2 Mainstreaming Social Accountability in Mongolia (MASAM) Project 3 4 Mainstreaming Social Accountability in Mongolia (MASAM) Project with national and local CSOs partners, quality of implementation to produce valid, and solid feedback on govern- local government officials and staff, and outcomes and documented evidence ment programs and services which service providers. of results. There are models that have can serve as starting point for collab- According to stakeholders, all sub- more than adequately covered all areas orative decision-making and problem projects harnessed multi-stakeholder of assessment and shown enough solving. collaboration and coordination to proof that the particular experience or 3. Exposure to and familiarity with gather feedback on access to and approach is ready for replica-tion and other social accountability models quality of health and education services scale, most notably that of Khovd and and approaches suitable to local in general, to specific and tar-geted Selenge. Mongolian context, apart from the service provision for tuberculosis All sub-projects were able to Citizen Report Card. patients, temporary residents, and demonstrate results in the ability of 4. Devising more formal and oral health. Assessment results were their initia-tive to improve service institutionalised ways of integrating gathered, consolidated and presented delivery, and have enough potential and main-streaming lessons from as feedback to decision-makers and for replicability and scaling up, it will their initial sub-project experience service providers as basis for action and/ do them well to address some areas and make their models a more or service improvement. Most action for improvement. Part 3 of the report permanent and regular feature plans (5 projects) were developed with discusses the individual sub-project of governance. One that seeks to direct participation from the CSOs while experience in greater detail and integrate citizen feedback and to 4 other projects were by the service proposes some actionable points at monitor results of service delivery. providers themselves (4 projects), the Aimag level. On the whole however, but including some level of inputs and MASAM as a project may also introduce recommendations from the CSOs. One interventions and activities as follows: project was unique in that it sought 1. Deepening understanding and to influence the improvement of the appreciation for social accountability procurement process by taking part in and citizen participation in decision- planning and contract implementation/ making, service delivery, and delivery. govern-ance, especially on the part Even as all sub-projects have been of local government counterparts successful in implementing their social and duty-bearers. accountability initiatives and activities 2. Strengthening local capacity for as planned, there are notable vari- project development and design in ances in the level of understanding and gen-eral, and in generating objective, 5 6 Mainstreaming Social Accountability in Mongolia (MASAM) Project Improving Health Services for Vulnerable Groups of People: The Dornod Experience 20 Inclusive Health Services in Govisumber Aimag 25 Introducing a Community Inclusive Monitoring Mechanism Sub-project in Khentii Aimag 30 Public Participatory Schools in Khovd Aimag 36 Participatory Health Service project in Khuvsgul Aimag 43 Improving the Tuberculosis Ward Services in the Aimag of Selenge 47 Reducing Oral Disease among Children in Sukhbaatar Aimag 52 Collective POWER in Uvs Aimag 56 Public Participatory Schools with Accountability in Uvurkhangai Aimag 61 Part 4: Conclusions and Recommendations 66 Key Lessons and Considerations for replicability and scale of MASAM Sub-projects 69 Some Recommendations 71 Bibliography 73 Annex 1: Interview Guide 74 7 8 Part 1: Background, Assessment Framework and Study Methodology Mainstreaming Social Accountability in Mongolia (MASAM) Project Background and Objectives of the Study Jointly funded by The Swiss Agency for Development As ten (10) aimag sub-projects are about to conclude Cooperation (SDC) and the World Bank (WB), the their implementation, the World Bank commissioned MASAM project (2015-2019) is being imple-mented an independent external assessment to un-derstand in 10 aimags and 3 Ulaanbaatar districts. implementation details and success factors in each of The program aims to mainstream social accountability the sub-projects. The assessment aims to recognize for more transparent, accountable and effective where sub-projects have per-formed exceptionally public resource management at national and local well in terms of social accountability process, results levels by: and impact, and sustainability. This assessment seeks to feed into two things: 1. Increasing the capacity of CSOs to hold government to account; and, 1. Internal and donor reporting; and 2. Strengthening the institutionalization of social 2. Interim project decisions on potential activities to accountability by improv-ing the effectiveness, scale up and replicate. formalization and sustainability of disclosure and participation mechanisms. Through social accountability, citizens in poor localities will have increased access to public decision-making processes and quality services. 9 10 Assessment Framework The framework for this assessment is present as the six (6) country projects These factors include, but are not limited adapted from RTI International’s study covered by Wetterberg, A., Brinkerhoff, to, history, processes, sociopolitical by Wetterberg, A., Brinkerhoff, D. W., D. W., & Hertz, J. C. (2016) structures, available resources, and & Hertz, J. C. (2016), “Governance and Wetterberg and Brinkerhoff (2016) capacities that affect identification Service Delivery: Practical Applications explain that social accountability of social accountability interventions of Social Accountability Across comprises the array of actions and and their outcomes and how social Sectors.” The study focused on six mechanisms-beyond the ballot box- accountability may be sustained. projects in different parts of the world, that engage citizens in holding the state As such, it is deemed important which applied social accountability to account. They further described that and strategic to implement social interventions on varying themes, such social accountability, from a normative accountability interventions at both the as health, education, and improved perspective, is providing venues for supply and demand sides; the supply- local government response capacities citizens to engage with the state and that side being the state’s capacity and and service delivery. Results from in itself contributes to good governance responsiveness, while the demand-side the authors’ scrutiny of the projects and effecting democratic values. From is the citizen capacities for exercising surfaced common elements among all the instrumental point of view, social social accountability (Wetterberg & the case studies despite the differences accountability is a means to an end. The Brinkerhoff, Chapter 9: Cross-Sectoral in country contexts, which constitute field of international development sees Social Accountability in Practice: the assessment framework adapted for social accountability interventions as a Findings from Six Cases, 2016). This is to this study. combination of citizens’ engagement facilitate not only citizen’s participation, Similarly for MASAM, the initiatives of with the state to express their views but also government’s creation of an the ten (10) sub-project grantees seek and needs and of officials taking enabling environment for participation to mainstream social accountability as responsibility or being held to account and expression and its responsiveness a regular and institutionalized approach for their choices and actions. to citizens’ views and needs relatively for governance, decision-making, Considering the international parallel to each other. and service delivery at the local level. development view of social Some examples of social accountability Therefore, assessing progress of sub- accountability, the assessment interventions cited for both the supply project implementation and the results framework suggests that social and demand sides are mechanisms generated from the intervention require accountability is largely influenced by for performance assessment and essentially the same elements to be macro- and micro-contextual factors. monitoring, user committees, Mainstreaming Social Accountability in Mongolia (MASAM) Project participatory planning processes, and The final element in this framework is sustainability, which refers to the advocacy training. continuation of social accountability efforts by local actors after project activities In terms of outcomes from social conclude (Brinkerhoff, Hertz, & Wetterberg, 2016). Evidence of sustainability of accountability interventions, Wetterberg social accountability may be seen through: (a) visibility of state responses; (b) and Brinkerhoff (2016) looked into government resources to respond; (c) political support for social accountability; three aspects: (1) governance; (2) and (d) attitudes toward citizen and state roles in service delivery. empowerment; and (3) service delivery. The authors define governance as the relationships between the state and citizens, referring to the following concrete examples of outcomes: (a) mechanisms for including citizens in state processes; (b) enhanced responsiveness to citizen’s concerns; (c) increased interactions between citizens and state actors; (d) improved government performance; and (e) stronger rights and protection for marginalized citizens. Models identified in terms of empowerment were: (a) citizen agency to exercise new opportunities for voice; (b) monitoring of government activities; and (c) enhanced civil society capacities. Tangible outcomes on service delivery include: (a) localized improvements in service delivery processes; (b) policy shifts to enhance service delivery; and (c) suggestive evidence of improvements The Assessment Framework as adapted: The Assessment Framework as adapted: in sectoral outcomes. Methodology 11 The assessment is both descriptive and diagnostic. It seeks to document actual performance of the sub-projects and to determine whether each sub- Data gathering for all the sub-projects was done through a combination of face to face interviews during field visits and project stakeholder meetings, 12 as well as through online/video/phone calls for projects that were not visited due to travel restrictions and time limitations. Respondents were informed and mobilized through the WB Country Office in Mongolia through email. English to Mongolian to English translation services during interviews were provided by the local consultant Tsunara Ann Purevtogtokh-Ganbold and Methodology translators hired by the Bank. Face-to-face key informant and group interviews were conducted during actual visits to the following project sites: The assessment is both descriptive and Date of diagnostic. It seeks to document actual Aimag Institutions/Respondents Visit/Interviews performance of the sub-projects and to Uvs 4-5 September 2017 Local NGO Coordinator and determine whether each sub-project Citizen Monitors has achieved its intended results based AGH Quality Department on the submitted proposals. It likewise Aimag Health Department looks more closely at barriers and Office of the Aimag Governor factors to more effective and successful Khovd 5-6 September 2017 School Director and Soum implementation of social accountability Governor ( — Soum) interventions as well as opportunities Aimag Education Department for replication and scale, both at the School Director, Parent Volunteers and Teachers ( — Soum) level of the individual sub-projects, and Local NGO Implementer (Policy for the MASAM Project as a whole. Group) Aimag Social Policy Department All sub-project grantees (aimags) under MASAM are expected to participate in the assessment but selection and actual Selenge 8 September 2017 CSO Network of Selenge interviews was according to actual Aimag Social Policy Department Aimag Health Department availability of respondents while data Aimag General Hospital gathering (ie. convenience sampling). The assessment was able to cover and Sukhbaatar 11 September 2017 CSO Network of Sukhbaatar interview representa-tives from the Office of the Aimag Governor Office of the Soum Governor national NGO partners/Coodinators and Aimag Health Department from among three key sectors of local Aimag General Hospital implementers: Khentii 12 September 2017 Local NGO Coordinator and CSO • Local government (aimag and soum Representatives level, when available) Family Health Clinic Aimag Health Department • CSO coordinators and citizen monitors Govisumber 18 September 2017 Local NGO Coordinator Aimag Social Policy Deparment • Service Providers (School or Health Aimag Health Department facility) Page 12 Mainstreaming Social Accountability in Mongolia (MASAM) Project Phone Interviews were likewise conducted with representatives from the following offices and aimags: Data gathering for all the sub-projects Uvurkhangai 14 September 2017 Aimag Social Policy Department was done through a combination of face Aimag Education Department to face interviews during field visits and School Director ( —-Soum) Local NGO Coordinator project stakeholder meetings, as well as through online/video/phone calls Dornod 14 September 2017 Aimag Social Policy Department for projects that were not visited due to Aimag General Hospital travel restrictions and time limitations. Local CSO Council Coordinator Respondents were informed and Khuvsgul 16 September 2017 Aimag Monitoring and Evaluation Department mobilized through the WB Country Aimag Social Policy Department Office in Mongolia through email. Family Health Clinic English to Mongolian to English Aimag General Hospital translation services during interviews Local NGO Coordinator were provided by the local consultant Gobi-Altai 16 September Local NGO Coordinator Tsunara Ann Purevtogtokh-Ganbold and Aimag Education Department translators hired by the Bank. Lastly, Face-to-face key informant and group Lastly, nationalUB-based national NGOs were UB-based NGOs convened for were convened for a focus group a focus group discus-sion discus- interviews were conducted during sion to clarify thethe to clarify theory of of theory change of their change respective of their sub-projects respective as well sub-projects as the as well actual visits to the following project assistance that they have provided to their counterparts. Present during the FGD as the assistance that they have provided to their counterparts. Present sites: held 15 September 2017 were representatives from Trans-parency International- during the FGD Mongolia, held 15 Mongolian September Education 2017All4Education Alliance, were representatives fromMongolian Trans- CSO coalition, Phone Interviews were likewise Public Health Professionals Asso-ciation, and MonFemNet. An interview with the conducted with representatives from parency International-Mongolia, Mongolian Education Alliance, Democracy Education All4Education Cen-ter was CSO coalition, September held 17 Public Mongolian 2017. Health Professionals Asso- the following offices and aimags: ciation, and MonFemNet. An interview with the Democracy Education Cen- ter was held 17 September 2017. 13 14 Part 2: MASAM and the Aimag Sub-projects at a Glance Mainstreaming Social Accountability in Mongolia (MASAM) Project In order to meet the objectives of the project and large. Key interventions at the MASAM project level to build on gains of previous piloting experiences, involved: MASAM has given particular focus on working 1. Design and implementation of a Social with local level stakeholders not only in terms of Accountability certificate course in collaboration increasing capacities for social accountability but with international and national training institutions also in terms of harnessing interests, awareness (Affiliated Network for Social Accountability in and capacity of citizens and communities to tackle the East Asia and the Pacific and the National and resolve issues at the local level and where good Academy of Governance). governance, citizen empowerment, and improved 2. Provision of grants for the implementation of service delivery are immediately and directly felt by social accountability mechanisms and initiatives the people, especially the poor. to tackle and resolve local issues in the health and education sectors. For this purpose, ten (10) aimag sub-projects were 3. Coaching and technical assistance support from chosen for capacity-building, funding and technical national NGOs. support, and provided opportunities to build effective collaboration with their respective local government units, service providers (in the health and education sectors), other local organizations and citizens at 15 16 The Social The Accountability Course MASAM for Implementers Sub-projects Prior to the implementation of the sub- During the training, participants were Ten (10) aimags were chosen as projects, a total number of forty six exposed to topics and sessions that priority areas for MASAM at project (46) participants coming from twenty will deepen their understanding of and incep-tion, based on a mixed criteria six (26) national CSOs, ten (10) local appreciation for social accountability of poverty incidence, readiness for SA, CSO representatives/coordinators, and the tools within the Public Finance and health and education development and ten (10) government counterparts Management cycle that they can deploy indicators. These aimags are Dornod, from the participating aimags attended for their respective sub-projects. Gobi-Altai, Govisumber, Khentii, Khovd, a 3-day training-workshop on Social Participation to the course was meant Khuvsgul, Selenge, Sukhbataar, Uvs Accountability. to help the national NGO partners and and Uvurkhangai. Stakeholders in the The workshop was designed and representatives from participating aimags were convened to de-sign and implemented jointly by ANSA-EAP animals in the development and implement their social accountability and NAOG in order to enhance the implementation of their social initiative based on a series of capacity participants’ capacity “to identify, accountability initiatives as part of the building activities. Guidelines for discern, and select context appropriate capacity-building interventions under selecting sub-project topics were social accountability tools that will help MASAM. based on stakeholder consensus on them engage their local government a local issue or “felt need”. Aimag towards an improved health and stakeholders met with and decided education service delivery.” on a national NGO partner, who served as their mentor throughout the implementation process. Key Topics and Sessions covered during the Social Accountability Of the ten sub-projects, 7 are in the Workshop (October 2016) Health sector, while the other 3 are in • Experiences of working with Government or Civil Society the Education sector. Majority of the projects sought to engage public sector • Social Accountability as an approach to Good Governance counterparts by assessing services and • Tools of Social Accountability providing feedback through the use of the Citizen Score Card (4); two (2) • Social Accountability Tolls in the context of the Aimag sub-project projects deployed the assess-ment tool proposals developed by the Mongolian Education basis for action and/or service improvement. Most action plans (5 projects) were developed with direct participation from the CSOs while 4 other pro- jects were by the service providers themselves (4 projects), but including Mainstreaming Social some level of inputs and recommendations from the CSOs. One project Accountability in Mongolia was unique in that it sought to influence the improvement of the procure- (MASAM) Project ment process by taking part in planning and contract implementa- tion/delivery. Association called the “Participatory The sub-projects profiles are summarized in the table below: The sub-projects profiles are summarized in the table below: Schools” model; two (2) other projects sought to measure stakeholder Sector Aimag Tool Used Approach feedback and satisfaction based on standards set by laws and government Citizen Score Card Participatory assessment and Health Dornod Service improvement planning policies (on procurement and primary health case services); one sub-project Education Gobi-altai Good School model Participatory assessment and planning conducted 3rd-party monitoring; one project deployed the “Good School” Health Govisumber Citizen Score Card Participatory assessment and Service improvement planning assessment tool developed by the national civil society coa-lition, named Standards of HHC Participatory assessment and Joint Checklist and Stakeholder service improvement planning “All4Education” . Health Khentii satisfaction survey In terms of approach to social accountability, all sub-projects Participatory Schools Policy analysis, Participatory model assessment and Joint (school- harnessed multi-stakeholder Education Khovd level) planning collaboration and coordination to gather feedback on ac-cess to and quality Health Khuvsgul 3rd-Party Monitoring Participatory assessment and Service improvement planning of health and education services in general, to specific and targeted service Citizen Score Card Participatory assessment and Joint Health Selenge service improvement planning provision for tuberculosis patients, temporary resi-dents, and oral health. Citizen Score Card Participatory assessment and Health Sukhbataar Assessment results were gathered, Service improvement planning consolidated and presented as feedback Procurement/Contract Participatory procurement planning, to decision-makers and service Health Uvs award checklist and monitoring and assessment Stakeholder satisfaction providers as basis for action and/ survey or service improvement. Most action Participatory Schools Participatory assessment and Joint plans (5 projects) were developed with Education Uvurkhangai model (school-level) planning direct participation from the CSOs while 4 other pro-jects were by the service providers themselves (4 projects), The sub-projects were also designed and implemented with technical sup-port and but including some level of inputs and coaching from UB-based national NGOs. The Democracy Educa-tion Center worked recommendations from the CSOs. One with the aimags of Dornod, Selenge and Sukhbataar, the MongolianPage Education 16 project was unique in that it sought Alliance worked with the aimags of Khovd and Uvurkhangai, the Mongolian to influence the improvement of the Public Health Professionals Association worked with Khuvsgul and Govisumber, procure-ment process by taking part in MonFemNet worked with Khentii, Transparency International-Mongolia worked with planning and contract implementa-tion/ Uvs, while the aimag of Gobi-altai was supported by “All4Education”. delivery. 17 18 Part 3: Assessment of the MASAM Sub-projects Mainstreaming Social Accountability in Mongolia (MASAM) Project This part of the report documents and assesses sub-project implementation according to the essential elements for effective social accountability practice as discussed in Part 1. Each sub-project report has three main parts: • Description of sub-project experience according to intent (as described in the project proposal) and actual implementation; • Documentation of outputs and outcomes according to the essential elements for social accountability (Social Accountability mechanisms, Outcomes as improvements in Governance, Citizen empowerment, and Service Delivery, and Sustainability); and, • Assessment of strengths and opportunities for improvement. 