Achieving better health outcomes for all

"With the help of facilitators, we are no longer reluctant to voice our opinions." Citizen from East Nusa Tenggara Province

Citizens in the remote Indonesian province of East Nusa Tenggara have learned how they can create change in their communities. By collectively voicing their opinions about local health service provision and by engaging in solutions to improve these services, better health care can be achieved.

One example of this is the Maternal, Newborn and Child Health Project (2014-2018), which was funded by the GPSA and implemented by the partner civil society organization (CSO) Wahana Visi. The project sought to improve maternal and child health services across 30 villages in this remote and relatively poor province where more than half of children under five are stunted, and more than 20 percent of the population live below the national poverty line.

Using Wahana Visi’s ‘Citizen Voice and Action’ approach, the project worked with residents, service providers, and local officials at the village, sub-district, and district levels. It raised awareness of the rights and entitlements of these different groups and helped them develop plans collaboratively to enhance standards and the quality of services for mothers and children. Community scorecards were also used to monitor the quality of health service provision.

The project led to real change for these communities. This included a reduction in maternal and infant mortality, and an improvement in infant nutrition, which was at least partly attributable to the project. Local residents also gained a better knowledge of what types of health services were available to them and this also led to better resident relationships with health service providers, which contributed to increased use of these services.

Lessons for how citizens can create change

Research was conducted throughout the project to identify project results and the processes and factors that contributed to those results. The project created change in two key ways.

First, it empowered citizens to be part of the decision-making process. It also shifted power relationships within the local healthcare system. The very act of organizing the community to collectively voice their opinions both gave community members the confidence needed to speak up and made their opinions harder to dismiss. Some project participants explained that they have moved from a position of “participating and being told what to do,” to “participating and disagreeing, or suggesting what is to be done.”

Second, the project paid attention to strengthening the local healthcare system as a whole. By creating dialogue that included previously excluded stakeholders, and building collaborative relationships between citizens, local government, and health service providers, stronger information, more effective resource flows, and positive feedback loops were introduced within the system. As an evaluation of the project showed, these processes expanded the reach of the health system and improved access and delivery of quality services at the local level.

Creating a body of evidence from GPSA projects

Gaining insights into what brings about lasting change is at the heart of the GPSA’s mission. All projects funded by the GPSA have knowledge and learning elements that, over time, have resulted in a considerable body of knowledge on how social accountability can be applied to tackle poverty and improve service delivery, sector governance, and accountability in different contexts. That knowledge is embodied in the GPSA’s Theory of Action and available on the GPSA’s website.