Citizens Engagefor Change Social Accountability for Better Public Services Omar Asghar Khan Foundation Published by Omar Asghar Khan Foundation January 2017 Lay-out and printing by Sense Communications Pvt. Ltd. This publication was made possible with financial assistance by Open Society Institute. Its support is gratefully acknowledged. Omar Asghar Khan Foundation Established in 1999, Omar Asghar Khan Foundation is creating opportunities for people, particularly the vulnerable, to collectively secure human and livelihood rights by strengthening their asset base and making Institutions and policies pro-poor. The foundation’s field-based work is primarily in Khyber Pakhtunkhwa. Its advocacy has a national focus. The Foundation has offices in Islamabad and Abbottabad. Citizens Engagefor Change Social Accountability for Better Public Services Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. Margaret Mead Contents 1. Introduction 2. Case Studies on Social Accountability District Kohistan Operationalizing a THQ tracking budgets for equipment/staff & working with the media Reconstructing a road destroyed by the 2010 floods using the RTI to access government documents District Abbottabad Improving tertiary-care facility holding governments to account on their pledges Upgrading rural healthcare tracking budgets for equipment/staff & building political support District Battagram Reconstructing schools destroyed by the 2005 earthquake sustained advocacy with multiple stakeholders 3. Conclusions Acronyms ANP Awami National Party BHU Basic Health Unit C&W Communications & Works CM Chief Minister CNIC Computerized National Identity Card DHO District Health Officer DHQ District Headquarter (hospital) EDO Executive District Officer ERRA Earthquake Reconstruction & Rehabilitation Authority HFA Health Facility Assessment KKH Karakorum Highway KP Khyber Pakhtunkhwa MPA Member of Provincial Assembly NGO Non Governmental Organization PC-1 Planning Commission-1 (a government project document) P&D Planning & Development PTI Pakistan Tehreek-e-Insaf RHC Rural Health Center RTI Right to Information THQ Tehsil Headquarter (hospital) UC Union Council UHAP Union Council Health Action Plan VC Village Council 1. Introduction Since 2013 the Foundation has adapted and intensified its strategies in Khyber Citizens have a right to access quality basic Pakhtunkhwa to benefit from opportunities services and participate in democratic for citizen-government interaction processes. For over a decade Omar Asghar provided by the local government set up in Khan Foundation is helping citizens to 2015, and, by enabling laws like the Right to know and claim this right. It assists them to Information Act 2013 and the Right to be more informed, skilled, organized and Public Services Act 2014. Among the confident in engaging with elected and Foundation’s repertoire of interventions is non-elected duty-bearers, to stimulate the promotion of citizen monitoring to public demand, and, to put pressure on the increase downward accountability and government to deliver quality services. responsiveness of public services to citizens, especially the more marginalized. The Foundation also helps strengthen the supply side of the governance equation by The Foundation designs and delivers assisting public representatives and tailor-made training for civil society government officials to be more responsive organizations helping them to become to citizens. familiar with social accountability and learn its different methodologies. It also assists The Foundation’s strong commitment to trained civil society organizations in equity is reflected in the priority it places on applying social accountability skills to working with and for marginalized groups monitor the government’s performance like the poor, women and the youth. and hold it to account. It helps citizens and duty-bearers better understand and benefit from the advantages of working together to achieve improved public service delivery and better development outcomes. Using participatory methodologies to support citizen monitoring in some of the poorest areas of KP 1 This publication documents the Foundation’s experiences of supporting social accountability in some of the poorest parts of Khyber Pakhtunkhwa’s Hazara region -- in the districts of Kohistan, Battagram and Abbottabad. It presents five case studies on civil society engagement with government for improving healthcare and access to schools, and, reducing the isolation of the very poor living in remote mountains. The case studies, categorized by district, give details of how civil society organizations, assisted by the Foundation, identified public grievances, developed social accountability strategies, gathered valid data, and, engaged with the government to address their problems. Beyond generating evidence-based demands for changing the conditions of public facilities, the case studies show how social accountability is making civil society organizations more vibrant and knowledgeable, capable of strategizing, analyzing and organizing. It is helping citizens become more familiar with their right to demand quality services and the responsibility of the government to deliver them. Citizens are more aware of ways to access information about government activities and decisions, the skills to evaluate their impact, and the will to engage in governance to change their lives. 