Mainstreaming Social (MASAM) Project - Иргэн - Төр...Mainstreaming Social Accountability in...

Mainstreaming Social Accountability in Mongolia

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withnationaland localCSOspartners,localgovernmentofficialsandstaff,andserviceproviders.

According to stakeholders, all sub-projects harnessed multi-stakeholdercollaboration and coordination togather feedback on access to andqualityofhealthandeducationservicesin general, to specific and tar-getedservice provision for tuberculosispatients, temporary residents, andoral health. Assessment results weregathered, consolidated and presentedas feedback to decision-makers andserviceprovidersasbasisforactionand/or service improvement. Most actionplans(5projects)weredevelopedwithdirectparticipationfromtheCSOswhile4 other projects were by the serviceproviders themselves (4 projects),but includingsome levelof inputsandrecommendations from the CSOs. Oneproject was unique in that it soughtto influence the improvement of theprocurementprocessby takingpart inplanningand contract implementation/delivery.

Even as all sub-projects have beensuccessfulinimplementingtheirsocialaccountability initiatives and activitiesas planned, there are notable vari-ancesinthelevelofunderstandingand

quality of implementation to produceoutcomes and documented evidenceofresults.Therearemodels thathavemorethanadequatelycoveredallareasof assessment and shown enoughproof that theparticular experienceorapproach is ready for replica-tion andscale,most notably that ofKhovdandSelenge.

All sub-projects were able todemonstrate results in the ability oftheir initia-tive to improve servicedelivery, and have enough potentialfor replicability and scaling up, it willdo them well to address some areasfor improvement. Part 3 of the reportdiscusses the individual sub-projectexperience in greater detail andproposes some actionable points attheAimaglevel.Onthewholehowever,MASAMasaprojectmayalsointroduceinterventionsandactivitiesasfollows:

1.Deepening understanding andappreciationforsocialaccountabilityandcitizenparticipation indecision-making, service delivery, andgovern-ance, especially on the partof local government counterpartsandduty-bearers.

2.Strengthening local capacity forproject development and design ingen-eral,andingeneratingobjective,

valid,andsolidfeedbackongovern-ment programs and services whichcanserveasstartingpointforcollab-orativedecision-makingandproblemsolving.

3.Exposure to and familiarity withother social accountability modelsand approaches suitable to localMongolian context, apart from theCitizenReportCard.

4.Devising more formal andinstitutionalised ways of integratingand main-streaming lessons fromtheir initial sub-project experienceand make their models a morepermanent and regular featureof governance. One that seeks tointegrate citizen feedback and tomonitorresultsofservicedelivery.


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ImprovingHealthServicesforVulnerableGroupsofPeople:TheDornodExperience 20

InclusiveHealthServicesinGovisumberAimag 25

IntroducingaCommunityInclusiveMonitoringMechanismSub-projectinKhentiiAimag 30

PublicParticipatorySchoolsinKhovdAimag 36

ParticipatoryHealthServiceprojectinKhuvsgulAimag 43

ImprovingtheTuberculosisWardServicesintheAimagofSelenge 47

ReducingOralDiseaseamongChildreninSukhbaatarAimag 52

CollectivePOWERinUvsAimag 56

PublicParticipatorySchoolswithAccountabilityinUvurkhangaiAimag 61

Part4:ConclusionsandRecommendations 66

KeyLessonsandConsiderationsforreplicabilityandscaleofMASAMSub-projects 69

SomeRecommendations 71

Bibliography 73

Annex1:InterviewGuide 74

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Part 1:

Background, AssessmentFramework and Study

Methodology


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Background and Objectives of the Study

JointlyfundedbyTheSwissAgencyforDevelopmentCooperation (SDC) and the World Bank (WB), theMASAMproject (2015-2019) isbeing imple-mentedin10aimagsand3Ulaanbaatardistricts.

Theprogramaimstomainstreamsocialaccountabilityfor more transparent, accountable and effectivepublic resource management at national and locallevelsby:

1. Increasing the capacity of CSOs to holdgovernmenttoaccount;and,

2. Strengthening the institutionalization of socialaccountability by improv-ing the effectiveness,formalizationandsustainabilityofdisclosureandparticipationmechanisms.

Through social accountability, citizens in poorlocalities will have increased access to publicdecision-makingprocessesandqualityservices.

Asten(10)aimagsub-projectsareabouttoconcludetheirimplementation,theWorldBankcommissionedanindependentexternalassessmenttoun-derstandimplementationdetailsandsuccessfactorsineachofthesub-projects.Theassessmentaimstorecognizewhere sub-projects have per-formed exceptionallywellintermsofsocialaccountabilityprocess,resultsand impact, and sustainability. This assessmentseekstofeedintotwothings:

1. Internalanddonorreporting;and

2. Interimprojectdecisionsonpotentialactivitiestoscaleupandreplicate.

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Assessment Framework

The framework for this assessment isadapted fromRTI International’s studyby Wetterberg, A., Brinkerhoff, D. W.,&Hertz,J.C. (2016), “GovernanceandServiceDelivery:PracticalApplicationsof Social Accountability AcrossSectors.” The study focused on sixprojectsindifferentpartsoftheworld,which applied social accountabilityinterventions on varying themes, suchas health, education, and improvedlocal government response capacitiesand service delivery. Results fromthe authors’ scrutiny of the projectssurfacedcommonelementsamongallthecasestudiesdespitethedifferencesin country contexts, which constitutetheassessmentframeworkadaptedforthisstudy.

