Leveraging Communities’ Capabilities to Increase Accountability for Health Rights: The Case of Citizen Voice and Action

Abstract

Citizen Voice and Action (CV&A), a rights- and strengths-based social accountability approach developed in the global South, helps communities marginalized by unfair power relations to counter low accountability. By creating a dynamic of entitlement within communities and obligation by duty-bearers, it improves power relations and frees communities to build shared agency through reciprocity which advances health rights claims. After outlining capability theory and linking it to human rights, this paper explains CV&A’s origins in democratic struggles for rights and its current praxis. Using Ugandan case studies, it examines how people suffering its low accountability claim health and human rights by culturally engaging with each other and with duty-bearers. When interpreted as a set of collective freedoms and capabilities to struggle, social accountability helps explain how democratic action with and for communities at multiple levels aligns policy implementation with service performance to produce standards of public healthcare that community members value.

Keywords:

• Collective capabilities
• Social accountability
• Citizen Voice and Action
• Uganda
• Right to health
• Human rights
• Marginalized communities
• Reciprocity

Acknowledgements

Drafts of this article benefited from valuable comments and editing from Susan Blackburn, Andrew Newmarch, Terry Macdonald, Kris Argall, Jamie Edgerton, Neville Carr, Genny Walker, Betty Wamala, Stuart McKean, Jeff Hall, peer reviewers and editors. The author also thanks WVU colleagues, CV&A teams and community members and officials for providing extensive case study data and helping create CV&A from CBPM.

Disclosure statement

No potential conflict of interest was reported by the author.

ORCID

David Walkerhttp://orcid.org/0000-0003-2739-4401

About the author

David Walker is a part-time researcher at World Vision Australia and PhD student at Monash University.

Notes

1. On collective dimensions of the right to health, see Chapman (2016).

2. A 2010 photo shows a local official proudly displaying a sign at H stating no fees were charged.

3. Clinic records showed that in the first quarter of 2012 alone, 17 mothers served by this clinic died perinatally.

4. To facilitate comparability between findings from all clinics, WVU staff chose two “global criteria” (overall satisfaction with the quality of HC staff and satisfaction with the overall services and structures), which each community rated. Some communities also rated criteria they chose.

5. For Coalition details, see http://wrauganda.blogspot.com.au/2012/04/civil-society-coalition-on-maternal.html.

6. Previously WVU had catalysed coalition-led national CV&A dialogues in education (Walker 2016), indicating the importance of collective learning capabilities—not explored in this article.

7. The local CV&A team, together with local WVU staff supplied evidence in this paragraph.

8. CV&A calls dialogical action “dialogue.” Freire (1993, 125–183) says dialogical action emancipates communities when they are organized and cooperate with each other to appropriate and synthesize culture, opposing processes of anti-dialogical action which conquer, divide and manipulate the oppressed to entrench the status quo. This article and CV&A are indebted to Freire’s praxis.

9. While Ibrahim (2017) argues that collective capabilities are subject to being co-opted, the Case suggests that sustained focus on shared objective and intersubjective knowledge allied with solidary capabilities reduced such co-optation.