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Reframing citizen-state relations from the bottom up - EVA-BHN's model of social accountability in Pakistan

Palladium’s Empowerment, Voice and Accountability for Better Health and Nutrition (EVA) project aims to empower, organise and facilitate citizens and civil society to hold the governments of Punjab and Khyber Pakhtunkhwa to account for the delivery of quality Reproductive, Maternal, New-born, Child Health and Nutrition services. Palladium implements EVA in partnership with the Centre for Communications Programmes Pakistan; the Centre leads on work with media and religious leaders within the project.

EVA is structured around a model of social accountability that facilitates local community groups to raise issues and demands related to health

In the second of our EVA case studies we explore EVA’s model of social accountability in Pakistan. Click on the DOWNLOAD button for full publication.

In a recent paper on social accountability projects, Jonathon Fox distinguishes between ‘tactical’ and ‘strategic’ social accountability projects. Tactical projects are bounded interventions that assume citizens will be spurned into collective action by the provision of information on the performance of those governing them or what could be called the old way of thinking about social accountability. Thus, they are limited to society- or demand- side efforts to amplify citizens’ voices and often focus on specific accountability tools, such as citizens’ score cards or participatory budgeting. In contrast, strategic approaches 'deploy multiple tactics, encourage enabling environments for collective action for accountability and coordinate citizens’ voice projects with governmental reforms’.

Fox positions strategic projects as more promising than tactical projects because they work on both vertical accountability, or citizens’ ‘voice’, and the mechanisms and institutions able to sanction underperforming service providers, which Fox terms ‘teeth’. This often involves the use of coordinated tactics, as in efforts to combine media campaigns and information on service provision with training for civil society organisations, and the creation of vertically integrated citizen-state interfaces at multiple governance levels, such as with front line service providers, departments responsible for service delivery and national oversight institutions. Fox’s review of the existing evidence base suggests that these ‘sandwich strategies’ can provide ‘bite’, address common problems such as the displacement of corruption or rent-seeking activities from one sector to another, and support the institutionalisation of horizontal and diagonal accountability mechanisms.

Building on experiences in Pakistan and elsewhere, EVA is structured around a model of social accountability that facilitates local community groups to raise issues and demands related to health, with a focus on reproductive, maternal, new-born, child health and nutrition services. When citizens’ demands cannot be resolved locally, either through a lack of traction or because they require broader policy changes, they can be raised within district and provincial level forums in which community members, civil society activists, state representatives and EVA staff engage one another. More broadly, the project works with Pakistan’s print and television media, and is building networks of journalists and religious leaders. These activities are designed to legitimise EVA’s activities, amplify the voices of its community groups, and to educate the wider population as to their rights and entitlements.

Just over half way through its lifecycle, EVA is noticing that that its efforts to link local citizens’ groups to forums at higher levels of Pakistan’s governance architecture are key to its early successes. Central to these links are civil society representatives that can engage and speak with high level bureaucrats and politicians. For example, EVA has found that journalists, heads of professional associations and religious leaders are all useful allies for raising the voice of citizens. Indeed, despite often being overlooked by the practitioner community, these actors have the skills and connections needed to carefully apply pressure on powerholders. As has been found elsewhere, often this pressure is applied outside of the project’s formalised forums and draws upon social norms that outsiders have trouble discerning. What is most important is that actors find ways of constructively engaging one another that lead to responsive governance.

In this sense, EVA’s evolving model of social accountability accords with Fox’s call for ‘strategic’ approaches that vertically integrate monitoring and advocacy efforts. Nonetheless, to get to this point EVA has sought to be adaptive, politically smart and locally led. As outlined in our [Reframing Citizen-State relations from the bottom-up] research paper, this includes consistent efforts to question its theory of change, and to react to emerging lessons from the field and political developments that change the lay of the land in the regions it works. Despite some significant early setbacks, this has enabled the project to build structures and relationships that span the state-society divide, and to create re-occurring opportunities for citizens to engage powerholders to demand their rights and entitlements. Although practitioners must always remain mindful of the fast-moving and fluid nature of politics in contexts such as Pakistan, EVA believes its experiences to date hold lessons for similar projects and we hope this case study will add to the growing body of evidence on supporting social accountability.