19 20 Improving Health Services for Vulnerable Groups of People: The Dornod Experience The sub-project in Dornod is The sub-project proposed to improve At the outset, the CSO council was aware implemented in partnership with the access to quality health services of the significant number of vulnerable Democracy Education Center (DEMO) by assessing the transparency and people in Baghs 1, 2 and 8, according entitled “Improving health services for delivery of public health services by to data from the Social Welfare Service vulnerable groups of people”. Together health centers. It is hoped that through and Social Insurance Departments. with the local council of CSOs in Dornod feedback from the results of the Citizen However, it was also felt that apart aimag known to have a long history and Score Card (CSC) survey, service from the lack of access to decent and sufficient organisational capacity, the providers together with concerned affordable health services, citizens sub-project was meant to make health stakeholders will develop a Service complained of difficulties in setting care services available to vulnerable Improvement Plan to make health appointments with doctors, having to groups of people. Targeted beneficiaries services and social insurance coverage physically wait in line after 3-4 attempts are the 2,922 identified poor citizens of accessible for the extremely poor and of securing such a schedule. The project the 1st, 2nd, and 8th baghs of the aimag vulnerable households and citizens. team resolved to use the sub-project center who are unable to receive health Immediately upon the start of project as an opportunity to improve health and medical care. implementation, the CSO council signed service delivery, improve the quality According to the proponent’s project a Memorandum of Understanding with and coverage for health services, proposal, Dornod aimag is inhabited the Aimag Governor’s Office which in and to ensure citizen At the participation in was aware of the sig outset, the CSO council nerable people in Baghs 1, 2 and 8, according to dat by 22,900 households or a total turn formally constituted the project fare Service and Social Insurance Departments. Ho population of 76,500, with 56.8% living implementation committee composed The Dornod Sub-project at a Glance that apart from the lac in the aimag center, 11.5% in the soum of representatives from 12 civil society and affordable health plained of difficulties in center, and 31.7% in the countryside. organizations, 8 citizens, 3 members of Lack of access to health with doctors, having to Dornod registers among the lowest the local CSO council, and designated services and health insurance coverage from Improved access to quality health services at the after 3-4 attempts of s among extremely poor aimag level life expectancy throughout the country, representatives from the Governor’s households ule. The project team with death rates extremely high among Office, Departments of Social Policy, Through: sub-project as an op health service deliver poor households who are unable to Social Insurance, and Health, Family An Assessment of and coverage for heal transparency and delivery avail of health insurance services due Health Clinic and Regional Diagnostic of public health services sure citizen participati to their lack of civil registration and and Treatment Center/Aimag General using the More concretely for go identification documents, no permanent Hospital, and the Secretary of the Citizen Score Card became the means to the medical insurance addresses, and poverty. Governor. In order to achieve above-mentioned objectives, th mented key activities as outline below: 1. In consultation with local project stakeholders, the to use CSC tool with DEMO, the national NGO pa day training workshop on the use of the Citizen S 40 volunteers. On the last day of the workshop, the Mainstreaming Social Accountability in Mongolia (MASAM) Project service delivery. More concretely for The assessment was conducted for were disseminated to citizens. government, the project became the and with two Family Health Clinics Senior doctors and consultants means to enroll 219 citizens into the and the Regional Diagnostic Center/ have allocated a day each week medical insurance system. Aimag General Hospital. to conduct checkups/visits in their In order to achieve above-mentioned 3. The CSC survey was participated in respective wards and departments, objectives, the project team by 112 hospital/clinic staff and 234 and started to see patients from implemented key activities as outline people from among the identified rural soums even without prior below: vulnerable groups of people appointments. Because of this according to the Bagh Governor’s new system, medical advice was 1. In consultation with local project provided to 1,450 vulnerable stakeholders, the CSO council Office. citizens. To improve personnel decided to use CSC tool with DEMO, 4. Organized face-to-face meetings behavior, the hospital invited a the national NGO partner, conducting discussed the results of the CSC trainer from the National Health a 3-day training workshop on the use assessment to develop a service Development Center to give a of the Citizen Score Card attended improvement plan. The Regional training for hospital staff. by 40 volunteers. On the last day of Diagnostic Center/Aimag General the workshop, the participants: 1) Hospital conducted awareness identified the major issues they will sessions for their personnel and conduct the assessment on using formulated an action plan with the the CSC tool; 2) reviewed laws and Hospital Director providing guidance regulations; and, went on field to in the action planning process. observe how the social insurance 5. The implementation of the 3-month program was being implemented. service improvement plan resulted 2. As agreed with project stakeholders, in specific courses of action meant the CSC survey was focused on to resolve issues or areas of challenges and difficulties in receiving weaknesses as identified during medical services, particularly the the CSC survey and face-to-face behavior and ethics of medical dialogues. Most noteworthy are: personnel towards patients. The CSC • On the part of the Service survey was designed to assess five Provider (Regional Diagnostic areas which were: Center/Aimag General Hospital): • Attitude/ethics of medical staff; Revision of procedures to ease • Workload of medical staff; the workload of personnel and make setting appointments easier • Public health education; for the patients. Information • Setting hospital appointments; and, on services and procedures for availing these services (through 2 • Implementation of related newly set-up customer hotlines) legislation. 21 22 Sub-project Outputs and Outcomes As discussed in Part 1 of this report, behavior of medical personnel, Department, the sub-project has each sub-project was observed and workload, securing appointments for allowed them to pay close attention to assessed for actual results across services, health education, and the complaints and conflicts confronting essential elements for an effective social insurance system. service delivery. One key learning point social accountability intervention. Attended by 52 participants from various was that listening to inputs from CSO The following sections document and government offices, service providers, counterparts “paves the way for making discuss the case of Dornod: and CSO council members, the group policies and programs more relevant to endeavored to arrive at a 3-month the needs of the citizens.” service improvement action plan with In order to follow through and coordinate 25 specific tasks for implementation by activities on government commitments, 1. On the SAC Intervention Design to identified accountable offices. the Aimag Governor’s office formed a improve supply and demand sides of task force (albeit adhoc) of 7 members, governance and accountability including the heads of the Social Policy, The conduct of the CSC survey, 2. On Outcomes: Concrete Deputy Governor’s Office, and Soum participated in by both citizens and improvements in local governance, Governor’s Office. service providers, has allowed for the citizen empowerment, and health service delivery. Empowerment: Eight (8) local civil identification of issues confronting society organizations with individual health service delivery, especially Governance: The Aimag Department mandates were able to work together on the differing perceptions of the of Social Insurance was able to identify in the sub-project united by the two concerned parties regarding the and register 148 new beneficiaries sole purpose of advancing social behavior/ethics of medical personnel to the social insurance system and accountability. Seen by government towards patients. Despite the provided them with information on as capable counterparts in doing differences on perception and actual how to avail of and participate in government’s work, the network and rating, stakeholder feedback from the government programs. Government the individual CSOs are perceived as results of the CSC was used as basis officials for their part, realized that being “able to see issues on the ground and starting point for discussions during service delivery is not the sole work better than government officials do”, face-to-face meetings between patients of government and that citizen according to an official from the Social and medical personnel. Specific criteria participation is important especially in Policy Department. While one member and areas of assessment became terms of identifying problems, taking of the CSO coordinating team had the springboard for such dialogues action for its resolution, and acting some background in research and the to happen and set the parameters for as channels for bringing information conduct of surveys, all participants collective action planning regarding down to citizens. For the Social Policy were new to the CSC technology. It was Mainstreaming Social Accountability in Mongolia (MASAM) Project (Actual sample of) Citizens’ Rating and Recommendations • Developed procedures to improve (Survey prior to implementation of Service Improvement Plan) culture for service and developed Assessment Areas Rating a system to secure information on On service to provide health education 35.5 (Poor) medical services; On communication & ethics of health 39.4 (Poor) • Organized an open-door day Professionals to improve health education of On service for getting an appointment 31.9 (Poor) vulnerable groups of people; Recommendations: • Funding for the purchase of dental • Conduct one a month training for the public in an interesting way equipment, establishing a room • Regularly broadcast health education/training on all local TV stations for public health education and for • Conduct regular training for HCC doctors and nurses waiting senior citizens. • Make the evaluation routine noted by DEMO that the implementers which they secure appointments with 3. On mechanisms for sustainability. quickly learned the tool and were doctors and the behavior exhibited There is a resolve on the part of able to take advantage of their good by medical staff. Officials from the the service provider to conduct an communication channels and rapport Regional Diagnostic and Treatment independent assessment once a year, with local government officials and Center have initiated steps and concrete on top of the stakeholder satisfaction service providers. action to address issues identified in the survey which is mandated by the state CSO counterparts were instrumental CSC survey. Health Department. Although financial in making citizens aware of laws While the formulation of the service resources are uncertain at the moment, and regulations on: 1) standards for improvement plan did not involve the it is being proposed for inclusion to and health service delivery (e.g., PWDs and CSOs or citizens, feedback was used to funding under the Local Development Senior Citizens should be immediately determine areas for improvement which Fund, subject to the approval by the attended to); and, 2) social insurance in the second round of assessment was local council. coverage, reimbursement for out- rated significantly higher (from 35.6% The Social Policy Department, through of-pocket expenses. CSO council to 54% satisfaction rating). This was its existing monitoring and evaluation members realized that participation realized through action on the following (M&E) system, will likewise explore is an important aspect of governance areas: integrating CSO monitoring and include in terms of identifying problems and • Hospital units now have journals it in their 2018 budget proposal. No seeking their resolution. on which citizens can write their other more definite course of action or Service Delivery: After the conduct feedback on services and how they decision has been reached at the time of the first assessment, two areas availed of medical attention and of the interviews. were evaluated by citizens lower than services; what the service providers assessed • Conducted training sessions to for themselves. With this came the address attitude and behavior of realization that patients and citizens medical personnel; were not satisfied with the manner by 23 24 Assessment and Recommendations It is worth noting that the local CSOs (service provider) and meant almost • Greater involvement and have been credited for establishing entirely to improve how medical accountability over the tool and tool good communication channels and personnel relate with and behave develop-ment will ensure not only rapport with local officials and the towards patients. ownership over the process but also ser-vice provider. While the approach • Action instituted by the Governor’s local em-powerment and confidence and technology of social accountability office involved creating an inter- to run a similar citizen monitoring through the CSC tool is new for them, agency task force to follow through assessment on other government they are said to be technically profi- on and coordinate activities but noth- programs and services. Time and cient in the conduct of surveys/ ing concrete or sustainable was resources may have understandably research. However, for future social ac- identified as to how the concerned been tight but a more helpful countability engagements to become offices can contribute to service process would have been for the more effective and sustainable, it will be improvement apart from facilitating local stakeholders to develop the helpful to address the following issues: the registra-tion of 148 new questionnaire on their own with the • While social accountability is beneficiaries and raising awareness guidance of a more experienced understandably a new concept and on laws and regula-tions governing social accountability practitioner ap-proach to governance, it will social insurance. (e.g., UB-based NGO or peers). be beneficial for CSOs and local • There is an existing institutional • The use of the CSC as a tool for stakehold-ers, and for ensuring the mechanism for internal monitoring advancing citizen engagement transfer of technology to have them by the M&E Department of the aimag and so-cial accountability has its be respon-sible for formulating the as well as a desire to integrate citizen strengths and advantages. It has its assessment tool, and not just be monitoring but it does not have clearly own set of limitations as well. It will recipients of the tool, questionnaire, defined purposes and parameters, be beneficial if stakeholders undergo and methodology as developed nor a deeper understanding of social a more thorough process of problem by the national NGO partner. On accountability and its possible con- identification and analysis of issues a more fundamental level, local tribution to governance apart from con-fronting public sector services CSOs can benefit from a deeper using the approach to inform citizens and programs to determine the most understanding of and exposure to of existing programs and services. ap-propriate and relevant tool/s to social accountability practices in use. While the CSC is helpful in getting similar contexts. Should local stakeholders in Dornod constituents to provide feedback on Aimag wish to sustain the social ac- government programs, its user will • Majority of tasks and commitments countability initiative, the following are to the Service Improvement Plan run into technical issues of sampling recommended: and making generalizations on were the responsibility of the hospital Mainstreaming Social Accountability in Mongolia (MASAM) Project • The use of the CSC as a tool for advancing citizen engagement and so- Inclusive cial accountability has its strengths and advantages. It has its own set of limitations as well. It will be beneficial if stakeholders undergo a more Health thorough process of problem identification and analysis of issues con- fronting public sector services and programs to determine the most ap- larger trends of the population and and almost unnecessary (surveying Services in propriate and relevant incur unnecessary approach to the constituents coststool/s problem could to provide whentothe feedback use. While 1,120the people have on government is helpful CSC through identify 260programs, getting theinCSC) vulnerable citizens to its userwho will Govisumber been simpler issuesIf and faster. the needed core and social insurance. on larg- run into technical of sampling issue that the sub-project sought er trends of the population and incur to address was the lack of access making • unnecessary generalizations Institutionalizing a mechanism costs generating for when the ap- and processing citizen Aimag proach to health the problem to services due tocould non- been feedback their have simpler and faster. If the core is- The sub-project in the aimag of into the existing internal registration sue that the the social insurance tosub-project sought to address was mechanism monitoring the lack of of access the aimagto Govisumber is implemented in program, health a social services due audit exercise to their non-registration to the is government social insurance a notable pro- concern. partnership with the Mongolian Public (or even the Community Score While there is Score an expression of Health Professionals’ Association Card) a gram, social would audit have exercise allowed them(orto even the Community Card) would (MPHPA). De-signed to improve the desire to do so in the next fiscal have allowed identify themerrors exclusion to identify and exclusion then errors and then immediately have provision of health services and the year, this still needs to be formalized immediately the concerned have agencythe enrol concerned citizens to the and program. made more While it was actually systematic, clearly referral system for patient transfer agency enrol citizens to the program. indicating roles and responsibilities across tiers of service providers, the done in the case of the Dornod sub-project (with 148 citizens registered to While it was actually done in the case sub-project used stakeholder feedback the program of the Dornodas a result of sub-project (with project),of the148 CSO the monitoring route and the to get there mayprocess have specifically on the ethics, attitude, and with which this can be integrated into citizens been registered costly to the and almost program (surveying unnecessary the for-mal1,120 people through the M&E system. behavior of medical personnel. The as a result CSC) project), of the260 to identify the route vulnerable citizens who needed social insurance. feedback was gathered through the to get there may have been costly Citizen Score Card assessment in order to address citizen dissatisfaction with medical services and medical personnel. Targeted to cover the residents and households receiving services from the Aimag General Hospital, Soum medical centers and Family household clinics, citizen feedback was used to improve the delivery of services in compliance with Decree 307, 2009 so that AGH ward personnel provide medical counseling and other services even without securing prior appointments. 25 medical personnel. The feedback was gathered through the Citizen Score Card assessment in order to address citizen dissatisfaction with medical services and medical personnel. Targeted to cover the residents and households receiving services from the Aimag General Hospital, Soum medical centers and Family household clinics, citizen feedback was used to improve the delivery of services in compliance with Decree 307, 2009 so 26 Sub-project that AGH ward personnel provide medical counseling and other services implementation in in terms of ethics and behavior of even without securing prior appointments. Govisumber was led by the Social Policy medical personnel, professional The Govisumber Subproject at a Glance Department According the Aimag ofproponents, to sub-project residentsGovernor’s skills and capacity, access to Citizen dissatisfaction with Improved provision of health services, referral office of Govisumber who able to the chaired are not working avail of suffi- group information on health services and medical services and ethics, behavior and system for patient transfer across tiers and access to at the aimag level. Even as there was cient health services because of their lack of programs, and time spent for/during attitude of medical information on health information on, resource allocation for, and personnel services no formally constituted and organized weak participation in the provision of health medical appointments. FHCs were Through: council services. Despite coalition orthe of local many and varied reasonsCSOs, sub- assessed for the ethical behavior whyproject implementation was supported service provision is not up to par with re- and attitude of medical personnel, An Assessment of service quired standards of quality, the attitude and provision by Family Health Clinics and the by the cooperation of four local NGOs. sufficiency of human resources, and behavior of medical personnel was of primary Aimag Hospital Through a decree issued by the importance to stakeholders because of mani- the implementation of the referral using the and felt issuesthe fest Governor, project in securing task force was appointments, system. A total of 1800 citizens Citizen Score Card weak constituted communication by of medical person- from the representatives skills participated in the survey, with nel, the failure of self-assessment processes to surface issues that citizens According to sub-project proponents, Governor’s office (through the Social are not happy about, the stress, and pressure from extended and heavy 1003 citizens as respondents on the residents of Govisumber work hours are not being able passed Policy Department), Health Department, on to patients. Aimag Hospital Assessment, 797 to avail of sufficient health services Family health clinic, NGOs, and citizens respondents for the assessment of because of their lack of information representative. Initially put on the defensive, medical personnel resisted the assessment the FHCs, and a counterpart of 37.6% and feedback. They, however eventually understood that the desire to im- on, resource allocation for, and weak In for prove service provision, especially order to improve vulnerable households theand toquality pro- of and of total comprising hospital staff. participation in the provision vide the public ofwithhealth the necessaryaccess to through information health services, organized more spe- and col- 4. Conducted face-to-face meetings to services. Despite thelective many and of feedback varied NGOs and citizens, generated from an objective and cifically to improve the ethical behavior formulate the Service Improvement organized process. reasons why service provision is not of medical personnel through feed- Plan which was agreed on by 25 up to par with required standards of back from the CSC, thePage 28 following key participants composed of representa- quality, the attitude and behavior of activities were implemented by the tives from the Aimag Governor’s medical personnel was of primary Aimag working group: Office, Health Department, Aimag importance to stakeholders because Gen-eral Hospital, citizens, and local of manifest and felt issues in securing 1. Conducted meetings with local NGO partners. appointments, weak communication residents to identify problems skills of medical personnel, the failure confronting access to and quality 5. Implemented activities and of self-assessment processes to of health services. There were two interventions as identified in the surface issues that citizens are not rounds of meet-ings held with local Service Im-provement Plan. The happy about, the stress, and pressure organizations and government local NGOs organized appreciation from extended and heavy work hours offices which allowed the group to events for hos-pital staff to change being passed on to patients. narrow its focus and identify the sub- their attitude towards and get their project to be imple-mented. support for the project. The Aimag Initially put on the defensive, medical Health Department for its part, personnel resisted the assessment and 2. Invited the Democracy Education introduced the E-Health Registration feedback. They, however eventually Center (DEMO), another MASAM Pro- gram partner but not for Govisumber, system as a means for citizens understood that the desire to im- to secure appoint-ments with prove service provision, especially to provide a training on the use of the CSC. medical personnel without having for vulnerable households and to to physically queue up long hours provide the public with the necessary 3. Organized two survey teams. One and conducted a series of training information through organized and assessed the Aimag General Hospital, for medical personnel to make them collective feedback of NGOs and the other looked into the Family more customer-oriented and patient citizens, generated from an objective Health Clinics (FHCs) . The Aimag with clients. and organized process. General Hospital was assessed Mainstreaming Social Accountability in Mongolia (MASAM) Project Sub-project CSC survey given the high turnout of respondents from among the identified poor and vulnerable households. Citizen 2. On Outcomes: Concrete improvements in local governance, citizen empowerment and health Outputs and re-spondents, as well as their service providers, were asked to evalu-ate health service delivery. Governance: The Aimag Governor’s office Outcomes service provision using a scoring system of 0-100, with 100 as the highest rating. has actively participated in the project. It facilitated activities including face- The rating was on the areas for assess- to-face meetings through the Social ment agreed upon by the project Task Policy Department. Through the formally Force. These were on: Ethics and behavior desig-nated task force, the Office of the This sub-project was documented and of medical personnel; Professional Skills; Governor is directly oversaw and followed assessed utilizing the essential ele-ments Access to information on health services up on activities and commitments made for an effective social accountability and programs; Time spent in access- by the health de-partment and the service intervention as presented earlier. The key ing services; and the Referral system provider as outlined in the Service Im- points are discussed below. (specifically for FHCs). provement Plan. 1. On the SAC Intervention Design to According to citizens that participated In one of the face-to-face dialogues improve supply and demand sides of in the survey, all areas of as-sessment between NGOs and govern-ment governance and accountability “needed improvement”, compared to offices, one of the identified needs of the higher rating that service providers the hospital was the es-tablishment of At the beginning of project implementation, accorded themselves (e.g., citizens the team endeavored to involve citizens a cardiovascular ward. The office of the assessment on ethical behavior had an Governor has requested for funding from from the targeted areas in the initial average of 41 points or “poor” as against analysis of the situation. international donor organizations but the self-assessment rating of 87 points). was declined. The local government has This was to help focus the initiative and On the other hand, formulation of the decided to submit the pro-posal to the identify the specific problems confronting Service Improvement Plan in-volved central government for inclusion to the health service delivery in the aimag. representatives from the local NGOs, public investment program, as such cost Citizens and CSO participation was given together with the Aimag Governor’s is more than what the aimag government importance in the formal constitution Office, the Hospital’s management team, can bear. The request is already in the of the Task Force. As decreed by the and the Health Department. From out 2018 Aimag action plan, just the same Governor, there were members nominated of this exercise, the task force was able from among citizens’ representatives The Social Policy Department for its part, to identify eight key tasks and activities claims to have a clearer understanding and the local NGO partners, together which included the es-tablishment of an with representatives from the Aimag of the CSC/citizens’ assessment and ethics committee, the conduct of training monitoring, and has drafted a local Governor’s Office, the Health Department, activities to improve the attitude and and the service provider - the Family monitoring regulation to include a behavior of hospital staff, and ensuring CSC compo-nent in its monitoring and Health Clinic. sufficiency of human resources (to serve evaluation work. Citizen participation continued to play temporary residents on top of the regular a significant role in the conduct of the clients being served by the hospital). 