Similarly forMASAM, the initiatives ofthe ten (10)sub-projectgranteesseektomainstreamsocialaccountabilityasaregularandinstitutionalizedapproachfor governance, decision-making,and service delivery at the local level.Therefore, assessing progress of sub-project implementationandtheresultsgeneratedfromtheinterventionrequireessentially the same elements to be

present as the six (6) country projectscoveredbyWetterberg,A.,Brinkerhoff,D.W.,&Hertz,J.C.(2016)

Wetterberg and Brinkerhoff (2016)explain that social accountabilitycomprises the array of actions andmechanisms-beyond the ballot box-thatengagecitizensinholdingthestatetoaccount.Theyfurtherdescribedthatsocialaccountability,fromanormativeperspective, is providing venues forcitizenstoengagewiththestateandthatinitselfcontributestogoodgovernanceand effecting democratic values. Fromthe instrumental point of view, socialaccountabilityisameanstoanend.Thefieldofinternationaldevelopmentseessocialaccountability interventionsasacombination of citizens’ engagementwith the state to express their viewsand needs and of officials takingresponsibility or being held to accountfortheirchoicesandactions.

Considering the internationaldevelopment view of socialaccountability, the assessmentframework suggests that socialaccountability is largely influenced bymacro- and micro-contextual factors.

Thesefactorsinclude,butarenotlimitedto, history, processes, sociopoliticalstructures, available resources, andcapacities that affect identificationof social accountability interventionsand their outcomes and how socialaccountabilitymaybesustained.

As such, it is deemed importantand strategic to implement socialaccountability interventionsatboth thesupply and demand sides; the supply-side being the state’s capacity andresponsiveness,whilethedemand-sideis the citizen capacities for exercisingsocial accountability (Wetterberg &Brinkerhoff, Chapter 9: Cross-SectoralSocial Accountability in Practice:FindingsfromSixCases,2016).Thisistofacilitatenotonlycitizen’sparticipation,but also government’s creation of anenabling environment for participationandexpressionand itsresponsivenessto citizens’ views and needs relativelyparalleltoeachother.

Someexamplesofsocialaccountabilityinterventions cited for both the supplyand demand sides are mechanismsfor performance assessment andmonitoring, user committees,


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participatory planning processes, andadvocacytraining.

In terms of outcomes from socialaccountabilityinterventions,Wetterbergand Brinkerhoff (2016) looked intothree aspects: (1) governance; (2)empowerment;and(3)servicedelivery.

The authors define governance as therelationships between the state andcitizens, referring to the followingconcrete examples of outcomes: (a)mechanisms for including citizensin state processes; (b) enhancedresponsiveness to citizen’s concerns;(c) increased interactions betweencitizens and state actors; (d) improvedgovernment performance; and (e)stronger rights and protection formarginalizedcitizens.

Models identified in terms ofempowermentwere: (a)citizenagencytoexercisenewopportunitiesforvoice;(b)monitoringofgovernmentactivities;and(c)enhancedcivilsocietycapacities.

Tangible outcomes on service deliveryinclude: (a) localized improvements inservice delivery processes; (b) policyshiftstoenhanceservicedelivery;and(c)suggestive evidence of improvementsinsectoraloutcomes.

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The Assessment Framework as adapted:

Methodology

The assessment is both descriptive and diagnostic. It seeks to document

actual performance of the sub-projects and to determine whether each sub-

project has achieved its intended results based on the submitted proposals.

It likewise looks more closely at barriers and factors to more effective and

successful implementation of social accountability interventions as well as

opportunities for replication and scale, both at the level of the individual

sub-projects, and for the MASAM Project as a whole.

All sub-project grantees (aimags) under MASAM are expected to partici-

pate in the assessment but selection and actual interviews was according

to actual availability of respondents while data gathering (ie. convenience

sampling). The assessment was able to cover and interview representa-

tives from the national NGO partners/Coodinators and from among three

key sectors of local implementers:

• Local government (aimag and soum level, when available)

• CSO coordinators and citizen monitors

• Service Providers (School or Health facility)

The final element in this framework is sustainability, which refers to thecontinuationofsocialaccountabilityeffortsbylocalactorsafterprojectactivitiesconclude(Brinkerhoff,Hertz,&Wetterberg,2016).Evidenceofsustainabilityofsocialaccountabilitymaybeseen through: (a)visibilityofstate responses; (b)governmentresourcestorespond;(c)politicalsupportforsocialaccountability;and(d)attitudestowardcitizenandstaterolesinservicedelivery.

