development Councils, civil society actors, and health service providers. Once a community was chosen, Integrity Watch's employees met with the community to explain monitoring and its benefits.
Electing Integrity Volunteers: Each participating community was asked to select an integrity volunteer. The volunteer should preferably be literate, have a good reputation within the community, and be able to volunteer several hours each week to monitor health facilities.
Training of Integrity Volunteers: After their selection, all Integrity Volunteers received technical and social training from Integrity Watch's staff. The social activity covered the basic concepts of corruption awareness, community mobilization, and problem-solving. Specialized training covered the program's flow chart, monitoring forms, guidelines, how to conduct meetings, and how to identify and solve problems. The movement taught the Integrity Volunteer how to use the monitoring tools provided, conduct surveys, follow checklists, and collect data.
Gathering information: The Integrity Volunteer then obtained all the relevant clinic documents by requesting these from government officials and the health directorate. After collecting these documents, Integrity Volunteers conducted a baseline community survey. They interviewed 20 respondents who were stakeholders in their local clinic. This survey helped introduce the monitoring program to the community and collected information on community knowledge and participation in the clinic.
Monitoring the health facilities: The Integrity Volunteer visited the clinic two times a week, met with the head of the health facility, checked the environment, services, cleanliness, and quality of materials used for the patients and identified problems. If problems were revealed, the integrity volunteer, the integrity leader and Integrity Watch's provincial coordinator first tried to resolve the issues. If they were not resolved, they discussed these problems with the health directorate to convince the head director to resolve them.
Health Management Sharas (HMS): The core objectives of the CBM-H Program were to monitor health and oversee the proper functioning of Health Management Shuras (HMS). As mentioned, the IVs visited clinics at least twice weekly and completed monitoring forms. They also attended monthly HMS meetings and updated community representatives on the findings. At this stage, information on the relevant clinic was collected and recorded in Integrity Watch's database. Also, IVs completed weekly and quarterly monitoring forms recorded in the database. This information was then used to prepare a monthly feedback sheet submitted to the health management and community representatives. In addition, assigned IVs attended HMS meetings and monitored their performance.
Community Feedback Meetings: At these events, Integrity Volunteers provided activity feedback to their relevant community. They conducted this event monthly in the clinic.[i][1]
[i] Integrity Watch Afghanistan. Community Based Monitoring – Health. 2021. https://integritywatch.org/community-based-monitoring-health/
What Went On: Process, Interaction, and Participation
For example, the IWA Community-based Health Monitoring program: Local volunteers in Nangarhar ensured community access to health services during COVID-19.
Char Bagh-e-Safa Health Center at Surkhroad District in eastern Nangarhar province was closed to residents until a local integrity volunteer visited the health center in May 2020 after the COVID-19 outbreak. The volunteer, Farhad Ibrahimkhail, found that the center's Outpatient Department section was not operational and was closed to residents. The local people expressed their significant concerns over this issue. One resident said, "We don't even have access to basic health facilities at present, and now we have to live with the fear of COVID-19, but with an unapproachable health facility in our area."
After identifying the problem, the volunteer, backed by the local community and supported by Integrity Watch, shared the issue with officials at this particular health center. The center's health workers expressed their concern over the spread of the coronavirus, one of them stating, "The Department of Public Health has not provided us with the special precautionary equipment, for example with personal protective equipment kits, to prevent us contracting the virus. " They also expressed concern over patients’ lack of respect for social distancing practices when entering the center.
To address the problem, the local volunteer shared it with the community members and elders to obtain their viewpoints. After these meetings, Integrity Watch's provincial staff and community representatives arranged a meeting with the Deputy Director of the Provincial Public Health Directorate to discuss possibly providing personal protection equipment kits to this health center. After some valuable discussions during the meeting, the Deputy Director promised to respond to the problem by taking immediate action to resolve the issue.
Eventually, with close follow-up by Integrity Watch's provincial staff and the community's representatives, the issue was entirely resolved, and the community could benefit from the services provided at this center.[i][2]
[i] Integrity Watch Afghanistan. Local volunteer in Nangarhar ensure community access to health services during COVID-19. 2020. https://integritywatch.org/blog/stories/local-volunteer-in-nangarhar-ensure-community-access-to-health-services-during-covid-19/
Influence, Outcomes, and Effects
Integrity Watch expanded its Community-Based Monitoring of Health Centers (CBM-H) to 170 health centers in five provinces and planned to expand to 130 in eight additional areas. The program worked with local health councils and community representatives to monitor health services and advocate for the problems identified. The program has a 50% fix rate (half of the issues identified have been resolved). [i][2]
[i] Integrity Watch Afghanistan. Local volunteer in Nangarhar ensure community access to health services during COVID-19. 2020. https://integritywatch.org/blog/stories/local-volunteer-in-nangarhar-ensure-community-access-to-health-services-during-covid-19/
Analysis and Lessons Learned
See Also
https://www.communitymonitoring.org/
References
[1] Integrity Watch Afghanistan. Community Based Monitoring – Health. 2021. https://integritywatch.org/community-based-monitoring-health/
[2] Integrity Watch Afghanistan. Local volunteer in Nangarhar ensure community access to health services during COVID-19. 2020. https://integritywatch.org/blog/stories/local-volunteer-in-nangarhar-ensure-community-access-to-health-services-during-covid-19/
[3] Integrity Watch Afghanistan. Corruption and Conflict. IWA.Kabul.2010 : https://www.usip.org/sites/default/files/Amanda%20Mayoral/Lorenzo%20Delesgues%20Presentation%20November%208%202010%20(00019540).PDF
[4] Integrity Watch Afghanistan Official webpage: https://integritywatch.org/blog/slideshow/community-based-monitoring-of-trial-cbm-t/