27 28 The proposal will be pre-sented for improvements according to survey not medical professionals themselves. approval at the Aimag Council meeting. respondents. Moreover, they note that But given prior work on monitoring the Empowerment: Prior to MASAM there is now a nar-rower gap between implementation of the Local Development sub-project implementation, NGOs in the assessment scores given by the Fund and the experience of sub-project Govisumber did not have any experience citizens and medical personnel. Customer implementa-tion that has allowed NGOs collaborating with each other. While the satisfactionis in fact reflected not just in to establish a working relationship with coordinating NGO had some experience the survey results but in the documented government plus an openness to and implementing projects for international reduction of com-plaints received. recognition of citizen monitor-ing, there organizations like Mercy Corps and Certain action points in the Service is willingness to continue working with the German Agency for International Improvement Plan have yet to be citizens in the planning, budgeting for and Cooperation, it did not have working implemented, but concrete steps have spending of the LDF. relations with other NGOs in the area already been taken to ad-dress them For the Aimag Governor’s Office, and, more so, with the government. For such as the introduction of the E-Health mechanisms for sustainability are the NGO counterpart coordinator, sub- Registration system as a means for being explored by incorporating citizen project implementation meant that levers securing appointments and referring monitoring in the health de-velopment had to be pushed for local NGOs to work clients to/from the Family Health Clinic program of the 2018 Action Plan. Past collaboratively with each other, towards and the Aimag General Hospital. The experience has been that results of a common agenda of working with and hospital, through its newly established internal assessments by the hospital making the local government accounta- Ethics Committee has likewise drafted was not reported to the public and were ble to its constituents. guidelines in dealing with medical treated as part of internal proce-dures. Service Delivery: Despite the many personnel report-ed for misconduct or Recognizing that citizens are important issues confronting health ser-vice inappropriate behavior. In relation to this, stakeholders in policy and decision- delivery in Govisumber, stakeholders (in to help ensure that patients feel fully taken making, the Social Policy Department government and the NGOs themselves) cared of and attended to, the FHC Director wants to make monitoring an annual have identified the behavior and attitude of has banned the use of social media and provision in the plan, and that results med-ical personnel as the most pressing ordered the blocking off of access to wifi will be made public and shared to the issue that they wanted to as-sess and give connection during clinic hours. local council so that such feedback can feedback on. All commitments in the action plan will be be incorporated in plan formulation and monitored and followed through the Ethics decision-making. Admittedly for the Health Department, changing behavior may take a long time Committee which is likewise tasked with For the Family Health Clinic, there is and will also require ad-dressing the institut-ing prevention measures against expressed willingness to em-ploy the more fundamental issues confronting and to correct violations on staff ethics. CSC at the FHC level and work with the health service delivery (such as funding 3. On mechanisms for sustainability. local NGO to as-sess the FHC services and the hiring additional personnel and, twice a year. Results of which will also be The NGOs feel the need for further reported to the public. perhaps, even social insurance coverage). capacity building in gathering and They however noted that in the second providing feedback to government. In round of assessment conducted five assessing health service provision, there months later, af-ter the conduct of face- was hesitation due to lack of information to-face meetings and training activities for on the sec-tor mainly because they are hospital staff, there have been significant Mainstreaming Social Accountability in Mongolia (MASAM) Project need more strategic and integrated • Effective social accountability initiatives Assessment and solutions across governance levels, are built around a common and sound Recommendations and not just superficial and band- understanding of the role citizens and aid solutions that at best only help citizen feedback can play in governance Having chosen to focus on the attitude appease zation of thecitizen Local dissatisfaction Development with and decision-making. Fund where there is clearly More somethan just level and behavior of medical personnel as ser-vices. Mobilizing volunteers, the being channels of interest and technical capacity on the part of local NGOs to design the for communication and against the many and more fundamental conduct of massive surveys, gathering, information dissemination, government processing methodology appropriate and presentingfor and feedback. gathering citizen stakeholder citizens groups should see issues confronting health ser-vice delivery in the Govisumber Aimag, • feedbacksocial Effective accountability require initiatives themselves not just technical are built around a common as partners and in decision- sub-project stakeholders were able to knowledge sound and skillsofbut understanding role citizens making the significant and pro-gram and citizen feedback implementation can play in identify specific and concrete measures material resources as well. The Health in the spirit of constructive engagement. governance and decision-making. More than just being channels for that will help resolve such con-cern. Department already recognized that Citizen monitoring and mechanisms for communication the behavior and and information attitude of medicaldissemination, sustaining government the effort and citizens in Govisumber However, given the narrow and shallow focus for gathering feedback and personnel groups should Aimag General the themselves at see is not as partners yet a shared value in decision-making among and pro- mobilizing citizen participation, it has Hospital gram and Family Health implementation Clin-ics in the spiritare stakeholders. of constructive NGOs do Citizen engagement. not feel not allowed for more strategic and brought about by even bigger issues in competent in assessing government monitoring and mechanisms for sustaining the effort in Govisumber is not programmatic responses to health the health sector. Should stakeholders services and programs. Government yet a shared wish value among to involve citizens stakeholders. in more sees NGOs do not NGOs feel competent as vesselsinfor mainly service delivery, especially on the part of local government. and programmatic strategic government assessing services issues, information and programs. dissemination. Government sees NGOs Service a good starting point will be to focus providers viewed the sub-project as mainly as vessels for information dissemination. Service providers viewed At the time the interviews were on the planning for and utili-zation of the means to narrow the gap between conducted and at the conclusion of thesub-project the as the means Local Development Fundtowherenarrow the gap between medical personnel medical person-but and citizens, sub-project implementation, health nel andis there citizens, but only clearly some in of level sointerest far as providing only in the latter so far an opportunity as providing to an the latter department officials were cognizant technical capacity and understanding on the part ofof theopportunity gainthey to that understanding gain of the struggles former so “will com- of of the underlying issues why medical local NGOs to design the appropriate the struggles of the former so that they personnel behave the way they do plain less when they are not immediately attended to”. methodology for gathering citizen “will complain less when they are not towards patients. While it does not feedback. immediately attended to”. justify the behavior, hospital staff are passing on the stress to patients and are unable to provide them the attention that they deserve, due to the fact that the hospital and family health clinics are un-derfunded, understaffed, yet overloaded with work. In terms of social accountability practice, the following might have to be ad-dressed in order for more effective collaborations in the future: • Need for greater clarity of purpose and approach to solving systemic problems (regardless of sector) that 29 30 Introducing a Community Inclusive Monitoring Mechanism Sub-project in Khentii Aimag Primary health care in Khentii, as in other Focused on working with two HHCs Sub-project implementation in Khentii aimags, is provided by Family Health (the first serving the most populous was led by UB-based NGO Mon- Clinics (also referred to as Household community in the aimag center and the FemNet, in partnership with local NGOs Health Centers or HHCs) which are second for the remote, more vulnerable and their monitoring teams orga-nized private, voluntary health organizations communities), the sub-project in Khentii for the purposes of the project, two contracted by government. Service sought to improve service quality (2) HHCs whose contracts were up for provision is bound by a contract signed and access to primary health care by renewal, and the concerned offices of by the Aimag Governor and the Head of introducing a third-party monitoring the Aimag Governor. the Health Department. This contract mechanism in the performance The local CSO network has 20 active includes provisions for performance assessment of HHCs. Us-ing standards members, out of which 9 organizations which are private, voluntary health organizations contracted by govern- assessmentsment. which however do not and provisions mandated by the Ministry Service provision is bound by a contract signed by the Aimag Gover- were selected to be part of the take into account stakeholder nor and the Head of thefeedback of This Health Department. Health contract and includesas stipulated in the provi- implementation team, complemented and is perfunctorily performance assessments whichcontract sions for renewed. however do notHHCs, for take intocitizens ac- are likewise by 10 people from the bagh areas expected to evaluate the performance count stakeholder feedback and is perfunctorily renewed. where the HHCs were located and The Khentii Sub-project at a Glance of the HHC as well as contractual Focused on working with two 4 representatives from the local obligations HHCs of the (the first serving mostother signatories thetwo government. Upon signing of the – the populous the aimag and the Health Aimag inGovernor community Memorandum of Un-derstanding, the Improved primary health Poor service quality and access to primary health care care services in compliance with contract Department. center and the second for the re- Head of the Social Policy Department stipulations mote, more vulnerable communi- The results were taken into consideration ties), the sub-project in Khentii was designated to represent the Through: and given weight in the assessment and sought to improve service quality Governor. Inclusion of 3rd-party and access to primary health care monitoring in the renewal of contract with the HHC and Being part of the local project by introducing a third-party moni- performance assessment of the parties to the HHC in the action planning process with the toring mechanism in the perfor- implementation team, the CSO network contract (HHC, Aimag Governor, Health Dept.) Governor’s mance assessmentOffice. of HHCs. Us- coordinator was part of several crucial ing standards and provisions man- dated by the Ministry of Health and as stipulated in the contract for HHCs, citizens are likewise expected to evaluate the performance of the HHC as well as contractual obligations of the two other signatories – the Aimag Governor and the Health Department. The results were taken into consid- eration and given weight in the assessment and renewal of contract with the HHC and in the action planning process with the Governor’s Office. Mainstreaming Social Accountability in Mongolia (MASAM) Project decisions on the project such as the selection of team members, issue and 2. Development of a handbook and guidelines for the conduct of Sub-project problem identification, and sub-project participa-tory monitoring. Integral design. Particularly for the sub-project, to this was survey design and tool development by the partner NGO Outputs and Outcomes improving primary health service MonFemNet. Pilot testing of the delivery was designed to be achieved survey design was dont with 40 through: respondents. a) Introducing a public participatory 3. Setting up of and capacity-building for the monitoring groups. The sub-project was documented and monitoring mechanism in the assessed for actual results across contracts of HHCs (in 2 out of 4 4. The public participatory group of the essential elements for an effective service providers); local implementation team’s conduct social accountability intervention which b) Training CSOs and citizens to conduct of a community mapping exercise are documented as follows: monitoring; and, that allowed them to determine the lo-cation and profiles of vulnerable c) Enhancing transparency and groups, especially temporary 1. On the SAC Intervention Design to accountability of HHCs through residents. Simultaneous to the improve supply and demand sides of construc-tive engagement. mapping exercise, they conducted governance and accountability In order to achieve above- a stakeholder satisfaction survey, The main point for engagement is mentioned objectives, the project with criteria and indicators similar the tripartite contract for primary implementation and management to that of the as-sessment tool as health care services entered into by team conducted the following key annexed to the tripartite contract. the aimag Governor and the Health activities: These notwithstand-ing that the Department with the FHC or HHC. Local contracts were newly signed and the 1. Review of the assessment criteria stakeholders, with the guidance of service providers were not up for in the tripartite contract provisions. the national NGO partner MonFemNet assessment just yet. From out of the review process, it reviewed the existing provisions of the was resolved to introduce public 5. Conduct of health service monitoring contract and other related legislation partic-ipatory monitoring as part among five key groups of citizens and policies from the Ministry of Health. of the contract agreement whereby according to services/programs Given that the contracts with two out of citizens will be asked to evaluate the offered by the HHC: newborn, the four service providers were up for parties to the contract—the Family pregnant women, elderly, temporary renewal, they were able to revise and Health Clinic, Aimag Governor and residents, and vulnerable groups. introduce provisions for integrating the Aimag Health Department— 6. Formulation of the Service/ a public par-ticipatory assessment through a survey that will be carried Performance Improvement Plan. in these two contracts, with the out by the local NGO partners. Results assessment criteria and instrument of the survey were aggregated annexed to the main contract. and constituted 50% of the total assessment of HHC Performance. 31 32 From out of the community mapping equipment to contracted HHC – and For the aimag Health Department, and the survey, the group was able to ensuring quality public health service citizen monitoring and participa-tion identify constraints and issues in the provision is a new term and approach. Even delivery of services by HHCs as against With the initial results of the assessment as citizen satisfaction sur-veys are standards and indicators prescribed by and feedback provided to the Governor’s regularly conducted (once every the Minis-try of Health. office and its Health department, quarter) to assess the performance of Drawing on survey results, HHCs there has been a greater stake and offices under the health department, together with con-cerned stakeholders involvement on the part of the Soum the organiza-tions have the benefit from the Aimag Governor’s Office, the and Aimag government units to address of choice to take action (or not) on Health Department, Bagh Governor, gaps and take on tasks identified in the results of the survey. Citizens or and local NGOs, formulated a Service the Service Improvement Plan that citizens groups are not involved in the Improvement Plan. This will, hopefully, are simply beyond the accountability de-sign, administration and analysis of allow the HHC to have better rating in of the private service provider as they the survey, more so in the reso-lution actual performance assessment as are clearly contractual obliga-tions by of issues and therefore do not have provided for in their contracts. government. any means to exact ac-countability in their current practice. Given project Because of the value placed on experience how-ever, there is an 2. On Outcomes: Concrete stakeholder participation, the 2018 expressed willingness to replicate the improvements in local governance, Aimag Action Plan being proposed by model and conduct citizen monitoring citizen empowerment, and health the Health Department contains specific on other government programs and service delivery. provisions on CSO participa-tion seeking ser-vices (especially on health). to improve private-public partnerships, Governance: The subproject reinforced CSO coopera-tion, and allowing for Empowerment: According to the local the accountabilities and re-sponsibilities some functions to be delegated to and CSO coordinator, citizens, especially of the Aimag Governor and the Aimag per-formed by CSOs and professional temporary residents are not aware of Health Depart-ment in providing other associations. and the difference of services offered by elements – such as infrastructure and family health clinics (at the bagh level) and the Soum health clinics. Their participation in the stakeholder Areas for improvement by the HHC according to the stakeholder satisfac-tion survey (and, prospectively, satisfaction survey: in the HHC Performance Assess-ment) • Due to a lack of space of the HHC, it should focus on creating as much comfort as possible in has made them aware of the services terms of the organization of the rooms and corridor; and has given them the means to tell • When providing the health care services, set up a day where the elders, disabled people and children with nutritional deficiencies are visited regularly and provided at-home monitoring; government about the level or quality of • Decorate the area for the preliminary examination and vaccination; services that HHCs provide. • Upgrade the tools and equipment of doctors on call; While the tripartite contracts prescribe • Open a fitness room and make it available for the citizens permanently; • Increase the number of doctors and nurses, permanently employ the employees trained at the standards of quality and timelines, laboratory; citizens are not aware of these • Provide capacity building for the already trained volunteers and incentive for further standards and more so, are not able employment to tell government about the quality Mainstreaming Social Accountability in Mongolia (MASAM) Project of services they get. Through the Citizens’ rating comprises 50% of the de-livery by making other parties to the survey results, citizens were able to total assessment. For the HHC, the contract accountable for their part as collectively articulate citizens’ needs initial assessment has correctly pointed well. At present, all stakeholders (CSO, and influence the formulation of the out gaps in facilities and services that government offices, service providers) service improvement plan for the they need to improve on yet ignored for are aware of and are able to articulate benefit of the larger community. the longest time. Useful feedback and the need for monitoring programs and Citizens groups or CSOs involved in insights were brought out by the survey services financed by government. The the sub-project believe in the power of and concerned stakeholders have since health department is determined to feedback such that they see the potential tried to address the problems through implement the approach to other FHCs of replicating the effort in assessing the the Service Improvement Plan. as well as with Soum Health Centers, services of the Aimag General hospital, Key actions taken include: national and aimag level programs. pub-lic utilities, waste management, • Procurement of diagnostic equipment Because prevention and detection and education services. They see to improve laboratory services of diseases require public infor- the importance of citizen monitoring through the Local Development Fund mation and knowledge, they see in exacting good performance for of the Bagh and Soum governors; citizen participation as an important contracted services. To them, it is the component of public health services. beginning of an effort “for citizens to • Instituting mechanisms to provide As demonstrated by their experience know their rights, trust government funding for services availed of by in the aimag, the Health Department and ensure the citizens have access temporary residents (the costs for will push for citizen monitoring in the and influence to decision-making.” whom should be covered by the Bagh implementation of tripartite contracts they come from given their tempo- and will recommend for such policy to Some citizens used to be highly critical of rary resident status in the aimag all things government, but participation the Ministry of Health. center, but they also go to the HHCs in the assessment has made them take whose contracts do not stipulate into account their own responsibilities their accomoda-tion); and, in making government programs effective because, as one respondent • Setting up an electronic data base put it, “the state cannot solve all the of patients being served by the HHC problems of our family health clinic. including temporary residents. Our participation is highly important.” Service Delivery: As discussed earlier, 3. On mechanisms for sustainability. a public participatory mechanism was According to the head of the Aimag included in the tripartite contract for Health Department, there was initial HHCs as re-vised and implemented this resistance to citizen monitoring on the 2017. The revised contract introduced part of the HHC. They were however an assessment scheme whereby items convinced to support the project with rated below 80 are catego-rized as the explanation that citizen monitoring “needs improvement” and therefore will help improve their work and service require the parties to take action. 33 34 Assessment and Recommendations The sub-project was successful in performance contract with HHCs was meeting its intended objectives due a strategic mechanism and entry point to the buy-in and support from the for integrating community participation contracted service provider. Despite in the assessment of family health being tied to the same contract clinics. Being parties to the contract stipulations for the last seventeen and performance assessment, years, the two pilot HHCs acceded to accountability was likewise demanded the proposed contract revisions and from the Aimag Governor and the allowed for par-ticipatory performance Aimag Health Department who in turn assessment to be included in the expressed support for the adoption redrafted agreements. Additionally, the and implementation of the service Revised contract stipulations integrating citizen participation in performance assessment of HHCs and government offices: • The Independent Working Group appointed by the decision of the Standing Committee of the Social Policy of the Aimag Citizens’ Representative Khural shall conclude the Contract by half- year and full-year; and shall decide and approve matters regarding the extension, termination of and amendment to the contract. • The Independent Working Group shall adhere to the indicators and requirements stated in the “Structure and Operations of the Household Health Center”, MNS 5292 – 2011, Mongolian Standard as well as the criteria adopted by the 1st and 2nd Appendix of this Con-tract: • The operations of the Household Health Center shall be evaluated in conformity with the indicators and requirements mentioned in the Article 7 of the “Structure and Operations of the Household Health Center”, MNS 5292 – 2011, Mongolian Standard; • As indicated in the 1st Appendix, the evaluation provided by the citizens in regards to if the actions undertaken within the framework of the Community Inclusive Monitoring (CIMM) methodology have fulfilled some of the indicators and requirements stated in the 5th and 6th Articles of the “Structure and Operations of the Household Health Center”, MNS 5292 – 2011, Mongolian Standard shall be converted to percentage; • 50% of the integrated evaluation concerning the 3.3.2-3.3.4 indicators shall be the evaluation provided by the representatives of the service recipients-citizens within the the framework of the Public Scorecard. Mainstreaming Social Accountability in Mongolia (MASAM) Project improvement action plan and to a life beyond the MASAM sub-project CSO network needs to strengthen further involve CSOs in other programs term, the CSO network may need to its capacity for evidence-based requiring private-public partnerships. revisit its bases for unity and work en-gagement (i.e., research) and Khentii’s model for integrating a towards a shared agenda of exacting substantiating objective feedback, community-inclusive monitoring accountability from government and perhaps initially with support from mecha-nism is a readily-replicable service providers. national NGO advisers/consultants. practice to other private service • Project management leaders • There has been no concrete action providers con-tracted by government themselves have expressed reported regarding feedback given (in health and possibly other sectors). difficulty in looking for and to the Aimag Governor’s Office and It will be ben-eficial for project mobilizing volunteers according to the Aimag Health Department, as implementers in Khentii to address the the criteria recom-mended by the par-ties to the tripartite contract following areas as well: national NGO partner at the start of and therefore may need further • The CSO convener may have had implementation. While initially they documenta-tion. • Despite willingness significant to replicate experience working the wanted in on experience recruit toother local CSOs and FHCs/HHCs and • Despite willingness to replicate the Soum Healthwith pro-jects Centers, international citizen appreciation and for citizen volunteers that participation had capacity is limited to in- experience in other FHCs/HHCs and multilateral organizations. However for research and communication Soum Health Centers, appreciation volving citizens groups in public information and skills, campaigns they towards pre- somehow compro-mised the other organizations forming for citizen participation is limited to vention and early detection of diseases. and Government counterparts recruited volunteers on thecould basis part of the implementation team are in-volving citizens groups in public greatly benefit seemingly fromby bound a deeper more tactical of commitment and availabil-ity. understanding of the value of citizen moni- information and campaigns towards and project-based terms. Given that If the third party assessment were pre-vention and early detection of the revised contract agreements have to be continued and sustained, the diseases. Government counterparts could greatly benefit from a deeper understanding of the value of citizen moni-toring and its possible application to other government concerns. 