2 2. Case studies on Social Accountability District Kohistan Three phenomenal mountain systems: Chronic poverty in Kohistan is compounded Hindukush, Himalaya and the Karakorum by high vulnerability to natural disasters, meet in Kohistan, explaining its name which is escalating as climate changes which means the land of mountains. The unfold. Affected people have little time to magnificent River Indus meanders through cope before the next emergency strikes. The the district’s tough rocky terrain spread past ten years, or so, are illustrative. The across 7,492 sq km1. According to a 2011 area and its people suffered a devastating assessment, Kohistan is the most deprived earthquake in 2005, militancy since 2007, district of the province, with about 70 per massive floods in 2010 and another cent of its population without adequate earthquake in 2015. health, education and other facilities2 . Women, children and the elderly are more Behind these statistics are lives that are vulnerable to this virulent mix of complex desperately poor. An estimated 470,000 challenges. Severe restrictions on their people3, living in small villages scattered mobility makes it hard for them to access across imposing mountains, survive on the painfully limited essential services minimal subsistence agriculture and available, impoverishing them further. off-farm uncertain income. Timber in the area has high profits but is controlled by just a handful. Many ancient tribal customs cause insecurity, worsened by more recent trends in militancy. 1 Pakistan Bureau of Statistics, (2006), Government of Pakistan 2 Haroon Jamal, (2012), Districts’ Indices of Multiple Deprivations for Pakistan 2011, Social Policy & Development Center 3 Pakistan Bureau of Statistics, (2006), Government of Pakistan 3 THQ complex in Pattan, January 2015 4 District Kohistan Operationalizing a THQ tracking budgets for equipment/staff & working with the media Kohistan has three Rural Health Centers (RHCs) and 37 Basic Health Units (BHUs). It Women Medical Officer was not does not have a District Headquarter available at any of the surveyed RHCs. Hospital (DHQ). Health Facility Assessment of District Kohistan 2012 In 2007, the government constructed an imposing structure for a Tehsil Headquarter The THQ complex was like an oasis in a Hospital (THQ) which was to replace the parched desert. But its 100-bed capacity, small RHC in Tehsil Pattan. The Omar operating theater, emergency care, and, Asghar Khan Foundation came across this doctors’ residence were hauntingly empty – THQ in 2010 while it was providing relief there was no staff, equipment, medicines, assistance to people affected by the furniture or essential utility connections. devastating floods that swept through Signs of neglect were everywhere, except a Kohistan’s valleys. shiny plaque on the entrance announcing its opening on 1st February 2007 by an MPA. Plaque announcing the THQ’s inaugural in 2007 Inside the forsaken THQ 5 The Foundation and its partners in Kohistan decided to push for operationalizing this oversized white elephant sprawled on the bank of River Indus. They started by tracking Khyber Pakhtunkhwa’s budgets since FY2010-11 to assess if funds were provided for equipment and other requirements for a functional THQ. The assessment confirmed that funds were Funds for THQ Pattan (P.Rs. in Millions) allocated each year since FY2011-12 but KP Budget FY Allocation Expenditure remained unused apart from Rs.52.38 2011-12 83.22 52.38 million spent in FY2011-12. The THQ remained forsaken. The local healthcare - 2012-13 21.33 staff continued to function out of the RHC 2013-14 21.41 - at Pattan. The case of Pattan’s THQ was 2014-15 21.41 - presented in public meetings, press conferences and in discussions with 2015-16 - - parliamentarians, political leaders and 2016-17 62.15 TBC government officials. Trained local activists kept a watch on the THQ for signs of activity. Citizens monitoring the incomplete THQ 6 Sustained public pressure prompted action. The Foundation collaborated with Geo TV In 2015, the debris in the THQ was cleared, to project the