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

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