35 36 Public Participatory Schools in Khovd Aimag Public Participatory Schools in Khovd Aimag The sub-project in Khovd aimag, entitled “Public Participatory Schools with Accountability”, was implemented in partnership with the Mongolian Educa- tion Alliance (MEA). The sub-project sought to address the governance, The sub-project in Khovd aimag, entitled settingallocation, mandate for resource expenditure, and multi-stakeholder decision-making in up parent-teacher At theaimag beginning ten (10) secondary schools that are isolated from the center, in low- of sub-project “Public Participatory Schools with councils which are mostly inactive, income soums, and are, more often than not, unable to participate inthe implementation, donor-Aimag Governor’s Accountability”, was implemented in teamprojects the project funded the felt that need support schoolfor office issued an ordinance appointing activities. partnership with the Mongolian Educa- effective mechanisms for participation the members of the project coordination tion Alliance (MEA). The sub-project in the planning for and monitoring of team composed of representatives According to the situational analysis conducted by key stakeholders in the aimag, most, if not all, schools do not provide sufficient information and ac- sought to address the governance, school operations. To address this, of the resource cess to decision-making processes on governance, Education Department, the allocation, resource allocation, expenditure, and the sub-project deployed and expenditure-tracking, the MEA- planning for their Governor’s operations. Schoolsoffice, and CSOs. In order to have dete- multi-stakeholder decision-making developed riorating “Community-inclusive conditions, are insufficiently staffed to handle the school popula- ensure the smooth implementation and in ten (10) secondary schools that are Schools” Assessment tool that could coordination of activities, the project tion, and lacked support from concerned stakeholders. Moreover, despite the mandate for setting up parent-teacher councils which are mostly inac- isolated from the aimag center, in low- help mobilize community participation coordination tive, the project team felt the need for effective mechanisms for team further organized participa- income soums, and are, more often in planning, tion inimplementation, and of policy the planning for and monitoring analysis school operations. and implementation To address than not, unable to participate in donor- this, the operations, reporting of school policies, sub-project deployed the MEA-developed “Community-inclusive teams. The policy team, composed funded projects that support school and internal regulations. Schools” Assessment tool that could help mobilize community participation of technical staff from the education in planning, implementation, and reporting of school operations, policies, activities. and internal regulations. department and local NGOs, was According to the situational analysis tasked with conducting an inventory At the beginning of sub-project im- conducted by key stakeholders in the The Khovd Sub-project at a Glance and analysis of the policies governing plementation, the Aimag Gover- aimag, most, if not all, schools do not Lack of information on and Community participation in secondary school operations in the nor’s office issued an ordinance aimag. From of analysis, this they identified access to governance, planning for, provide sufficient information and ac- resource allocation and expenditure tracking, and implementation and reporting of school appointing the members the pro- cess to decision-making processes planning for school operations, policies and coordination team for jectopportunities strengthening and/ composed operations internal regulations of representatives of the Education on governance, resource allocation, Through: or revising education policies that will Department, the Governor’s office, expenditure-tracking, and planning for An Assessment of allow for more effective participation and CSOs. In order to ensure the their operations. Schools have dete- schools and collective problem-solving school-level in implementation smooth governance and and coor- riorating conditions, are insufficiently operations. dination of activities, the project using the coordination team further orga- staffed to handle the school population, “Participatory Schools” model by MEA nized policy analysis and imple- and lacked support from concerned mentation teams. The policy team, stakeholders. Moreover, despite the composed of technical staff from the education department and local Page 45 Mainstreaming Social Accountability in Mongolia (MASAM) Project The implementation team had 20 2. School-level assessment and the Director, teachers and par-ents) members, with two members looking crafting and implementation of school looked for partners and donors by after soum/school level mini-projects improvement action plans scouring organizations and business that had three key activities: the conduct • Organized discussions among within the 10-kilometer radius of the of the assessment; the development/ teachers and students to identify and school environs. implementation of the school operations define the problems at the school • Once household members (especially improvement plan; and, documenting/ level were held. In one school for from among herder families) became reporting activities for submission to instance, 5-6 discussion sessions aware of the issues that schools the Governor’s office, the Education were conducted, attended by a total and their children faced (such as Department, and MEA. number of 800 participants. deteriorating conditions in the school To create a model for participatory • A number of participants from each dorm, and addiction to billiards school management, collective problem of the 10 pilot schools were se-lected and online/video games in the two identification, and action planning, to attend a workshop conducted by schools visited for this assessment), activities implemented were clustered the Aimag Education Department they readily volunteered to take a into these three main areas: during which they were introduced more active role in school affairs (in 1. Policy analysis to the concept of participatory school the renovation of the dorm and their management, including the conduct children’s quarters and in monitoring • Analysis of national and local policies their children’s activities). on education and determina-tion of of the as-sessment using the tool whether provisions are relevant to developed by MEA. 3. Aimag-level/Inter-school learning current context and needs of schools • A survey was conducted according exchange were done—basically a study of to the criteria for public partici- • There was documentation and related literature. patory schools and results were sharing of experiences from the • Public perception survey on efficacy presented to teachers and parents. par-ticipating schools to facilitate and relevance of specific poli-cy The results were used as basis dissemination of results to other provisions was run. Two key findings for collective problem solving and non-pilot schools in the aimag. are public displeasure over the action planning. One school visited • Public information campaigns in appointment of school director and for this assessment had 500 survey the media to talk about successes council members by the Governor; respondents (parents, government in mini-project implementation by and, the recommendation to transfer staff, and school teach-ers). certain schools were run. the appointing au-thority to the • Because school resources were not Education Department. enough to address even the top- • Proposals on strengthening citizen most priority issue, members of participation in school govern-ance the school/soum-level mini-project were crafted. teams (Soum Governor, School 37 38 Sub-project Outputs and Outcomes 1. On the SAC Intervention Design to of clear processes and mechanisms to involved the larger community and local improve supply and demand sides of operationalize participation in decision- business organizations in collaborative governance and accountability making. There is no room for wider action planning. The education policy team was able consultation and participation from In almost all the pilot schools, to analyze the policy and regu-latory among community stakeholders in the respondents gave the lowest scores to environment that governs the school governance and operations of schools. parents’ participation in school affairs operations. They learned that there is Because of these findings, the sub- and activities, but the iden-tification of an existing law that provides for and project was able to identify opportunities priorities depended on the context and mandates partici-pation through the for greater stakeholder involvement in requirements of the schools and the local school council. However, through the management of schools outside of learners. In one school for instance, the survey conducted among parent- the purview of the school council. top issues were the need to increase respondents, they also got stakeholder At the school level, the conduct of parent involvement in their children’s feedback on how implementation is discussion groups and the “Par- de-velopment, physical conditions in constrained by some provisions of the ticipatory schools” assessment-cum- the school (i.e., tables and chairs), and same law. As a case in point, the school survey has allowed for the identification the need for building a concert/art hall council is rendered irrelevant and and prioritization of school-level issues. for performances and exhibitions. eventually become inactive because Given that there were 10 participating members of the school council and the The formulation and implementation of schools in the sub-project, the issues the mini-projects (school im-provement school director are appointed by the identified and the action taken on Aimag Governor. According to the desk plan) allowed for multi-stakeholder these issues also varied across soums commitment and ac-tion including study and survey they conducted, the and schools. From out of the issues governor appoints his own party mates. aimag and soum government offices, identified and prioritized, school parents and community members, So in reality, according the head of the communities were able to do collective local policy team (of the sub-project), business and civic organizations. It problem-solving. In fact, one school has made the local community aware there is no power nor incentive for the was able to convene 200 students, 100 council to operate except as a stamp pad of and take action on real issues con- parents, and all teachers and staff to fronting the school that are also beyond to the council and governor due to lack identify and prioritize school issues and Mainstreaming Social Accountability in Mongolia (MASAM) Project the resources and capacity of the 2. On Outcomes: Concrete that through collaborative problem- school management to resolve such as improvements in local governance, solving, local issues can be resolved the rehabilitation of dorm facilities and citizen empowerment and education even if there is no increase in the budget monitoring of children’s free time while services. of the soum government. Given the right in school. Governance: On the part of the Aimag process and motivation, government The mini-project in one school was Education Department Offi-cials, Soum can harness the individual and collective able to harness local resources and Governor, and School Directors, there contribution of herder fami-lies (who commitment from herder families is now recogni-tion of the role and are usually away), the community and who more often than not just basically contribution that CSOs and community local organizations. “deposit” their children in schools at members can play in resolving problems Seeing the fruits of their collective the beginning of the academic year. In in school. Their understanding of and labor from sub-project implementation, another school, parents and teachers appreciation for social accountability the Education Department has forged conducted their own separate action revolves around instituting fair-ness and an agreement with the schools planning process and arrived at their justice in education service delivery and under its supervision to strengthen own initiatives—with parents deciding involving citizens in running the schools. social accountability and to increase to monitor student behavior and In one soum for instance, the Governor constructive engagement with local teachers’ preparation for the state has totally changed her perception on stakeholders as well as ensure the examinations. solving problems in the school (and active participation of school managers Having gone into problem-solving on other aspects of governance and in meetings and initiatives by their mode and seeing the benefit of greater public service). Solving development respective school councils. Education stakeholder participation, some schools concerns, according to her, is not officials have drafted and sought were able to acti-vate parents’ councils just looking for and seeking funding approval for their Action Plan to include and dorm parents’ councils and to provision but more importantly about budget allocations for the training of push for change of school operational the community solving their problems, monitors, CSO/parents participation policies, installation of internal moni- about harnessing communication and in the school budget proposal making toring systems, and citizens monitoring local resources, networking with other process, public reporting of school of the school budget, plan-ning and potential local partners. It was shown performance, and making school audit expenditure tracking. reports available to school councils and citizens at large. At the aimag level, the project “Solving our problems does not implementation team was able to or- Empowerment: With their involvement only mean looking for and receiving in the assessment of school conditions ganize a facility and provide a venue funding but more importantly for sharing of experiences and lessons and participation in collection action about the community solving their planning, participating parents became from among participating schools. Non- problems.” participating schools were challenged more involved in ensuring productive and encouraged to implement the same -Governor of Myangad Soum, time for their children while in school. model and replicate the experience in Khovd Aimag They feel that their children now have their schools based on the good results being experienced by the pilot schools. 39 40 better prospects for proceeding to video games and billiards). Teachers For one, the ten participating schools university-level education. Such change are able to focus on teaching and are mostly located outside the aimag in mentality also meant assuming improving on the subject matter they center and difficult to reach which greater accountability for the education are responsible for. In the case of the caused some issues considering budget of their children, both in school and at two schools visited, the improvement limitations. Information was difficult home. in physical and mental environment to share and consolidate given the Parents also gained knowledge makes the school more fit for learning distance of the schools from the aimag and experience in school planning, to happen and has, according to parents, center. Gathering all stakeholders governance and operations. Part of this resulted in improved grades and overall for the sharing of experi-ences and is knowing what school managers have school performance. lessons also meant having to cover for to give way and prioritize less because 3. On mechanisms for sustainability. their transporta-tion expenses. Project of the many problems confronting implementation also ran into scheduling Sub-project implementation in Khovd problems considering the end of school school operations. In one school for was not without some chal-lenges. instance, the parents gained an insight year break and so organiz-ing events as to why teachers had less time pre- paring for the state examinations than Highlights of the “Community-Inclusive School (CIS) - Human Development Center Subprogram of the Health Department, as proposed to the Aimag Local they should because of stu-dents Council becoming addicted to mobile/video games and billiards, a harmful situation Purpose: Developing the school as a citizens’ development center, where in a family, which the local government eventually educational and social environment, a children can grow into a responsible, self- did some-thing about as part of the confident citizen who has an ability to make a decision, live collectively and become a life-long learner. mini-project implementation. Objectives: On the part of the larger community, they have become activated and • Expand community inclusiveness in school development and develop it as a local community development center. motivated to look after the welfare of schools. Local project im-plementers • School - establish a human development center and legal environment, ensure sustainability. and stakeholders claim greater confidence over their ability to “solve • Create community monitoring in school services and introduce social accountability. other problems as well.” Key activities (relating to community participation): Service Delivery: Because of greater • Organize a regional training aimed at providing a capacity to conduct CIS quality parent involvement in the af-fairs of evaluation methodology to a representation of 15 secondary schools that were not part of the project the school and the volunteer activities that they have imple-mented, including • Report the implementation of the school year plan to school committee and public monitoring not just the activities of • Regionally organize a training to a representation of each soum citizens to conduct children but that of teachers as well, monitoring and evaluation in school services, budget planning and expenditure teachers have been freed up from • School shall annually have the citizens’ monitoring and evaluation conducted in mundane but almost necessary tasks certain service quality, budget planning and expenditure; report and implement the of monitoring how their students spend recommendation their free time while in school (over Mainstreaming Social Accountability in Mongolia (MASAM) Project and mobilizing students and parents department has developed an education Lastly, the aimag government has seen became a hurdle for some schools. sub-program on public participatory the value and potential of harnessing Notably, despite the few limitations schools which seeks to replicate participation such that even as the mentioned above, the project the initiative in all soum schools. project was still being implemented, implementation team was able to put Given the results of the policy review the local government already provided in place some measures that will allow conducted as part of the project, the resources in the amount of 160 for the initiative to become sustainable implementation team has put together Million MNT in support of sustaining and more effective in the long run. a proposal for replication subject to the the “schools as centers for human ongoing deliberation and subsequent development” project. At the school level, there is expressed approval by the local council. commitment to continue the mini- project and several volunteer groups Both education department officials have in fact been activat-ed to help and CSO leaders feel confident that the in improving school behavior and measure will be approved by the aimag development. The school director in one legislative council. concerned learning institution has the During the consolidation workshop for intention of including such mechanism the project, the ten pilot schools were as part of the school development also joined by the other soum schools policy. all throughout Khovd aimag. With the In another case, with the leadership of documentation of the experiences one school director, local stakeholders across the pilot schools, education have started to introduce changes to the stakeholders would know more about internal policy for school operations. what works and what does not. This is meant to institutionalize the The model being replicated in all aimag set up of teachers looking after the schools is thus greatly informed by the particular welfare of the children collective experience and insights from especially in their dormitory. They the participating schools. also plan to introduce provisions in With the school-level mini-projects the performance contracts of school being able to tap into institutions and administrators and teachers that will resources they feel they have not fully strengthen cooperation between the taken advantage of before (such as school, its community, and the children. local volunteering efforts, resources At the aimag level, particularly for from the private sectors and organi- the Education Department, there is a zations for philanthropy), there is now clear understanding of and motivation a new-found confidence in mobilizing, for adopting a bottom-up process for coordination, and collaboration even for identification of issues, such that the future endeavors. 41 issues can therefore be effective in mobilizing various stakeholders. The project was able to tap into intrinsically available motivations and re- sources for parents to become involved in the education of their children, and for business sector/civic organizations to help their local schools. 