As governments and the international aid community scramble to respond to the COVID-19 pandemic, direct citizen engagement in public health programs has already had a demonstrable positive impact on the success of these programs.
While governments in both middle-income and low-income developing countries face the pandemic with support from international aid agencies, the large-scale, rapidly disbursing programs strain weak public delivery systems and provide massive opportunities for fraud and corruption. Numerous reports have emerged detailing service shortfalls and corrupt practices within the administration of these programs. These practices include the marketing of counterfeit medical supplies, as well as inflated pricing of masks, protective clothing, and body bags.
Effective monitoring of public procurement contracting, and the distribution of assistance to ensure that the poor are fully served can reduce corruption levels. To achieve this end, civil society can play an essential, independent role.
Early results from ongoing COVID-19 response programs around the world attest to the crucial value-added in emergency healthcare response when citizen organizations and public authorities work together. The lessons learned from citizen-driven projects can optimize transparency and minimize corruption in COVID-19 response programs.
COVID-response civil society interventions, supported by the Partnership for Transparency Fund (PTF), have been implemented in two Indian states, the Gambia, Uganda, Ghana, and Argentina to help enhance the impact of their government’s COVID-19 response programs. Civil society organizations (CSO) in these countries have:
· helped to raise awareness of COVID-19 preventive measures through community outreach and media events
· provided safety hygiene kits to vulnerable communities and ensuring they receive their entitlements
· monitored procurement and distribution of essential medical equipment and supplies to hospitals, clinics, and patients
· worked with investigative journalists to unearth waste
· constructively engaged with authorities by providing feedback to improve implementation.
While a variety of mechanisms have been employed to improve COVID-19 response programs, the focus remains the same: citizen engagement and monitoring to ensure transparency improves final results and serves all citizens.
This model has been applied to past anti-corruption projects in the health sector, and proven effective. For example, in 2011, PTF supported the Anti-Corruption Coalition of Uganda (ACCU) — a current COVID-response partner — to reduce the leakage of critical anti-malaria medicines in Uganda’s Lira district. ACCU developed a monitoring framework and trained a field team of local women equipped with bicycles and cameras to document and confirm deliveries. Issues that surfaced from their observations were principally resolved through discussions with health officials and at village forums, and when appropriate, brought to national level authorities by a working group established through the program. As a result of the efforts of these Ugandan women, the stock of anti-malaria drugs in Lira began lasting two to four weeks, rather than disappearing within a week.
In Nepal, PTF partnered with Samuhik Abhiyan, a Nepalese CSO. This project focused on citizens, government, political leaders, the private sector, and the media to strengthen public awareness, create corruption monitoring committees (CMCs), and implement a number of instruments like citizen charters and score cards to monitor health service delivery. The project registered a 35 percent increase in health service attendance and poor patients began receiving 85 percent of their free medicines. Further, ten corruption cases were identified by the CMCs, six of which were settled.
Thus far the current civil society interventions undertaken by PTF partners have had a similar impact on public health procurement and supply within the context of COVID-19 response programs.
In India, despite restrictions on the availability of mobility permits during the lockdown, PTF’s partners in Odisha and Rajasthan have been able to distribute food and hygiene kits to families of migrant workers who lost their livelihood due to the nationwide lockdown. Further, by collaborating with local government authorities, they helped to identify families that were in the greatest need of assistance and connected them with social safety net schemes. They have also monitored quarantine facilities and migrant worker transportation to their home states, and helped to ensure that supplies were procured at reasonable prices. As the emergency relief phase comes to an end, these Indian CSOs have initiated a transition to focus on transparency, accountability, and control of corruption in the recovery programs.
Taking a creative approach to combatting corruption, SAVE-Ghana, a PTF country partner, has received an enthusiastic response from both citizens and government officials to its new call-in radio program The People Must Know, developed in collaboration with a local radio station. This program includes information about personal prevention of the disease, locations of testing sites, and where to seek treatment. The radio show also provides details about the intended beneficiaries of the large sums of money — provided by the Ghanaian government, the World Bank, and USAID — intended to combat the coronavirus. As a direct consequence of this radio show, community groups have increasingly questioned the relevant government authorities, seeking access to their entitlements. There is also a new, demonstrable willingness of power holders to engage and respond to community concerns and deliver tangible results. Leveraging airwaves and making use of widely accessible tools, SAVE-Ghana has bridged not only geographical but ideological distances between civil society and government by creating a trusted space in which citizens are no longer reticent to air their complaints and concerns, while at the same time giving officials direct access to the people they serve.
The projects in India and Ghana demonstrate the efficacy of this model of combatting corruption in the public health sector. By leveraging citizen engagement, CSOs are able to streamline services and ensure they reach the vulnerable populations most in need. These lessons learned are applicable across regional contexts.
Additional projects — where PTF has been able to support affiliates in other countries — have not yet progressed enough to assess their impact, but have been designed to employ a similar methodology. These ongoing projects have had encouraging initial results.
In Uganda, in Kasangati district, ACCU has focused its COVID-19 relief efforts on training health workers and community members to monitor service delivery. ACCU has also launched a public information campaign to inform citizens of their entitlements. Reports of inadequate supplies of personal protective equipment have already emerged, and ACCU continues to work with the relevant authorities to rectify these problems.
Poder Ciudadano, a PTF partner in Argentina, has already made significant progress toward increasing transparency in COVID-19 relief programs. Poder Ciudadano has developed a methodology for citizen monitoring of the storage, distribution, and delivery of critical medical supplies and equipment; created a national information system tracking COVID-19 financial flows from donors and state budgets to hospitals and clinics; and started a national network of CSOs trained in monitoring the delivery of critical medical equipment at the hospital and clinic level.
Ultimately, combatting corruption in the public health sector is not a new challenge, but in the era of COVID-19 and necessarily rapid response programs, opportunities abound to manipulate the system and take advantage of the vulnerable populations most at risk. However, past projects that trained CSOs to increase transparency in medical supply chains have resulted in significant improvements to the process. By applying these lessons learned to a COVID-19 context, PTF’s CSO partners have already had an impact on their countries’ response programs, and expect to produce further successes from similar initiatives.
However, this tried-and-true model of citizen engagement at times of crisis has not reached its full potential with regard to COVID-response programs. In too many countries, governments have used the pandemic to announce emergency powers that limit the activities of civil society organizations, curb the ability of CSO leaders and volunteers to travel, and impose new restrictions on journalists. The international community needs to raise its voice and protest these limitations. At stake is the ability of CSOs and media to achieve their full potential to ensure honesty in all aspects of public health services at this critical time.
In countries where such restrictions have not been imposed, too many CSO-led health-related projects remain unable to meet their full potential due to the chronic lack of funding needed to support such work. For example, ACCU in Uganda is ready and able to mount a country-wide COVID-19 monitoring program, but presently has no prospect of garnering the necessary financial support. For context, the support needed to enable this program would amount to less than 1 percent of the cost of the Uganda government’s total COVID-19 response expenditures. While most official aid agencies now articulate support for non-governmental actors that provide social services, financial support for monitoring service delivery typically remains absent.
It is critical that the leadership of donor institutions prioritize this issue and address the gap between words and deeds. The international aid community must commit to tangible support in order to unleash the full potential of citizen engagement. With the necessary funding for citizen engagement, the full impact of global COVID-19 relief and recovery effort can be realized.
Richard Stern is the president of the Partnership for Transparency.