Citizen Voice and Action: Civic demand for better health and education services (2011)

• civic education;
• a community monitoring score card of local services, a social audit;
• monitoring of government standards;
• an interface meeting which brings together all stakeholders; and
• community-driven advocacy based on evidence gathered from the other activities.

The CVA Cycle (SOURCE)

Civic education teaches communities about their tangible rights to services under local law. It  also introduces national standards regarding teacher-pupil ratio; the ratio of pupils to textbooks; the maximum distance a child should have to travel to school; the number of nurses and midwifes that should be employed at a clinic; or the types of drugs that should be available etc. These standards are then compared to the reality in individual primary schools and health clinics. Communities rate services provided by their school or clinic through a scorecard, developing their own qualitative performance measures, such as “pupils well treated by teachers” or “monthly written tests” to monitor the school’s improvement or “no drug stock outs” to monitor the health clinic. This paves the way for constructive, evidence-based dialogue between communities, service providers and government officials.

Advocacy and Impact:

In relation to the right to health, J-PAL researchers used Randomized Control Trials to study the impact of CVA at 50 clinics in 9 districts of Uganda. After one year, relative to comparison villages, health facilities in treatment villages: 

• Experienced a 12-minute reduction in average wait time 
• Experienced a 13% reduction in absenteeism 

The treatment villages also showed a: 

• 33% drop in under-five mortality 
• 58% increase in use of skilled birth attendants 
• 19% increase in number of patients seeking prenatal care 

In relation to the right to education, Oxford University and Makerere University researchers tested the impact of the methodology in 100 schools in 2011 through a random control trial and found:

• 0.19 standard deviation increase in test scores (moving the average student from the 50th to the 58th percentile for academic achievement).
• 8-10% increase in pupil attendance.
• 13% reduction in teacher absenteeism.

Importantly, the researchers compared World Vision's participatory scorecard and an externally derived scorecard and found that only the participatory scorecard had impact. Moreover, communities using the participatory scorecard were 16% more likely to opt for collective action.

Further reading

Jeff Hall, 'Citizen Voice and Action: World Vision's Approach to Social Accountability' (Presentation). Link to source. 

Word Vision (2009), Citizen Voice and Action: Guidance Notes. Link to source.