42 • The model is simple and easy to follow regardless of settings and allowed be designed to note whether school- for immediate action planning. Stakeholders were able to create an envi- level mini-projects were able to move Assessment and ronment that will allow for easy adoption what works and what will not, given parents beyond andanimating the sizable a solid documentation to become number and mobilizing involved in the sub- of participating of Recommendations schools in the sub-project. project activities, but more strategically towards collective problem solving. Moreover, because most soum schools The sub-project of Khovd aimag is a Still, some easily areas relate tofor improvement education and the are worth noting. Operationally, the con- are located far from the aimag center, well-documented and highly replicable issues surrounding it are. After solidated documentation should be designed all “it education note whether to managers and school-level CSO leaders model, not only in terms of the rest of takes a village to raise (and mini-projects were able to move beyond educate) have to find and animating effective ways moremobilizing of parents the schools in the aimag but possibly a child.” Education issues can spreading information as well as to become involved in the sub-project activities, but more strategically to- as a national policy recommendation to therefore be effective in mobilizing sharing information and lessons. the Ministry of Education. The strengths wards collective various problemThe stakeholders. solving. projectMoreover, because most soum schools More importantly though, being an going for Khovd in this experience was able to tap into intrinsically are located far from the aimag center, education managers and CSO lead- initiative framed from the perspective of include: available motivations and re-sources ers have to find more effective ways of spreading social information accountability, as well the project as should • Clearly identified gaps and policies for parents to become involved in the sharing information be able to make its stakeholders realize governing the operations of schools education of their and lessons. children, and for that education service delivery remains that make the local school council business sector/civic organizations the primary responsibility of the state unable to exact accountability More to help their local importantly schools. though, being an initiative framed from the perspective of and state instrumentalities. from the school management. If • The model is simple social accountability, the project shouldand easy beis able to make its stakeholders This the premise upon which stands local school councils were to be to follow regardless of settings realize that education service delivery remains the proposition the primary the education that responsibility of less beholden to their appointing and allowed for immediate action theplanning. state andStakeholders state instrumentalities. department, school managers, and authority, and therefore act as a were able This is the premise upon which stands even national level policies and strong mechanism for checks and theto create an envi-ronment proposition that the education that willdepartment, school managers, and even programs should be able to address balances, school directors and the allow for easy adoption and a solid national level policies and programs should be able address toin gaps and gaps and issues education service counterpart school council should documentation of what works and issues delivery. While parent participation is not be appointed by the aimag education whatin will service not, given sizable While parent participation is important, thedelivery. important, it is not an end in itself. While governor, as proposed by local it is not an of number end in itself. While participating schoolssuccessful in in some schools, it needs to be successful in some schools, it needs to project implementers. the sub-project. documented that mini-projects in most schools fact mini-projects have inthat led to exacting be documented in • The experience has clearly Still, some areas accountability for improvement from state most schools actors, across levels have in fact led to exacting of governance. demonstrated multi-stakeholder are worth noting. Operationally, the accountability from state actors, across engagement and collaborative con-solidated documentation should levels of governance. problem-solving from among government (soum and aimag levels), civil society organizations, community members and par-ents, and business and civic organizations. Page 54 These collaborative engage-ments were happening across contexts and the various school issues confronting the 10 pilot soums. Perhaps it should also be noted that stakeholders can Mainstreaming Social Accountability in Mongolia (MASAM) Project Participatory Health temporary residents are able to provide feedback on services from the Aimag Service project in General Hospital and the HHC in Murun Soum. More specifically, the project was to help improve patients’ satisfaction Khuvsgul Aimag with the physical environment of and waiting time in the hospital. The sub-project in Khuvsgul entitled charged against the budget of the HHC/ The local coordinating team, with “Participatory Health Services” was soums of their Participatory place of residence Health and Service not support project in Khuvsgul Aimag from the national NGO partner implemented in partnership with the that of Murum’s HHC. Should temporary implemented the following key Mongolian Public Health Professionals’ residents require health in The sub-project services, they “Participatory Khuvsgul entitled activities: Health Services” was implemented in partnership with the Mongolian Public Health Professionals’ Association (MPHPA). Through an have to go to the tertiary level Aimag Association (MPHPA). Through an order issued 1. by Small the Aimag group Governor,discussion among order issued by the Aimag Governor, General Hospital which theyteam for implementation either the project key stakeholders to decide on the was convened and composed of repre- the project implementation team was do not have enough from the Social or sentatives information they Department, the Health Depart- Development focus and design of the sub-project convened and composed of repre- are not adequately attended ment, Aimag General to because Hospital, participating Household Health Center of Murun Soum and the local NGO network which resolved has 35 active proceed toCSO mem- and focus on the sentatives from the Social Development of the lack of bers doctors, nurses and other (5 of them cooperated on this project) and health sector was responsible given the inputs from for project Department, the Health Depart-ment, health professionals. coordination. the aimag officials, service providers Aimag General Hospital, participating The objective of the sub-project in in the health and education sectors, Household Health Center of Murun Khuvsgul is temporary According to respondents from the aimag, Khuvsgul has a constant influx of to improve temporary residents who stay at the aimag center the localinNGO. and(particularly Murum Soum and the local NGO network which residents’ access Soum) to health for a minimum of sixand care months. to These temporary residents typically has 35 active CSO mem-bers (5 of them 2. A census was conducted to determine ensure that service providers are able end up needing access to health services and programs in the aimag cen- cooperated on this project) and was ter, instead of the soum health clinic where they thearenumber and profile of tempo-rary formally registered. to adequately implement the patient Residents who are not registered in the aimag residents. responsible for project coordination. transfer system between center are unable to obtain mandatory health tiers care from health of the Household Health Centers of Murum Soum According to respondents from the service provision. since the Through a 3rd-party bills they incur for medical services 3. Jointly are supposed led to by the NGO and the Quality be charged against the budget of the HHC/soums of their Division of the hospital, a stake-holder aimag, Khuvsgul has a constant influx monitoring tool based on the World place of residence and not that of Murum’s HHC. Should temporary residents require health services, of temporary residents who stay at the Health Organization’s “Leave no one satisfaction survey was conducted they have to go to the tertiary level Aimag General Hospital for which they aimag center (particularly in Murum behind” principles, either do notstakeholders have enough information and or they are three times: attended not adequately in January 2017 with Soum) for a minimum of six months. to because of the lack of doctors, nurses and other 390 hospital health clients as respondents; professionals. These temporary residents typically end The Khuvsgul Sub-project at a Glance again in march 2017 with 200 The objective of the sub-project in up needing access to health services and hospital clients and 190 FHC clients Khuvsgul is to improve temporary programs in the aimag cen-ter, instead Lack of access to and information on quality and regular health care Health care coverage for temporary residents and respondents; as access residents’ to health care and lastly in May- June 2017 with 200 hospital clients enhancement of the patient of the soum health clinic where they are services for temporary residents transfer system and to ensure that service provid- formally registered. Residents who are and 190 FHC clients as respondents. ers are able to adequately imple- Through: ment the patient transfer system not registered in the aimag center are This was to assess service provision between tiers of health service Citizen feedback and unable to obtain mandatory health care assessment of services (e.g., provision. Throughservice a 3rd-partymanagement plan, for temporary residents from the Household Health Centers of and service providers treatment of patients, over-all health monitoring tool based on the World Murum Soum since the bills they incur using improvement) by aimag general Health Organization’s “Leave no 3rd-party Monitoring one behind” principles, stakehold- for medical services are supposed to be Page 55 43 44 hospital and family health clinics. Issues identified in this survey as priori-ty areas for resolution Sub-project Outputs included: increasing time allocation for outpatient check-ups by and Outcomes attending physicians; improving the transfer system of pa-tients between different tiers of hospitals/service providers; resolving the provision of and funding for health services In the following sections, output 2. On Outcomes: Concrete availed of by temporary resi- from sub-project implementation of improvements in local governance, dents; and, increasing public health the activities enumerated above are citizen empowerment and health knowledge among citizens. In March documented and analyzed in view of service delivery 2017, 270 hospital and 46 FHC staff the essential elements and contextual Governance: The conduct of the census participated in a survey to rate their factors for effective social accountability allowed the aimag government offices to satisfaction with their respective initiatives. identify and locate temporary residents medical facilities. and allowed for more efficient services 4. Face-to-face meetings were to patients in every soum. When citizens 1. On the SAC Intervention Design to held to discuss the results of the stay more than six months in the aimag improve supply and demand sides of assess-ment. This was attended center, they become entitled to medical governance and accountability by representatives from the Aimag services in the soum where they Governor’s Office, Health Department, The design and conduct of the temporarily reside. Soum Government, Aimag General stakeholder satisfaction survey has allowed relevant government offices to The project coordinating team has Hospital, Family Health Clinic/HHCs, hear and determine issues confronting already drafted a regulation whereby if citizens and NGOs. health care provision. a temporary resident receives medical 5. Information and education sessions services from the HHC, the facility will for citizens were conducted to im- Service providers value the assessment be reimbursed by their “home” soum prove health-seeking behavior and because they believe that the health clinic. Because funding for health help manage or mitigate risks to independent assessment done by the facilities is on a per capita basis and health providers and other citizens. CSO “is more realistic and rational” health facilities are funded based on which can pressure them into improving the total number of registered residents 6. A presentation of the results of the services they provide. in the last three years, temporary project implementation was made to the aimag government, service Because CSOs and citizens were part of residents availing of health services in providers, and the civil society council the design, administration and analysis their adoptive soums put a strain on the and its member NGOs. Results of survey results, they were part of resources of the HHC. were likewise shared to 24 soum problem-solving discussions with With the results of the census and the governors, and other international health service providers. database of temporary residents, the organisations present in the area. Mainstreaming Social Accountability in Mongolia (MASAM) Project aimag health department has a basis considering that according to the local • Introduction of E-Service registration for claiming reimbursement from the NGO coordinator, patients reported and appointment system to reduce soum government through an MOU. having had to visit the facility a lesser waiting time and queues; While there is no existing national law or number of times when availing of • Production of infographic/schematic policy regarding funding for temporary services. In availing of medical analysis diagram to help patients find the right residents, which has in many ways or laboratory services for instance, the doctors for their needs; caused conflict among service providers patient previously had to make more regarding their budget allocation and than 5 visits to the hospital; this has now • Establishment of social health office utilization, the implementation of the been reduced to just 2 to 5 visits. Before to handle health counseling for project allowed stakeholders to identify the project was implemented, patients citizens, giving psycho-social advice, these problems and have pushed aimag had to endure long waiting time and information dissemination towards stakeholders into referring the issue delays to just book an e-appointment. better health-seeking behavior; and, to the Ministry of Health and to the At present, they are able to make • Training for staff on better behavior Parliament committee on social policy. appointments as soon as they arrive towards patients. Empowerment: No reported outcome at the hospital and has thus eradicated as of the assessment. unnecessary delays and waiting. 3. On mechanisms for sustainability Service delivery: From out of the results Hospital staff took the survey results positively and thought that it was useful All three key stakeholders, government, of the stakeholder satisfaction survey, feedback for improving health services. service provider, and CSO representative service providers have taken action and The formulation and implementation of view that citizen participation and instituted changes such that over the the service improvement plan which monitoring can play an important course of three satisfaction surveys they called “Change starts with me” contribution in decision-making and (one prior to the service improvement devised work teams around each service delivery. The aimag governor’s plan), the over-all rating given to the identified area for improvement which action plan has a provision for ensuring hospital and the Family Health Clinic in are: Improvement of communication inclusive participation and accountable Murum Soum has steadily improved. In skills, ethics, and attitude of medical governance. the first survey conducted in January 2017, 18% of respondents (N=392) personnel; advocacy and counseling The Family Health Clinic director sees rated the aimag hospital as “Poor”, and for patients; improvement of physical inclusive assessment being done this has significantly gone down in the environment; culture of service; more regularly (twice a year). Worth subsequent surveys. efficiency and timeliness of services; mentioning too is their view that CSOs and, regular visits to patients. are crucial partners in informing citizens For instance, in the second survey in While CSO counterparts were not about health services and programs, in March (N=390), 3.9% of respondents involved in the formulation of service public health education, and improving gave the hospital a “Poor” rating. While improvement plan, the service provider health seeking behavior and not just perhaps the improved rating cannot be has already implemented some key to criticize the work of health service solely attributed to the implementation activities as a result of the survey providers. of the service improvement plan, customers and patients might feedback and recommendations have benefited from changes made provided by the local CSO such as: 45 46 Assessment There are a number of areas for improvement. The CSOs them-selves the opportunity to directly work with improvement that need to be addressed were not part of the formulation of CSOs in the aimag, local government before the experience can be replicated the service improvement plan and offices can move towards more or scaled up: were therefore just providers of the collaborative decision-making • There is need for clarity of purpose information from the survey de-spite practices, and seeing CSOs as critical and approach in solving systemic their involvement in all phases of partners in this these processes. problems. This requires more the discussion and project imple- • Longer-term and sustainable strategic and integrated solutions, mentation. resolution of health care provision and not just surface-level and token • The perception of duty-bearers and for tem-porary residents may be a initiatives that help appease the service providers that CSOs and citi- matter for policy advocacy at the dissatisfac-tion of citizens. zens’ organizations are means for national level – i.e., Ministry of • While results of the stakeholder making information available to the Health and Parliament – to look into satisfaction survey and problem cit-izens, as conduits for teaching the allocation and health financing solving exercise allowed the project citizens to look after their own health, scheme for health service provision implementation/coordination team must be considered. Articulated by the Family Health Clinics and Soum to identify problems confronting appreciation for the role of CSOs/ Health Centers. Even as the project health service delivery, service Citizen par-ticipation is limited to implementers have identified the improvement initia-tives are being an extension of government, need to change the financing scheme seemingly taken on by the offices as means to reach citizens and and population quota per FHC, the concerned but not from a con-certed constituents in availing of health issue will have to be elevated and and coordinated effort of service services and pro-grams. Having had resolve at the level of the national ministry or parliament. Mainstreaming Social Accountability in Mongolia (MASAM) Project Improving the settled on the health sector, they chose to focus on the need to improve Tuberculosis Ward the quality of services by the TB ward due to worries on the spread of the disease and the aimag’s inability to Services in the Aimag bring down TB incidence. 2. The local CSO partner conducted a of Selenge preliminary research on TB preva- lence in the aimag. The sub-project in Selenge aimag was of the disease because people either do implemented in partnership with the not come for treatment or are unable to 3. Decision was made to work with the UB-based NGO Democracy Education complete treatment. Improving the Tuberculosis Ward Democracy Services Education in Center (DEMO) Center (DEMO). Called the “Improving the Aimag of Selenge who in turn provided guidance With the MASAM sub-project, aimag in developing the methodology Tuberculosis Ward Services”, the sub- stakeholders The led by the local CSO sub-project in Selenge aimag was implemented in partnership with the project was designed to arrest the for conducting a participatory UB-based NGO Democracy Education Center (DEMO). Called the “Improv- network, sought to improve the access assessment. arrest implemented a DEMO increasing incidence of tuberculosis to and quality ing Tuberculosis Ward Services”, the sub-project of services was designed to the increasing incidence of by the (second tuberculosis 5-day training workshop to capacitate highest in the country). (second highest in the country). Tuberculosis ward of the Aimag General local stakeholders on the use of Selenge is situated near the Russian Hospital through mobilizing citizen and Selenge is situated near the Russian border and has gold mining opera- the Citi-zen Score Card, as well as tions in six to seven soums of the aimag. Because of this, populations are border and has gold mining operations patient feedback and joint assessment exposed to higher risks of contamination andto design spread and plan of the disease be- implementing in six to seven soums of the aimag. of services and service cause pro-viders of the influx and regularusing traffic of people mecha-nisms in the mines. In 2016, for the conduct of the tuber- Because of this, populations are the Citizen Scoreculosis Card. To realize contamination this stood at 18.2 survey. cases for every one hundred thousand exposed to higher risks of contamination sub-project objective, thepeople implemented – or even higher than this official number. To treat Tuberculosis and spread of the disease be-cause of cases, the Aimag General hospital has a TB the following bedsactivities: ward field 4. A implementation with 5 out of the total 25 team of 20 the influx and regular traffic of people people was split into 3 groups. Each dedicated mainly for TB patients. On average, the hospital treats 180 1. Key stakeholders, with 60%the including people annually, of theCSOpatients coming from the local areas. Due group was tasked to conduct the in the mines. In 2016, tuber-culosis to poor conditions in the hospital and overloaded staff, service delivery is had preliminary network, compromised discus- contamination stood at 18.2 cases for and may have possibly given rise assessment on of to the further spread particular the aspects of sions to explore project disease because ideas people and either do tonot come forservice treatment delivery, or are unablewhichto are: human every one hundred thousand people – select project focus. After the group or even higher than this official number. complete treatment. resources, equipment, and physical To treat Tuberculosis cases, the Aimag The Selenge Sub-project at a Glance facilities. 324 citizens and 17 hospital With the MASAM sub-project, General hospital has a TB ward with 5 aimag staff participated stakeholders in the assess-ment. led by the local Improved quality and delivery of health services CSO network, sought to improve out of the total 25 beds dedicated mainly Increasing incidence and spread of tuberculosis by the Tuberculosis ward 5. Face-to-face meetings were of the Aimag General the access to and quality of ser- for TB patients. On average, the hospital Hospital conducted vices by analyze to ward the Tuberculosis of and level off treats 180 people annually, with 60% Through: results of on the General the Aimag the assessment and Hospital of the patients coming from the local Citizen feedback and joint throughfacilitate collective mobilizing citizen and pa-problem-solving, assessment of services tient feedback and joint assess- areas. Due to poor conditions in the and service providers espe-cially with the development of ment of services and service pro- hospital and overloaded staff, service using the viders the service using improvement the Citizen Score plan. delivery is compromised and may have Citizen Score Card Card. To realize this objective, the possibly given rise to the further spread sub-project implemented the fol- lowing activities: 47 1. Key stakeholders, including the CSO network, had preliminary discus- sions to explore project ideas and to select project focus. After the group settled on the health sector, they chose to focus on the need to improve Page 63 48 6. New initiatives were implemented 1. On the SAC Intervention Design to Face-to-face meetings then sought to as a direct result of the assessment improve supply and demand sides of level off on respondents’ un-derstanding and in furtherance of immediate governance and accountability of the assessment and, from out of needs as indicated in the service im- At the beginning of sub-project more conversational and collaborative provement plan. This includes the implementation, the CSO network was discussions, respondents were able to conduct of public information cam- able to convene all relevant stakeholders accept the differences in assessment paigns on tuberculosis, consultation and to level off on their understanding results which then led to the collective activities regarding disease preven- and approach to fighting the spread of formulation of the service improvement tion and treatment plan and mobile tubercu-losis in the aimag. Nineteen plan. Parties to the MOU for the project diagnostic/treatment of TB for (19) monitors from within the local CSO (CSO network, Health Department, and patients in all soums using mobile network, together with the aimag health Governor’s Office) were represented diagnostic equipment recently department, the TB ward and public and were responsible for finding ways purchased through the National health specialists, were trained on the and means to resolve dissatisfaction Infectious Disease Center and the use of the CSC which was developed and issues on health service delivery Ministry of Health. Because of the from their common understanding particularly for TB cases. mobile diagnostic campaign, 15 of issues surrounding tuberculosis Worth noting though is that while it is new cases of tu-berculosis were and the needed steps to treat or curb the CSO network’s first time to provide detected and recorded by the health the disease. Areas of assessment organized and objective feedback on authorities. were on the Quality of facilities, Hu- a particular govern-ment program or man resource/Medical staff, Medical service, 28 local organizations that Equipment, Public education on TB, and formed the network in 2015 have an Sub-project Outpatient services. existing 4-party agreement with the Through the use of the CSC, the sub- local government, local entrepreneurs, and mining companies operating in the Outputs and project was able to surface stakeholder feedback and level of satisfaction on aimag. Regardless of changes to the how the TB ward of the Aimag General political landscape (a change in elected Outcomes Hospital was handling the treatment of tuber-culosis patients. There were governor or appointed officials, for example), the agreement will stand and allow the parties to work on supporting 324 citizens and 17 medical staff who participated in the survey. The lo-cal entrepreneurs and producers results were different for each set of (e.g., vegetable growers) that feed into Outputs from sub-project or off the mining industry. implementation and the activities respondents which became the starting enumerated above are documented point for conversation in the face-to- and set against essential elements and face meetings. Citizens, according to the contextual factors for more effective survey, thought services were poor. On social accountability initiative. They are the other uand, the doctors and medical discussed below. staff were “moderately satisfied” on the matter. Mainstreaming Social Accountability in Mongolia (MASAM) Project 2. On Outcomes: Concrete how plans and programs should reflect for 2018 (for the building of a dedicated improvements in local governance, the felt needs of citizens. TB facility, procurement of diagnostic citizen empowerment and health Citizens on the other hand are used to equipment, and proposals from 4 service delivery. criticizing and blaming gov-ernment for Family Health Clinics). Governance: According to the Aimag their problems. With their sub-project Empowerment: Social accountability Social Policy Department, lo-cal experience, citi-zens themselves have was a totally new perspective for CSOs government has tried to engage seen and been part of the process and the citizens at large. Governance citizens in the implementation of local to identify problems, its causes and in the aimag has always been top- development plans where they would resolution, from an integral and holistic down in approach but the sub-project convene meetings and assemblies perspective. In the end, governance was bottom-up—about citizens giving at the bagh and khoroo levels and and development projects can also be feedback on a particular service of seek local community needs for small about improving ways of working and gov-ernment. It was about citizens infrastructure. After which, citizens achieving intended results without the taking accountability over problems and are involved in the planning for and provision of financial resources but with not just blaming government for the monitoring of the projects funded efforts at harnessing and engaging the problems. The CSO net-work was part through the LDF and, more often participation of all relevant stakehold- of identifying the problems, analyzing than not, the planning and project ers to look at and work on problems the causes and taking responsibility identification process would always collectively. for them, just as much as government prioritize infrastructure-related Particularly for health service provision should. projects. and curbing TB cases in the aimag, Service Delivery: Based on the CSC The MASAM sub-project experience is local government officials have always results, stakeholder feedback in the a new approach and had in fact been a known of problems surrounding the face-to-face dialogues, and CSO little difficult to understand for the local disease yet have remained unsuccessful participation in the formula-tion of the government of-fices in the beginning. in bringing down the number of cases service improvement plan, officials In their mind, focus was improving and contamination. What the project from the Health De-partment and the public ser-vice in terms of process and has done for officials is highlight the Aimag General Hospital were able to on citizens taking of roles and respon- urgency of the issue and provide the institute ac-tion to improve service sibilities as part of governance. Projects necessary push for actors to collaborate delivery. While staff and officials of the were traditionally seen as provision and to listen to citizens’ needs based hos-pital initially felt uncomfortable and funding for infrastructure projects, on facts and evidence gathered by the about CSOs monitoring their opera- but not about im-proving services and partners from the civil society sector. tions and defensive about the results processes. It took a while for officials From the information gathered and because the citizen assess-ment was to under-stand the project, but in the made available to concerned agencies lower than their internal assessment, end, resulted to changed views on (such as new cases and extent of several service im-provements have gov-ernance and citizen participation. contamination), program and action been initiated. Some notable action According to the official from the social planning was focused and di-rected include: policy department, they have seen the toward the real and urgent issues, even importance of engag-ing citizens and including them in the budget proposal 49 50 • Joint proposal (CSO and health joint and collective en-deavor by all Local De-velopment Partnership” of sector officials) presentation to the stakeholders concerned. Moreover, GIZ’s Integrated Mineral Resources local council of the plan to curb and and despite ini-tial hesitation on the Initiative and the “Gender and and treat the dis-ease. part of hospital staff to be evaluated Institutional Analysis of Selenge” • Issuance of an ordinance on the for their services and operations, the research project funded by the ADB. holistic plan to improve ser-vices for plan is now an officially approved 3. All three stakeholders (government, TB patients which includes provision piece of legislation by the local service provider, and CSOs) have for a new building and facilities council. expressed appreciation for and exclusively for TB-related services. 