Why accountability?

							  Accountability in CARE Peru
• Promoting internal and external
  accountability…and why that is key to our
  work…
           Why accountability?
• Program principle 3 (apply to everything we do) – core
  component of RBA
• Key part of addressing underlying causes of poverty
  (especially, weak citizenship, public policy,
  discrimination)
• Core values of integrity and respect
• We need to “walk the talk”
• Ever greater demand from multiple stakeholders for
  CSOs to be more accountable
• Improves quality and impact of our work (lesson from
  emergency response program)
• Increases our legitimacy
• See it as a key part of our positioning as a national
  CARE Peru
                       Sistema de Rendición
                            de cuentas.




      Información      Participación,      Gestión de           Gestión de la
        pública y        toma de             quejas,              Calidad
     transparencia      decisiones          reclamos,
                                           sugerencias

                         Comité de                                Estándares,
-Escritos y hablados                    Línea gratuita,
                         vigilancia                                 normas,
Medios personales,                      correos electronicos,      principios
grupales y masivos.                     documentos escritos
                                GRI report




Indicators                       % of applicable indicators with data
                                 collected*
Financial indicators             100%
Environment indicators           29%
Human resource indicators        100%
Human Rights indicators          90%
Social performance indicators    75%
              Challenges
• Staff turnover
• Needs to apply to consultants as well staff
• Fear of handing over power, or being
  criticized
• How (much) to be transparent re $?
• Weak “demand” for accountability
• Promoting accountability with other NGOs
                   No Woman Behind:
Closing the gaps between duty bearers
     and right-holders to improve Safe
                           Motherhood




                           CARE Peru
                        November 2009
Women surveillance for more Accountable health services

• Capacity building to women leaders and civil
  society members on HRs, institutional
  responsibilities and legal framework

• Ayaviri: 20 surveillance leaders, volunteering and
  working since December 08 in: 1 provincial hospital,
  2 health centers and 2 health posts

• First visit to health facilities and local authorities to
  introduce the surveillance leaders (mostly women)
  with health personnel, presenting the initiative
Women surveillance for more Accountable health services

• Monitoring activities: one day / 2 wks, 3 to 8 hours.
  Women ask health services’ users in their own
  language about quality of health services and how
  they felt and were treated and observe health care
  procedures, taking note on good / bad practices and
  also the names of the health care workers
• Once a month women report their findings to
  Ombudsperson regional officer; he/she reports the
  finding back to the health care facility manager and
  health team

• Implementation of public audiences with the
  community members and other local stakeholders
“When I introduced myself with the hospital
doctor he ask me: ‘What is all this ‘Quality
surveillance’ thing? Here we are working hard,
you should be doing the same instead of losing
your time…or would you like me going into your
home and watching all what you make there?’

     I told him ‘Doctor, we are health community
 agents and we have been trained by ForoSalud
  and Ombudsman for this activity. You can not
   go to my home because that is private space,
 but I can come to the hospital because this is a
  public service, and here are my credentials…”

               Nilda Chambi, Azangaro women leader
   Evidence raised on the Integral Health Insurance
    (Seguro Integral de Salud – SIS) Performance


• Some findings: reduced hours for health services
  provision as a mechanism to discourage women using
  the health services and to charge for medicines which
  should be free; traditional vertical birth delivery not
  provided in Puno Hospitals

• Issues of non dignity treatment, little information
  provided, traditional postpartum food not provided
          Outputs from the surveillance

• Women in charge of surveillance and health
  services users have noticed an improvement in the
  quality of health services (opportunity, treatment,
  explanation, etc)
• Alliance with SIS officers have promoted corrections
  on faults to this program performance (availability of
  medicines, most clear norms for use of the SIS
  program). Emblematic case: change of health
  provider in Pueblo Nuevo (used to be drunk and
  provide service whenever he wanted).
• Political incidence have contributed to restore
  visibility on vertical birth delivery options for rural
  women and the importance of language issues
  within health service
       Overall Outputs from the Project
• Capacity building processes on health rights,
  participation and citizen surveillance to both civil
  society representatives and health providers of
  Ayaviri – Puno and Yauli- Huancavelica
• Implementation of the citizen surveillance
  processes in Ayaviri and Internal Negotiation /
  Public Audiences to present the evidence raised
  and analyze/ commit options to overcome problems
• Interest developed by the Peruvian Ministry of
  Health to analyze ways in which the Ministry of
  Health and Regional Health Authorities could
  promote and implement citizen participation
  mechanisms and citizen surveillance of health
  services
       “Changes are not from night to day.
It seems to me that some doctors and mid-
   wives have begun to understand why we
           are doing this voluntary work….
                      little by little they will
    realize their work also gets improved”

                             Eusebia Atayupanqui,
                               Leader from Ayaviri