2. Selenge boasts of a formally changed mindsets towards citizen • Soum visits, mobile diagnostics, constituted network of civil society par-ticipation in and monitoring of and treatment of new cases. Home organi-zations. Formed in 2015, government programs and services. visits were conducted in 16 out of the Association of Civil Society While they initially grappled with the 17 soums because of the immediate Organizations of Selenge aimag concept, sub-project implementation procurement of mobile diagnostics has 28 NGO members and 15 concretized the approach and equip-ment which allowed the citizen representatives. With the how such can result to actual im- hospital to reach out to and cover aim of uniting organizations under provements and services that citizens almost the entire population of the a “common aim and to be-come can benefit from. There is now a aimag. a vibrant organization” recognized shared interest in implementing by the public, the network and the approach and employing citizen • Public information campaigns on TB its members has had experience feedback and participation in to help change attitudes and behavior implementing two other projects decision-making, policy formulation, towards TB and how better health apart from the MASAM sub-project. and implementation of development practices can stop the spread of the These are the “Comprehensive projects, even outside the health disease (especially on completing sector. treatment so that the disease does not become drug-resistant). Profile of the Association of Civil Society Organizations of 3. On mechanisms for sustainability. Selenge Aimag There are three key elements that will Origins In 2015, 25 member organizations joined the Association while as of allow for sustainability and replicability September this year, it is operating with 28 NGOs and a representation of the social accountability initiative in of 15 citizens. Selenge. These are: the institutional Overview Association of Civil Society Organizations (ACSO) of Selenge aimag mechanism, platform for constructive is a non-profit association which serves the society and has three programs: “Responsible society”, “Occupational Safety, Health and engage-ment, and changed mindsets Responsible Mining” and “Let us Support Youth Development”. and attitude necessary for citizen par- ticipation and monitoring. Vision Creating multi-stakeholder partnership inclusive of government, business and civil society organizations for th development of Selenge; 1. There is the service improvement by ensuring creative participation of citizens in the society and building plan, which was not developed by capacity, shall make the operations of government organizations the service providers alone but is a acquire open, transparent and monitoring system. Mainstreaming Social Accountability in Mongolia (MASAM) Project Assessment on getting it right, and getting participants to understand and appreciate constructive engagement the mining sector. The CSO network has a signed four-party MOU with the Aimag government, mining compa- and collaborative problem-solving, nies, and local entreprenuers, that Sub-project implementation experience regardless of the magni-tude of the will make constructive engagement in Selenge aimag can lay claim to problem. free from political interference and several elements that make the elections. initiative highly replicable. Stakeholders • Formally constituted and organized may even consider implementing the network of CSOs, who committed to • Clear understanding of and ability to model in greater scope and scale to work towards a common agenda of articulate the purpose and benefits cover other programs and services by development for the aimag. Working of social accountability. Service the local government. These notable with a formally organized network providers initially felt defensive strengths are: makes for easier consensus building about the results but recognized and wider reach of representation. that the hospital may have been • Clearly identified problem, scope and The CSO network is also formally remiss in inform-ing the public approach to solving the problem. rec-ognized as a partner of the local about its services. This also involved Even as the focus of the problem is government unit, having executed an acknowledgement of individual • Immediate decision narrow in scope (which and action is the spread were taken by concerned government two formal MOUs, albeit for different and collective accountabilities of all against and of TB as(Health agencies perhaps Socialbigger Policy Departments) moved and the ends but practically same towards purpos- parties concerned and taking action issues in the public health sector), es—to collaborate and work towards to rectify such errors (e.g., what one adoption of the action plan not only at the Service Provider level but mak- the process with which it was the same agenda. Prior to the pro- was supposed to do but did not, what ing it the arrived of the for action plan capacity at demonstrates Aimag Governor’s Office especially that ject, the network had initial bases one is doing but is not enough, what systems several and analytical action thinking. points require The investments— and workingfacilities, infrastructure, for unity relations addi- with one needs to do herein onwards, to project did not tional personnel. fall into the trap of the Aimag government, particularly solve problems). wanting to solve many issues all at in looking after those affected and/or the same time. Rather, they focused • Immediate decision and action were in-volved in downstream activities in taken by concerned government agencies (Health and Social Policy Departments) and moved towards adoption of the action plan not only at the Service Provider level but mak- ing it the action plan of the Aimag Governor’s Office especially that sev- eral action points require investments - infrastructure, facilities, additional personnel.   51 52 policy environ-ment that govern oral Reducing Oral Disease health practices in the aimag. 2. Local project team members from the CSO and government (total of among Children in 20) attended a training on gathering stakeholder feedback through Sukhbaatar Aimag the use of the Citizen Score Card conducted by the UB-based NGO DEMO. 3. Rolled out the conduct of the CSC The sub-project in Sukhbataar aimag serviced by 16 dental pediatricians in assessment with 520 children was implemented in partnership schools and kindergartens. Due to the and parent respondents and with the UB-based NGO Democracy sheer number of children being served, 94 respondents from among Education Center (DEMO). Together inadequate tools and equipment, and service providers. The CSC sought Reducing Oral Disease among Children in Su- with key officials khbaatar from Aimag the Health the removal of a Health class in the stakeholder feedback on four Department, Aimag General Hospital, basic education curriculum, children areas: Oral health behav-ior and The sub-project in Sukhbataar aimag was implemented in partnership with Aimag and Soum Governors’ Office, the with oral health issues would naturally practices; Access to and availability the UB-based NGO Democracy Education Center (DEMO). Together with local CSO Network sought to improve flock to the Aimag General Hospital. This key officials from the Health Department, Aimag General Hospital, Aimag of dental health personnel (dentists oral health care and Soumservice Office, theand delivery Governors’ local CSOadds Networkpressure to its sought to improve al-ready bursting oral and nurses); Dental facility, tools oral health education delivery and in for children health care service carrying oral health capacity education considering for children in that the and equipment; and, Relation-ship schools. schools. hospital operates with only two dental between schools, parents and oral The issue of The poorissue oral health of poor care oral health for care clinics with four doctors servicing for children was chosen to be the focus health service providers. children wasof chosen to be the focus 68,000 the citizen feedback because of the rising cases of clients. gum disease and de- 4. Information and education campaigns teriorating oral health care. According to data cited in the sub-project pro- of the citizenposal, feedback because of the With the MASAM sub-project, there are 16 schools and 23 kindergartens in the aimag with a total implemented in all 4 schools of the rising cases population of gumof disease10,456 children andbeing stakeholders de-serviced wanted by 16 dental pediatricians in to improve the aimag center. Preventive check-ups teriorating oral health schools care. According and kindergartens. delivery Due to the sheer numberofoforal health children beingservices and oral were conducted for 2522 out of 2558 to data cited in the served, sub-project inadequate pro- and tools and equipment, health education the removal for of a Health youth and children class children from 4 schools.1150 children in the basic education curriculum, children with oral health issues would posal, there naturally are 16 schools and 23 through a participatory assessment of flock to the Aimag General Hospital. This adds pressure to its al- were found out to be suffering from kindergartens in the aimag ready bursting carrying with capacitya total and considering dialogue that the on such hospital operates with services using oral/gum disease. population of only10,456 children two dental clinics with four being the 68,000 doctors servicing Citizen Score Card. In order to clients. realize this, the following key activities 5. Based on the CSC survey results, The Sukhbataar Sub-project at a Glance With the MASAM sub-project, were implemented with leadership by face-to-face dialogues among Deteriorating oral health Improvement in the stakeholders wanted to improve the local CSO network after signing a service providers and representatives the delivery of oral health services and gum disease among 70% of youth and children delivery of oral health services and oral health education for youth and andMemorandum oral health education of for Agreement youth with the from the aimag governor’s office and in the aimag children andAimag Governor: children through a participa- health department were conducted Through: tory assessment of and dialogue for a leveling off on the assessment An assessment of oral 1. Conducted a preliminary survey on such services using the Citizen results and to identify root problems health services and health and group discussions involving Score Card. In order to realize this, and appropriate courses of action care education 1000 children and 90 parent the following key activities were through the joint formulation of the using the implemented with leadership by Citizen Score Card representatives in order to define the the local CSO network after sign- Service Improvement Plan. A total situation, ofreview ing a Memorandum Agreementexisting policies, of 22 activities were proposed to be with the Aimag Governor: and evaluate the regulatory and conducted as stipulated in said plan. 1. Conducted a preliminary survey and group discussions involving 1000 children and 90 parent representatives in order to define the situation, Page 72 Mainstreaming Social Accountability in Mongolia (MASAM) Project Sub-project Outputs and Outcomes Outputs from sub-project • The CSC survey and FGDs allowed 2. On Outcomes: Concrete implementation and the activities both citizens and service providers improvements in local governance, enumerated above are documented and to assess the quality of services, citizen empowerment and health juxtaposed against essential elements facilities and staff of the hospital, and service delivery. and contextual factors for more effective public health education mechanisms. Governance: Upon hearing of the social accountability initiatives, as fol- The survey and FGD results were results of the CSC, the aimag governor lows: used to provide objective feed-back ordered for the purchase of one set of to those concerned. dental equipment, the renovation of one 1. On the SAC Intervention Design to • Collated feedback from the citizens dental clinic in the aimag hospital, and improve supply and demand sides of was leveled off with the results of the allocation of one of the dental clinics governance and accountability the internal assessment done by the for youth/children patients. Through service pro-viders during the face- the issuance of ordinance #A/493, the The actual conduct of activities as to-face meetings. Aimag was able to purchase dental proposed and as planned by the equipment and setup a dental clinic with implementation team has allowed • The CSO network prepared and presented a list of recom-mendations resources coming from the governor’s the aimag to pilot test the social office amounting to 23,697,800 MNT. accountability approach to improving for service improvement. These were governance. This produced key outputs later adopted and implemented by the This action instituted by the Governor’s such as: concerned government agencies. The office manifests his acknowledgement list of recommendations identifies 22 of the gaps and value placed on the • Collective problem identification, activities and proposals. As of this recommendations put forth by the CSO analysis and problem solv-ing as assessment, only three activities monitors and as evidenced by the results the CSO network members, aimag have yet to be implemented. of the survey and FGDs. According government repre-sentatives, and to the Vice-Governor himself, being doctors of the hospital were part of • Organized and conducted oral health campaigns in partner-ship able to hear feedback on the issues the brain-storming process to design confronting program implementation the sub-project, the issues and with the CSO network. This served two purposes: as a public health allows the local government to “provide aspects for assessment through the the right service, to the right people, CSC, and inputs formu-lation of the information campaign, to educate children and their parents about in the right way.” CSOs will be taking service improvement plan. part in monitoring public services in good oral practices; and, as a service caravan, to diagnose and treat school accordance with the contract entered children with oral health problems. into between the Aimag governor. 53 54 The initiative will tap 46 trained citizen Lastly, having worked closely with result of the assessment. Such will be monitors. government has allowed people to gain implemented across 4 schools in the Empowerment: Being involved in a deeper understanding of the workings Aimag center towards improving oral the project conceptualization and of the public sector. Sub-project health among school children. implementation has opened minds and implementation has made them realize As part of the recommended action changed perceptions on the part of the that not all prob-lems can be solved plan, the hospital will also send off CSO leaders. For one, being aware of by resource provision but through its staff for further training to become the issues under-lying certain problems influencing, cooperating, and working specialists, and will em-phasize the felt by citizens and standards of service together with government to make pro- need for and conduct of public health that government ought to provide its grams and services more relevant to education cam-paigns (i.e., preventing constituents gave the leaders first-hand citizens’ needs. people for getting sick). knowledge and basis for monitoring and Service Delivery: The action plan While the hospital is used to getting assessing govern-ment performance, of the Aimag General Hospital took two to three complaints and feedback programs, and services. into consideration recommendations from citizens, they have never received This has allowed them to stir up from the CSO network. The hospital concrete and or-ganized feedback dialogue and conversation on issues administration and staff took the issues from CSOs as experienced in the sub- affecting citizens and to appreciate and recom-mendations seriously project. Having seen its efficacy, the how collective reflection and action can because it affirmed and validated Health Department and the Hospital compel gov-ernment to take action on concerns that the hospital and even the of-ficials are keen on exploring how these issues which they could otherwise Health Department were already aware citizen participation can likewise be actually choose to ignore. of but felt unable to do something about implemented in other programs and (e.g., following re-quired standards services (such as in education, to Secondly, seeking accountability of quality and staffing) due to budget from those in power also comes with increase parents’ participation). limitations. responsibility on the part of citizens. This case shows how health is now seen as The results of the survey and FGD became leverage for the hospital to 3. On mechanisms for sustainability. a shared responsibility between service pro-viders and beneficiaries, especially request for funding support from the Despite the limitation in time and on the aspect of health educa-tion, Soum and Aimag Governors such that resources to implement the sub- disease prevention, and health-seeking both offices were able to commit a project, local stakeholders were able behavior. total of 31.9 Million MNT (28.9 M from to put in place some mecha-nisms that the aimag governor, another 3M from can make the initiative viable for longer Moreover, this illustrates that the soum governor) for the purchase than the project term or in monitoring giving good feedback-and avoiding of mobile dental equipment, expansion and collaborating for other programs accusations of just evaluating programs and rehabilitation of facilities, and hiring and ser-vices of the local government. and services for no apparent reason- of one additional personnel. requires evidence especially if, initially, For one, the CSO network was able to local government people are not happy Baruun-Urt soum has developed an build and strengthen working relations with the reaction they are getting. oral health education program as a both from within the net-work itself Mainstreaming Social Accountability in Mongolia (MASAM) Project and with government counterparts, including the local council. And because of the positive experience of working Assessment and together (as “one voice of CSO”) and with government, they have expressed Recommendations willingness to use the model on other programs and services of government. The sub-project in Sukhbataar has acceptance of engaging with civil society In fact, the LGU already has an existing several strengths going for it that or-ganizations. Given the feedback signed agreement with the Labor Union makes the experience ready for from the CSC survey and FGDs, CSOs (a member of the CSO network) and possible application in other services were able to leverage the information to 11 Soum Governors to monitor the and program of the aimag. On the part seek action on and resolution of service soum governments’ perfor-mance and of the local government unit, there is delivery gaps which government may services. predisposi-tion to, prior awareness and have been aware of but have ignored. According to both the local government Salient Points of the formally constituted CSO Network’s and CSO representatives, such an Rights and Responsibilities agreement can be invoked to also conduct monitoring on education, 4.1 NGOs can freely join the network and organizations joined the network shall be water, quality of and access to services ensured with equal relations and integrated policy coordination. of the Aimag General Hospital (beyond 4.2 Shall be established according to the Law on NGO; shall acquire Board of Direc- tors, financial and human resources capacity and be free of conflict of interests. the TB ward). 4.3 Network shall be involved in submit-ting a proposal to the discussion aimed at The Deputy Governor himself has determining aimag and soum development solution as well as in the working expressed willingness to imple-ment group established in line with certain issues. the model with other projects and 4.4 Inform the public on product, work or service that will be procured through state programs. or local capital as well as product supply operations; promote relevant laws and regulation, jointly organize training with a government institution. To him, CSOs can act as government’s 4.5 Private entities shall provide assistance in obtaining survey on market demands independent counterpart to assess and customer satisfaction, provide support in developing SME project and perfor-mance of the soum government business plan as well as show an intermediary support in establishing a contact units. He believes in the value of the with external or inter-nal donor organizations. engagement such that the aimag 4.6 Private entities and civil society organiza-tions shall immediately, transparently government, according to him, is and openly deliver information and news that are not classified as state secret to supportive of the action plan put the public. forward by the Health Depart-ment. He 4.7 Develop a project and participate in selection of certain works and services to be completed by civil society organizations; within the framework of the sector and has endorsed said plan to the Advisory field, obtain financing according to an agreement. Committee for their approval. 4.8 Organize a public survey, conduct monitoring and inspection, inform the result to The action plan proposed by the Health the public. Department has a citizen monitoring 4.9 Promote decisions taken by the gov-ernment organization, express position and initiative enshrined in the proposal. issue a statement in this regard. 55 56 And because there is appreciation for the role that CSOs can play and given the presence of a reform champion in role in monitoring and engaging with government. The balance of power is nat-urally tilted to the side Collective the person of the Health Sector adviser, immediate action was taken on these of duty bearers (locally elected and appointed officials), the CSO can POWER in requests with an ex-pressed willingness balance this off by the power of to continue the engagement through the adoption of local policies and programs their numbers and their technical proficiency. Their abilities matter not Uvs Aimag that will allow for CSO participation and only in terms of social accountability The sub-project in Uvs aimag was en-gagement. On the part of the CSOs, tools and approaches, but in being implemented in partnership with Trans- there is a demonstrated familiarity with able to gather evidence as basis parency International-Mongolia entitled the tool and the attendant processes for feedback, especially on more “Collective POWER”. Through the and steps in gathering and presenting complex and complicated pro-grams leadership of the local NGO Coordinator stakeholder feedback. and services (beyond oral health and with strong support of stakeholders Key areas needing improvement include care, which understandably may be from the Aimag Governor’s Office, the following: a strong issue for the community but General Hospital and other local surely, there are bigger and more CSOs, the project took huge strides • While there is an organized presence urgent issues that could use some of CSOs in the aimag, they need to in improving the procurement of and feedback and improvement). access to quality medicines, supplies, further build on their bases for unity and to agree to work on making local • On the part of the Health Department and medical equipment. • On the part of government the Health more Department accountable for and of and the service of the service providers, providers, they they According to CSOs in Uvs, the procurement need to see the delivery CSOs not of programs andonly as a means services need for to mobilizing see CSOs notand only as a informing process by the Aimag General Hospital, (i.e., about concretizing self-avowed means for mobilizing and informing as undertaken by the Bid Evaluation citizens public health, but as co-creators, co-equals, and collabora- responsibilities, see box above). citi-zens about public health, Committee, is almost always awarded tors of program development and implementation. but as co-creators, co-equals, Parallel to this is strengthening and to the lowest bidder which has led to assuming a more active leadership and collaborators of program the purchase and delivery of low quality development and implementation. medicines and supplies, which when dispensed to patients and clients, has   contributed to growing dissatisfaction over the services and medicines, facilities, and equipment of the hospital. Underlying this are several issues concerning procurement. In their analysis, the procuring entity is unable to exact accountability on the supplier in cases of delayed deliveries, and delivery of drugs that are not compliant to specifications (either low quality or totally inappropriate drug replacements). Mainstreaming Social Accountability in Mongolia (MASAM) Project In order to address this, the sub- Transparency International). 3. Conducted a performance evaluation project worked at mobilizing CSO To achieve project objectives, survey on the members of the Bid and government counterparts to the following key activities were Evaluation committee. gather stakeholder feedback (on the implemented: Internal and External Procurement performance of the Bid Evaluation Pre-Project Implementation Monitoring Committee members), participation in 1. Issues relative to the procurement 1. Organized external citizen monitoring procurement planning and monitoring, of medicines and medical supplies groups composed of 20 volunteers and performance monitoring. To gather by the aimag hospital were analyzed (from the local media, citizens’ information on the above-mentioned using the problem and decision organizations, and professional approaches, the team deployed tools tree method with the guidance of organizations, e.g. pharmacists) to such as the Stakeholder satisfaction Transparency International (TI)- monitor the delivery of procured survey, Performance evaluation tool Mongolia. Through this process, items based on the revised bid and (based on the National Procurement local CSO stakeholders were able to contract specifications. Monitored Law) and Contract implementation/ identify core issues upon which the Collective POWER in Uvs Aimag and reported (through SMS or calls to Delivery checklists. project design was based. members of the Project Management The sub-project in Uvs aimag was implemented in partnership with Trans- Upon signing of the Project parency Memorandum International-Mongolia 2. Through entitled “Collective formal POWER”. Through the representations Team) if delivery of items was in of Agreement, the Project leadership Management of the local NGO Coordinator and with made strongby the of support stake- CSO Coordinator, local accord with the signed contract in team was formally holders from constituted. It was Office, General the Aimag Governor’s buy-in and and Hospital other of government support terms of specified brand, quantity, local CSOs, the project took huge strides in improving the procurement of composed of representatives of the offices was sought to set-up the and quality and delivery schedules. and access to quality medicines, supplies, and medical equipment. Aimag Social Policy Department, Local project management team and the A member of the external monitoring Council, Head of the According to CSOs Aimag in Uvs, the procurement processworking General by the Aimag groups. General Hospi- team even published the results of Hospital, Aimag Health Department. 3. TI-Mongolia awarded tal, as undertaken by the Bid Evaluation Committee, is almost always was to officially chosen monitoring activities in an article for the lowest bidder which has led to the purchase and delivery of low quality medi- External monitoring group members, as national NGO partner to provide a local newspaper. cines and supplies, which when dispensed to patients and clients, has contributed to organized and led by the local CSO technical assistance and coaching on growing dissatisfaction over the services and medicines, facilities, and equipment 2. Organized an internal monitoring coordinator, were selected of the hospital. Underlyingfrom thisamong improving are several issues concerning procurement procurement. In their processes in team of 15 people from among local CSOs inanalysis, the aimag. They the procuring were entity also is unable Uvs aimag. to exact accountability on the supplier in hospital staff. Led by the Quality cases of delayed deliveries, and delivery of drugs that are not compliant to specifi- complemented by a local coordination Procurement Planning department of the hospital, the team cations (either low quality or totally inappropriate drug replacements). team (supported by consultants from monitored utilization and availability 1. Identified the persons who are trained In order to address this, the sub-project worked at mobilizing CSO and government of medicine supplies. The team experts of counterparts to gather stakeholder feedback (on the performance on procurement the Bid Evalua- monitoring worked at resolving issues (on The Uvs Sub-project at a Glance and sought tion Committee members), their inputs in reviewing participa- availability of supply) based on the Procurement of low quality Procurement of and procurement instruments and tion in procurement planning and results of their internal monitoring. medicines and supplies monitoring, and performance monitor- and citizen dissatisfaction over services, medicines, improved access to quality medicines, supplies, and processes which provided guidance ing. To gather information on the 3. Conducted a customer satisfaction medical facilities and equipment in the hospital instruments/equipment in including above-mentioned approaches, special the team provisions and survey. Through: deployed quality tools such asconsiderations the Stakeholder in bid and 4. Utilization of survey results as basis CSO participation in contract instruments. satisfaction survey, Performance eval- for interface meeting with the aimag uation tool (based on the National Procurement Planning, Procurement and 2. Participated in the activities of the Bid Procurement Law) and Contract im- general hospital management and Performance Monitoring of the Bid Evaluation Evaluation plementation/Delivery Committee to advocate checklists. staff. Committee for the revision of bid, tender, and contract documents. 57 Upon signing of the Project Memo- randum of Agreement, the Project Management team was formally constituted. It was composed of representatives of the Aimag Social Policy Department, Local Council, Head of the Aimag General Hospital, Aimag Health Department. External monitoring group members, organized and led by the local CSO coordinator, were selected from among local CSOs in the aimag. They were also complemented by a Page 80 58 Sub-project Outputs The revised contract stipulations also and Outcomes paved way for the develop-ment of a tool/ checklist with the local CSO (external) monitors, which was used during Outputs from sub-project implementa- procurement documents) to ensure contract implementation to evaluate tion and the activities just enumerated quality and not just award the contract the per-formance of the Bid Evaluation are discussed below. to the lowest bidder by default. The Committee members. Citizen moni-tors reconstitution of the committee and the were able to alert decision-makers introduction of the special provisions and to halt the delivery of medicines 1. On the SAC Intervention Design to was timely in preventing a call that because they had direct and immediate improve supply and demand sides of was about to be made for bid proposals access to hospi-tal managers (being governance and accountability using the usual templates. The call a member of the project management would have resulted to awarding the team). Based on the monitoring tool, The conduct of the problem analysis contract to the lowest bidder and to they were able to prompt managers and the stakeholder satisfac-tion procurement of poor quality medicines. about delays in delivery, medicines that survey surfaced the level of citizen Procurement activities worth 1.4 Billion are duplicated in the deliv-ery list, and satisfaction with the services and MNT were undertaken using the revised items that were replaced with cheaper/ facilities of the aimag general hospital bid specifications. The project team lower quality products in violation of and the issues underlying such. The estimates government savings at 189 bid/contract specifications. results were presented to the project management and implementation team Million MNT because of such reform Results of the monitoring activities with representation from the Social initiative. and the customer satisfaction survey Policy Department, Local Council and the General Hospital. Additional contract stipulations to ensure quality of procured The team was able to advocate to and medicines and supplies: influence the Bid Evaluation Committee Customer have the right to experiment and verify. Such rights are exercised during to reorganize its membership and the scheduled period through two times of random selection approach shall transfer include representation from the the drugs and medical instruments to the laboratory selected by the customer and the local council, local CSOs, and the supplier shall reflect the incurring costs in the budget. The experiment and monitoring business sector. With the reconstituted costs shall not exceed 0,01 percent of supplier’s contract amount. committee, the sub-project team was In order to verify the technical specifications, the supplier shall have met the following also able to provide assistance and requirements: inputs in the review and revision of 1. Supplier shall have the drugs and medical instruments analyzed by the technical specifications, bid, tender independent, competent laboratory maximum not more than 15 days before the and contract documents. From out of determined supply schedule and submit the feedback along with the products. 2. Supplier shall be in charge of the relevant costs. the review, they were able to identify 3. Team inclusive of local citizens and consumers shall verify if the drugs and opportunities for reforming the process medical instruments supplied meet requirements indicated in the tender with which procurement decisions and documents and receive them. actions are made by introducing special 4. The conclusion shall be considered for the payment completion. provisions (to the usual templated Mainstreaming Social Accountability in Mongolia (MASAM) Project were used as basis for proposing requirements and/or services for local stakeholders have noticed the recommendations to the hospital hospital clients. Monitoring contract following: management. implementation has likewise allowed • Reduction of shortage on supply of 2. On Outcomes: Concrete for on-time delivery of procured antibiotics; improvements in local governance, medicines and goods, and therefore • Increase in number of patients being citizen empowerment and health assured availability of good quality served; service delivery. supplies in the hospital. • Reduction of infant mortality (from Governance: The Health Department Citizen Empowerment: With their 11 in the previous year to 5 in the has expressed support for the participation in the reconstituted Bid current year); and, reconstitution of the Bid Evaluation evaluation committee, local CSO • Reduction of citizens’ out-of-pocket Committee as well as the re-vision of representative/s has/ve be-come expenses for medicines. the bid and tender documents. Although familiar with the procurement process Results of the stakeholder satisfaction there is no formal policy issuance yet, and how decisions are arrived at. And survey also compelled action to he likewise sees the hospital conducting with the checklist/monitoring tool introduce an appointment system in pro-curement activities using the made available to the monitors, they the hospital through a phone hotline, revised bid and tender documents even have acquired some level of capacity rehabilitation of the hospital roof, and after the sub-project. to appraise the delivery of medical improvement of labor-atory equipment. products and supplies according to Government officials and service technical specifications as stipulated 3. On mechanisms for sustainability. providers appreciate the availabil-ity of in the contract and thus empowered to Prospects for sustainability of and accept the feedback arising from report and refuse outright the delivery the intervention are bolstered by the customer satisfaction survey as of products that are not in ac-cordance commitment to continue using the basis for problem-solving and action to technical specifications. revised bid and tender docu-ments planning. They will in fact explore as well as a willingness to replicate how citizen/CSO participation can be Service Delivery: According to the Finance Head of the Aimag Health the improvement of pro-curement made a feature in the decision-making procedures at the Soum clinic and Family processes of the aimag government. Department, a procurement specialist herself, the Bid evalu-ation committee health clinic levels. There has been no Because of feedback from citizens reported effort to make such proposal gathered through the customer satisfac- was able to improve on the transparency and effec-tiveness of their procurement of-ficial or institutionalized at the time tion survey, the local government unit the interviews were conducted for this has committed to increase budget process due to the external perfor- mance evaluation and the revised assessment. Citizen monitoring on the allocation for health and procurement other hand, is seen to mean additional of medicines by 200 Million MNT. technical specifications of bid, tender and contract documents. workload and will require additional The results of citizen monitoring resources to implement on the part of on procurement and strengthening This enabled the hospital to receive government. At the moment, the Aimag of quality considerations in the bid higher budget allocation for and procure Governor’s Office has designated one documents have generated pro-jected quality medical goods and supplies in staff to handle and look after citizen savings for the local government, which the most timely manner. In terms of complaints. can be used for pro-curing additional the hospital’s ability to deliver services, 59 60 Assessment and delivery and inspection of goods, citizens/citizen representatives were involved in the approaches to improve Recommendations the procurement of medicines and supplies. However, if the sub-project were to be Sub-project implementation in Uvs • Openness of the procuring entity scaled up and replicated in other areas aimag encountered some difficulties. (Aimag General Hospital) to open or services of government, it needs According to the CSO coordinator it was up the procurement preparation and to address weaknesses which can be quite a challenge to create a common contract implementation process categorized according to: understanding on and acceptance to citizen participation as well as to of social accountability from among expand the membership of the Bid • Project design - Procurement is a stakeholders which caused delays in Evaluation Committee; complex, complicated and highly implementation. Because of the time it tech-nical matter that takes time took to get the project off the ground, • Technical inputs and expertise for the untrained to understand and CSO volunteer monitors eventually provided by national NGO allowed for participate in. It would have helped choose to undertake monitoring of less closer technical aspects of examination the contract of procurement the implementers if the design were became inactive. In terms of actual and deploy project easierthe operations, to follow andand inter-nal issues disseminate and and tools identification of opportuni- procedures. clearer as to focus on strategic points external monitoring -teams ties for improvement did not to the bid and tender documents,in procurement for citizen participation. Seemingly a • Institutionalization The revisions while work directly nor coordinate with activities; case of wanting to solve too much based on the provisions of the national procurement law, is not an institu- each other as with the surveys that • Social/Political capital of the local and too many issues on procurement tionalized each and regular group conducted process even ex-the Bid as the of Evaluation Committee. For now, in a limited span of time, the project implementing partner being a former the matter ternal relies satisfaction stakeholder on the political will of decision-makers survey local council memberto continue himself,using and is unable to demonstrate concrete validated the results of the hospital’s the approach introduced. Needless to say, is therefore able to tap the concerned into may actors this re- re- and sustainable gains in either regular internal survey. Despite these source to participate and influence procurement planning or contract vert to using the traditional and templated bid requirements and contract minor setbacks, the project was able decision-making; and, implementa-tion monitoring. implement should tostipulations planned there compelling reasons and benefit for contin- be noand activities • Operations and implementing • Contract implementation monitoring realize intended uing and outputs sustaining owing such to the reform. mechanisms - While there were ties up and closes out the loop in im- following strengths: three dif-ferent monitoring, and proving the procurement process. From procurement planning to stakeholder feedback mechanisms implemented (stakeholder satisfaction survey, internal quality monitoring, and contract implementation monitoring) they were seemingly not feeding off of each other and complementing what each particular effort was doing for the project. At best, coordination took place at the level of the project man- agement team, but not between and among the three monitoring teams Mainstreaming Social Accountability in Mongolia (MASAM) Project • Sustainabilty - Transfer of technology to and deeper appreciation for citi- zen monitoring among local CSOs Public Participatory and citizen monitors (beyond their in-dividual interests and motivation). Schools with Citizen monitors need to be bound by and committed to goals of contract monitoring. Contract Accountability in monitoring re-quires resources for technical training of monitors and mobilization, and therefore will need Uvurkhangai Aimag to be implemented from a more strategic (perhaps not all, but a few important ones) and sustainable (regular) beyond the sub-project’s The sub-project in Uvurkhangai aimag income, and are more often than not, Public Participatory Schools with Accountability practice of providing “payments” to was implemented in partnership in Uvurkhangai Aimag with unable to participate in donor-funded the monitors. As CSOs build their the Mongolian Education Alliance (MEA) projects that support school activities. The sub-project in Uvurkhangai aimag was implemented in partnership with confidence and capacity to conduct entitled “Public Participatory Schools According the Mongolian Education Alliance (MEA) entitled “Public the Director of one toParticipatory contract monitoring, they can choose Schools with The with Accountability”. sub-project Accountability”. participating school, The sub-project sought to address the gov- parents do not to undertake monitoring of less sought to address the gov-ernance, ernance, resource allocation, expenditure and multi-stakeholder decision- get en-gaged with school activities technical aspects of the contract making in tenexpenditure resource allocation, secondary schoolsand which are isolated from the aimag center, low-income, and are more often than not, and unable the schooling to participate of their children in in donor- and deploy easier to follow and multi-stakeholder decision-making general. Most herder families are not funded projects that support school activities. disseminate tools and procedures. in ten secondary schools which are aware of school activities and more isolated from the aimag According center, to the Director of one low- participating school, parents do not get en- often than not, only the mothers would • Institutionalization - The revisions to gaged with school activities and the schooling of their children in general. the bid and tender documents, while attend meetings. For most schools in Most herder families are not aware of school activities and more often than based on the provisions of the national The Uvurkhangai Sub-project at a Glance the aimag, the local school councils not, only the mothers would attend procurement law, is not an institu- are mostly meetings. non-functional. For most schools in the To school Lack of information on and Community participation in aimag, the local school councils tionalized and regular process of the access to governance, resource allocation and planning for, implementation and direc-tors like her and to stakeholders are mostly non-functional. To Bid Evaluation Committee. For now, expenditure tracking, and planning for school operations reporting of school operations, policies and internal regulations in general, the sub-project is about school directors like her and to the matter relies on the political will involv-ing stakeholders parents in general, sub- citizens in school the and Through: of decision-makers to continue using operations project and management is about involving parents using the An Assessment of and citizens in school operations the approach introduced. Needless schools and collective MEA-developed “Participatory Schools” problem-solving and management using the MEA- to say, the concerned actors may model and ultimately making schools developed “Participatory Schools” using the re-vert to using the traditional and “Participatory Schools” as human model making centers. development and ultimately model by MEA schools as human development templated bid requirements and centers. contract stipulations should there be no compelling reasons and benefit To realize the project objectives, the following key activities were imple- for contin-uing and sustaining such mented: reform.  1. The national NGO partner MEA conducted a workshop on social ac- countability which to participants meant finding productive ways to get en- 61 gaged in the planning for and monitoring of school operations. The activity was also meant to train project stakeholders on the objectives and ex- pected results of the collaboration. Trainers from MEA oriented the partici- pants about the “Participatory Schools” methodology of problem identifica- 62 To realize the project objectives, the 3. The team of 20 volunteers for field and for information about school following key activities were imple- implementation cascaded the activities to reach herder parents. mented: MEA training to the soum/school Another school interviewed for the 1. The national NGO partner MEA volunteers mobilized for the sub- assessment implemented a mini- conducted a workshop on social project. They trained soum and school project purposively aimed at making ac-countability which to participants level implementers on the conduct of fathers more ac-tively participate meant finding productive ways to the schools assessment according in the education of their children. get en-gaged in the planning for and to the MEA-developed criteria and The group of fathers were made monitoring of school operations. participatory problem solving. to participate in a training called The activity was also meant to 4. At the school-level, local “Wisdom of life: Role of the father train project stakeholders on the stakeholders (school management in the family”; the school organized objectives and ex-pected results and staff, parents and volunteers) sports activities and social events; of the collaboration. Trainers from did an assessment of school and, through support from a Member MEA oriented the partici-pants management and op-erations using of Parliament, the group of fathers about the “Participatory Schools” the “Participatory Schools” survey. went on a study trip to UB for them to methodology of problem identifica- Out of the results, each school learn from the experiences of other tion, prioritization, and collective team developed action plans to schools. problem solving. resolve the issues identified in the 2. Organized the local project team survey. Most of the ten participating in partnership with the local CSO. schools identified the lack of or Three field teams were set up: policy weak participation of parents in analysis team, the implementation school activities as their main area of team, and the media/communications concern. team. Education Department staff 5. Each school team designed and also served as counterparts to implemented their “mini-projects”. the CSO volunteer teams but were One participating school implemented mostly involved in the policy and field a “mobile news” project as a means implementation teams. to strengthen information disclosure Mainstreaming Social Accountability in Mongolia (MASAM) Project Sub-project school activities and to mobilize parent involvement in parent activities through in-formation dissemination, learning School-level initiatives were also complemented with efforts from the Soum Governor’s office. In one school Outputs exchange, tree-planting and school beau-tification projects, and setting up for instance, the Soum Governor’s office allocated 1.5 Million MNT for the of parents’ development center in each purchase of mu-sical equipment that the and participating school. Collective problem solving also resulted to mobilizing school needed, and which was identified through the assessment process. Outcomes resources from local business and community stakeholders for school im- provement initiatives (e.g., one school Because of the mini-project, offi-cials from the local government understood the importance of child development was able to mobilize 24 Million MNT for and that their support to school (and such a project). the children’s de-velopment) will be for Outputs from sub-project implemen- the further development of the soum as tation and the activities enumerated well. above are documented and juxtaposed 2. On Outcomes: Concrete against essential elements and contex- improvements in local governance, Empowerment: Sub-project imple- tual factors for more effective social ac- citizen empowerment and health mentation has provided opportu-nities countability initiatives, as fol-lows: service delivery. for parents and the community at large to be part of collective problem-solving Governance: For the Aimag Education processes. Even as the mini-projects 1. On the SAC Intervention Design to Department, schools are places where were mainly geared towards parent en- improve supply and demand sides of children are formed as persons. gagement, especially the fathers’, some governance and accountability Addressing this mis-sion not only significant gains included: requires the involvement of the school Sub-project implementation allowed but that of the children’s parents as well. • Changing mindsets and making stakeholders, especially parents and In recognition of this, the Education De- parents recognize that education community members to assess school partment has developed a sub-program is a shared responsibility between operations and to identify weak-nesses which was presented to and approved them and the schools where the based on the Community Schools by the local council. The subprogram children go and parents (especially model. Because of the openness of seeks to mobilize parents in monitoring fathers) directly contribute per- local schools to engaging with citizens, the operations and daily activities of sonal resources for school needs they were able to identify issues, the school, and to make teachers more (e.g. one vegetable grower do-nating improve mechanisms for problem responsible in performing their roles. his produce) through the training solving, and mobilised resources to re- organised for 80 members of the solve the issues. Each project school Actual project implementation was local implementation teams and evolved its own monitoring tool and made possible by the Education for 300 staff of the participat-ing the results of the assessment was Department deploying 50% of its staff to schools. used as basis for organizing composite become part of the field implementation working groups (of teachers and teams, providing support, assistance to, parents, mostly fathers) to monitor and over-sight of the mini-projects. 63 64 • Tapping financial resources from an opportunity for them to show of working. Not only are they look-ing local business people and other local realities of the schools and at revising guidelines in how decision- organizations (one school mini- communities and for education making and planning processes are project was able to mobilize 25 Mil- manag-ers at the aimag level to carried out in school but also specific lion MNT in donations); focus their attention, programs and aspects of school operations such as • Implementing local initiatives in re-sources. the job description of the teachers response to identified issues in the For their part, schools see the value (making it part of their role to ensure schools (such as tree planting around of collaborative issue identifica-tion parent participation), and teachers’ the school vicinity, fencing the school and problem-solving, information performance evaluation among others. perimeters, and book campaigns for disclosure, and transparency of At the aimag Education Department the school library) and training 2000 school affairs and operations because level, part of the proposal and action parents across the 10 soums; it has made local stake-holders more plan submitted to and approved by the • Increasing awareness and better aware of and responsive to gaps and local legislative council is to include understanding of school activities, needs in their children’s schools. citizen monitoring of school activities programs and operations. One parent The mini-projects, while not directly to help improve over-all operations group monitored the imple-mentation funded through the school’s budget, and day-to-day activities, and to make of the school lunch program with was a result of contributions and teachers more responsible and ac- the School Director not-ing that the collaborative effort of parents countable in the performance of their because of their involvement in and and local organizations. One school roles. understanding of school activities, interviewed for this assessment Results of project implementation were they do not merely criticize the is going about the formulation of presented to and deliberated by the school amongst themselves (as they their action plan in a more inclusive Aimag local council and the governor’s were wont to do in the past); manner. In the past, planning was council. The local implementation usually done just by the school team exerted efforts to understand and • Exacting accountability for learning managers and staff. They are now in and instruction. In the past, parents support the sub-program proposal for the process of revisiting and changing instituting participatory mechanisms in were afraid to say what they thought internal school regula-tions such as about teachers’ per-formance. In schools. integrating parent participation in the one soum for instance, the School evaluation of teachers’ performance. Director heard par-ents making a request to improve Math instruction. 3. On mechanisms for sustainability. Service delivery: Soum level At the school level, some School officials and school managers think Directors are leading the charge in re- that having staff from the Aimag viewing existing internal regulations Education Department working and finding ways to make parent partic- with and visiting the soums was ipation a more integral part of their ways Mainstreaming Social Accountability in Mongolia (MASAM) Project Assessment and • Go beyond parents mobilization and involvement in school activities (which is a responsibility by the Recommendations parents themselves and not by service providers) and actually leverage and collective problem solving and improvements in education service deliv- capitalize this involvement towards Sub-project implementation in operations. Part of the action plan’s collective problem solving and ery. Uvurkhangai ran into some difficulties objective is to create a learning envi- improvements in education service •mainly of timing. because actual Demonstrate Convening and experiences results in ronment of the where these aimagmonitoring citizens as deliv-ery. community most efforts to mobilize and was stakeholders involvecouncils can had the parents share andwith harness to do them • Demonstrate actual experiences challenging during the coldest months experi-ences of citizen’s monitoring for merely being made aware of and involved with school activities, but not in and results of citizens monitoring as of winter and equally hard during school services, participation in school terms of knowing, most efforts to mobilize and involve the spring be-cause monitoring, and giving herder families feedback planning on particular and budgeting school processes, and the parents had to do with them were preoccupied with breeding cattle information disclosure programs and services. Such information may be used to demand ac- on results of merely being made aware of and and livestock. Some schools were school audits. countability constructively from service providers and local government involved with school activities, but also located near the Gobi and along If a similar social accountability initiative units. not in terms of knowing, monitoring, the steppes such that reaching them were to be replicated in other soums and giving feedback on particular Local CSOs •required need longer to take travel higheractive anda more and leadership role in the design or services in the aimag, stakeholders school programs and services. Such transportation costs. and implementation of activities. While maydecisions have to workare on mostly driven and address by some information may be used to demand Despite issues Education andand on schedules Managers some assistance technical areas for improvement such as: can be provided by a na- ac-countability constructively delays, stakeholders at the school tional NGO partner, all development and • The need to are engagements document local. There-the from service providers and local level were able to manifest recognition implementation of school-level mini government units. andlocal fore for valuedCSOs/coordinators the role of parents and must harness their energies or whatever projects and consolidate information • Local CSOs need to take a more active their participation. expertise On the part are available, and of taketheon a more catalytic role in ensuring that on whether or not, parents and leadership role in the design Education Department, it is highly soum and school level monitoring and engagements involvement in truly happen school are and has activities and implementation of activities. laudable that the subprogram which thus far resulted to claim-making made more sustainable. While decisions are mostly driven by the local council approved in July ar- and used citizen feedback to develop Education Managers and technical ticulated measures to activate parents interventions in response to identified assistance can be provided by a na- councils and ensure their permanent issues. tional NGO partner, all development and engagements are local. There- fore local CSOs/coordinators must harness their energies or whatever expertise are available, and take on a more catalytic role in ensuring that soum and school level monitoring and engagements truly happen and are made more sustainable.   65 66 Part 4: Conclusions and Recommenda- tions Mainstreaming Social Accountability in Mongolia (MASAM) Project All sub-projects have been successful in implementing their Part social 4: Conclusions account-ability and initiatives Recommenda- and activities as proposed and tions planned. Overall still, depth of understanding and quality of implementation to produce All sub-projects have outcomes been successful may varytheir in implementing across aimags. social account- Based on the and ability initiatives assessment of the and activities as proposed individual sub-projects, planned. Overall still, depth there are models of understanding that and have quality more than adequately of implementation coveredmay to produce outcomes all vary across aimags. elements and shown enough proof that the experience is ready for replication and scale. Other sub-projects may need further Based on the assessment of the individual sub-projects, there are models strengthening and interventions to tighten and clarify the design that have more than adequately covered all elements and shown enough of, approach to, and better understanding social account- proof that the experience is ready for replication and scale. Other sub- ability in order for them to be more effective and sustainable, projects may need further strengthening and interventions to tighten and even without MASAM support. The table below summarizes the clarify the design of, approach to, and better understanding social account- ability in orderacross assessment for themthe essential to be elements more effective for effective even social and sustainable, without accountability MASAM support. interventions. The table below summarizes the assessment across the 67 essential elements for effective social accountability interventions. Looking at the chart, one would immediately see that the sub-project expe- riences from Khovd and Selenge were able to cover all essential elements 68 Looking at the chart, one would immediately see that the sub- project expe-riences from Khovd and Selenge were able to cover all essential elements and may therefore be considered for immediate replication and scale. While all sub-project grantees were able to demonstrate results on the improve- ment of nesses service that to beas delivery may have regardsor addressed access and quality, interventions there required are to enable weak-nesses the that may projects implement have a more to be solid, addressed effective or interventions and sustainable practice of required social to enable the projects implement a more solid, accountability. effective and sustainable practice of social accountability. Areas for improvement and recommended courses of action at the individ- Areas for improvement and recommended courses of action ual sub-project level have been discussed in the preceding part of this re- at the individ-ual sub-project level have been discussed in port. In summary however, and based on the documentation and as- the preceding part of this re-port. In summary however, and sessment of sub-project experiences, it is recommended to consider the based on the documentation and assess-ment of sub-project following: experiences, it is recommended to consider the follow-ing: Key Lessons and Considerations for replicabil- ity and scale of MASAM Sub-projects Mainstreaming Social Accountability in Mongolia (MASAM) Project Key Lessons and Considerations for replicability and scale of MASAM Sub-projects 1. The MASAM design and approach number of officials interviewed for in turn will ensure that other for supporting social accountability the assessment view and think of instrumentalities and decision- initiatives ensure support and CSOs as extensions of government makers are made to understand acceptance on the part of the Aimag work, as means to inform citizens and value citizen participation and lead-ership at the get-go. of government programs and the results of citizen monitoring and Expression of support has translated services, and as bridge for fostering feedback. into issuances of ordinances that understanding and acceptance of 2. Because the design of the project constitute the project implementation behind-the-scene issues hindering itself ensures the buy-in of key team and be-stowing upon them service delivery. While involving local officials and decision-makers at the the rights, responsibilities and CSOs for information dissemination start of sub-project implementation, wherewithal to carry out tasks and is notably a significant starting CSO claim-making and feedback activities. Several aimag and soum point, govern-ment counterparts have to be made on solid, sound, governors have also expressed the have to eventually see CSOs as and unim-peachable assessment of willingness to formalize and integrate critical partners in decision-making government programs and services. citizen participation in decision- and collaborative problem solving. While project experience is enough to making at several levels: through the Not all officials are expected to expose participants to the value and formulation of and allo-cation of the fully understand nor embrace pro-cess of generating stakeholder Local Development Funds, inclusion social accountability and citizen feedback, such should be gathered, of citizen monitoring in the action participation per se. ana-lyzed and presented in a manner plans of the Health and Education What the MASAM project and CSO that cannot be easily be invalidated by Departments, and integrat-ing counterparts can do is to find and decision-makers and power holders citizen feedback in the regular M&E maximize social accountability on the lack of validity, objectivity and functions of local government of- champions on the part of the local rigor for conducting basic research fices. government. More often than not, - citizen feedback which is the start- However for some aimags, this does this champion can be found in the ing point for collaborative decision- not necessarily translate to actual heads/senior technical staff of offices making and problem solving. understanding of and appreciation of the aimag Health, Education, for citizen participation across all Social Policy, and Social Welfare critical decision-makers. For one, a Departments. These champions 69 70 3. Most projects deployed the CSC as a meth-odology and sampling, which shorter implementation time, tool for gathering stakeholder per- if not done properly can just be emphasizes immediate feedback and ception and feedback it was carried easily inval-idated by government accountability, and is less likely to out through surveys and therefore is officials who are less open to the run into issues of representativeness more often regarded as the Citizen idea of citizen feedback through of the sample and participants to the Report Card. While the tool is among constructive engagement. The process. And while most programs stakeholdersand CRC the easiest to deploy, odology sampling, which if not doneand (in its technical sense) may be services can properly can just be easily inval- be assessed and practitioners could benefit from good as a one-off project but may through the use of the CSC or CRC, idated a clearer differentiation by government of the CRC officials not be as sustainable as awho less long- are the open problem itself to need the idea of citizen not mobilize from the CSC. Because of the choice term mechanism for stakeholder stakeholder feedback to resolve. In feedback to use surveys, data gathering has through feedback.constructive While the Commu-nity engagement.the case ofThe wantingCRC (inhealth its technical to ensure thus required intensive human and Score Card (CSC) is mostly qualitative insurance coverage for temporary sense) fi-nancial resources to carry out may be good as a one-off and requires strong facilitation skills,project but may residents and more not be as vulnerable mem- sustainable and yet compromised on technical it is sufficiently participatory, requires bers of the community for example, a as a long-term mechanism for stakeholder feedback. While the Commu- social audit would have sufficed. Both the CRC and CSC are instruments to exact social nity projects Card Score 4. Some successful is mostly are more(CSC) accountability and responsiveness from service providers, and than others because of the choice of may often times be used interchangeably. qualitative and simple, easy to and focusedstrong fa- requires analyze, issue (e.g. tuberculosis, deteriorat- It will be good to be reminded about some fundamental differences cilitation skills, ing conditions sufficiently par- it is facilities, of dormitory between the two, as follows: oral health). Therefore, the resolution ticipatory, requires shorter imple- is more targeted and easy to The Citizen Report Card (CRC) vs. The Community Score Card (CSC) mobilize support mentation time, especially for for, emphasizes imme- a new initiative and approach for CRC CSC Unit of Analysis Household/ Community diate feedback resolving and accountability, community problems. This is in contrast with issues confronting Individual and is less likely procurement, to run for example, which into issues Data gathering Survey Focus group are more complex, complicated and discussions representativeness of technical and will therefore requireof the sam- more time and resources to address. Sampling Stratified random None/Aim is ple and CSOs participants may need to temper to itch process. the the participation to solve too many issues given And while most programs and ser- limitations in time and resources. Timing 3-6 months 3-6 weeks Whilecan vices the model is solid and may be assessed through the Scope Macro (city/state or Micro (local/ likely be successful in the long national) village level) use the CSC ofprocurement term, or CRC, monitors require the prob- training and technical capacity lem itself building need more than notmostmobilize citizen stake- monitors would. holder feedback to resolve. In the case of wanting to ensure health insurance coverage for temporary residents and more vulnerable mem- bers of the community for example, a social audit would have sufficed. Mainstreaming Social Accountability in Mongolia (MASAM) Project Some Recommendations Part 3 of the report covers areas for 2. Sub-project proponents may also Community Score Card would have improvement and recommendations benefit from exposure to and familiar- been a faster, more efficient and less for addressing these issues at the ity with other social accountability costly exercise for the proponents. individual sub-project level. The tools and approaches. Apart from 3. Thirdly, because the project design following set of recommendations in the CSC (which as implemented in itself has ensured immediate buy- this part of the report may considered essence is actually the Citizen Report in from government counterparts, by MASAM project designers, decision- Card) and Stakeholder satisfaction changes to configurations of makers and implementers in making survey, there are a host of other tools power and appointments in the decisions on the next phases of the and technologies that implementers aimag departments may disrupt project. These are mostly along the can employ in generating and or altogether discon-tinue the lines of further building the capacity of providing feedback to government good started by the sub-projects. project stakeholders not only in terms offices and service providers. For Additionally, the choice of is-sues to of social accountability but on project one, the Community Score Card is an be addressed are less controversial. management as well. easier and less costly tool to use as But circumstances may not compared to the CRC. Based on the necessarily be the same throughout project proposals prepared by the their practice of social accountability 1. Assisting project proponents in terms ten sub-project proponents, some and so civil society actors need to of clearly defining the problem and issues would have been best ad- be capacitated on constructive en- analyzing the issues underlying the dressed through public expenditure gagement (e.g. navigating through presenting problem. Once they are tracking, budget monitoring and controversial issues and managing clearer about the issues confronting so-cial audit which are just as challenging relationships with public service delivery, they should participatory, generates concrete government counterparts). identify which issues can be and objec-tive feedback as basis for addressed through social accounta- 4. Aimag-level implementers and service improvement, and involves stakeholders have expressed bility approaches, and verify that lesser number of citizen respondents the problem can benefit from stake- gratitude for the technical expertise and therefore will cost less to and advice provided by the national holder feedback and collaborative administer. Given the propensity to problem-solving from all those in- NGO part-ners. The national NGOs assess and give a rating to certain are credited not only in terms of volved. aspects of service delivery, the social ac-countability approaches 71 72 and tools but in over-all project familiar with and adapt them to local management as well. And because contexts, needs, and requirements. these national NGO partners are 5. Lastly, several officials of key critical conduits to-wards ensuring government offices and service that local stakeholders are able to providers themselves have realized understand and fully live out the the value for and expressed the practice of social accountability, desire to con-tinue integrating citizen as well as implementing their feedback, monitoring results, and initiatives in the most efficient and participatory decision-making in effective manner, the first set of formal processes of governance. rec-ommendations enumerated Except for a few ex-ceptions above may be best carried out with however, most other sub-projects the par-ticipation and support of have yet to devise more for-mal and these national NGOs. The challenge institutionalized ways of integrating though is to help local implementers and mainstreaming lessons from think through their problems and their sub-project experience. MASAM governance issues, facilitate the can capitalize on this expressed intervention design and development desire and provide assistance in process, and assist them in helping local government units to devising creative, collaborative, and develop, install, and activate these effective solutions to challenges in participatory mechanisms in terms governance and service delivery. This of concrete local policies, programs may also require them to go beyond and activities tools and approaches they are most Mainstreaming Social Accountability in Mongolia (MASAM) Project Bibliography Wetterberg, A., Brinkerhoff, D. W., & Hertz, J. C. (2016). Governance and Service Delivery: Practical Applications of Social Accountability Across Sectors. NC, USA: RTI International. Wetterberg, A., & Brinkerhoff, D. W. (2016). Chapter 9: Cross-Sectoral Social Accountability in Practice: Findings from Six Cases. In A. Wetterberg, D. W. Brinkerhoff, & J. C. Hertz, Governance and Service Delivery: Practical Applications of Social Accountability Across Sectors (p. 151). NC, USA: RTI International. Brinkerhoff, D. W., Hertz, J. C., & Wetterberg, A. (2016). Introduction: Governance, Social Accountability, and Sectoral Service Delivery. In A. Wetterberg, D. W. Brinkerhoff, & J. C. Hertz, Governance and Service Delivery: Practical Applications of Social Accountability Across Sectors (p. 7). NC, USA: RTI International. 73 74 Annex 1: Interview Guide 1. Supply Side: What formal mechanisms were made available for partici- pation and/or feedback? Who is/are the accountable officers taking charge of this? What decision/s and/or actions were taken? 2. Demand Side: Who were stakeholders involved? What is their level of awareness of the need for engagement, the tool/s, processes, and mechanisms for participation and feedback? 3. Project Implementation Results/Output Level: What feedback was pro- vided to the government agency and/or services? What inputs and/ or recommendations were taken into consideration in the planning and budgeting for, and delivery of services? What services and/or programs were availed of by citizens as a result of the access to information and feedback on access to and quality of these services and/or programs? What agreements, formal or informal, were reached between citizens and the government office regarding the feedback and/or inputs given? 4. Outcomes: What has the initiative result to in terms of improving gov- ernance? What did citizens do with the information they were provided or had access to? Were there improvements in terms of access, quality, and turn-around time? 5. Sustainability: How were project results able to influence change in out- look, behavior, and systems for governance both on the part of gov-ernment agencies and its officials, as well as from organized groups and the citizens in general? Is there willingness, commitment, re-sources, and formalized mechanisms to continue the initiative?