TheAssessmentFrameworkasadapted:

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Methodology

Theassessmentisbothdescriptiveanddiagnostic.Itseekstodocumentactualperformanceofthesub-projectsandtodetermine whether each sub-projecthasachieveditsintendedresultsbasedonthesubmittedproposals.Itlikewiselooks more closely at barriers andfactorstomoreeffectiveandsuccessfulimplementationofsocialaccountabilityinterventions as well as opportunitiesfor replication and scale, both at theleveloftheindividualsub-projects,andfortheMASAMProjectasawhole.

Allsub-projectgrantees(aimags)underMASAM are expected to participate intheassessmentbutselectionandactualinterviews was according to actualavailability of respondents while datagathering (ie. convenience sampling).Theassessmentwasabletocoverandinterview representa-tives from thenationalNGOpartners/Coodinatorsandfromamongthreekeysectorsof localimplementers:

• Localgovernment (aimagandsoumlevel,whenavailable)

• CSO coordinators and citizenmonitors

• Service Providers (School or Healthfacility)

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Data gathering for all the sub-projects was done through a combination of

face to face interviews during field visits and project stakeholder meetings,

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

translators hired by the Bank.

Face-to-face key informant and group interviews were conducted during

actual visits to the following project sites:

Aimag Date of Visit/Interviews Institutions/Respondents

Uvs 4-5 September 2017 Local NGO Coordinator and Citizen MonitorsAGH Quality DepartmentAimag Health DepartmentOffice of the Aimag Governor

Khovd 5-6 September 2017 School Director and Soum Governor ( — Soum)Aimag Education DepartmentSchool Director, Parent Volunteers and Teachers ( — Soum)Local NGO Implementer (Policy Group)Aimag Social Policy Department

Selenge 8 September 2017 CSO Network of SelengeAimag Social Policy DepartmentAimag Health DepartmentAimag General Hospital

Sukhbaatar 11 September 2017 CSO Network of SukhbaatarOffice of the Aimag GovernorOffice of the Soum GovernorAimag Health DepartmentAimag General Hospital

Khentii 12 September 2017 Local NGO Coordinator and CSO RepresentativesFamily Health ClinicAimag Health Department

Govisumber 18 September 2017 Local NGO CoordinatorAimag Social Policy DeparmentAimag Health Department


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Datagathering forall thesub-projectswasdonethroughacombinationoffacetofaceinterviewsduringfieldvisitsandproject stakeholder meetings, as wellas through online/video/phone callsforprojectsthatwerenotvisitedduetotravelrestrictionsandtimelimitations.

Respondents were informed andmobilized through the WB CountryOffice in Mongolia through email.English to Mongolian to Englishtranslation services during interviewswere provided by the local consultantTsunaraAnnPurevtogtokh-GanboldandtranslatorshiredbytheBank.

Face-to-face key informant and groupinterviews were conducted duringactual visits to the following projectsites:

Phone Interviews were likewiseconducted with representatives fromthefollowingofficesandaimags:

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Phone Interviews were likewise conducted with representatives from the

following offices and aimags:

Uvurkhangai 14 September 2017 Aimag Social Policy DepartmentAimag Education DepartmentSchool Director ( —-Soum)Local NGO Coordinator

Dornod 14 September 2017 Aimag Social Policy DepartmentAimag General HospitalLocal CSO Council Coordinator

Khuvsgul 16 September 2017 Aimag Monitoring and Evaluation DepartmentAimag Social Policy DepartmentFamily Health ClinicAimag General HospitalLocal NGO Coordinator

Gobi-Altai 16 September Local NGO CoordinatorAimag Education Department

Lastly, national UB-based NGOs were convened for a focus group discus-

sion to clarify the theory of change of their respective sub-projects as well

as the assistance that they have provided to their counterparts. Present

during the FGD held 15 September 2017 were representatives from Trans-

parency International-Mongolia, Mongolian Education Alliance,

All4Education CSO coalition, Mongolian Public Health Professionals Asso-

ciation, and MonFemNet. An interview with the Democracy Education Cen-

ter was held 17 September 2017.

Lastly, national UB-based NGOs were convened for a focus group discus-sionto clarify the theory of change of their respective sub-projects as well as theassistance that theyhaveprovided to their counterparts.Presentduring theFGDheld15September2017were representatives fromTrans-parency International-Mongolia, Mongolian Education Alliance, All4Education CSO coalition, MongolianPublicHealthProfessionalsAsso-ciation,andMonFemNet.An interviewwith theDemocracyEducationCen-terwasheld17September2017.

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Part 2:

MASAM and the Aimag

Sub-projects at a Glance


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In order to meet the objectives of the project andto build on gains of previous piloting experiences,MASAM has given particular focus on workingwith local level stakeholders not only in terms ofincreasing capacities for social accountability butalso in terms of harnessing interests, awarenessand capacity of citizens and communities to tackleandresolveissuesatthelocallevelandwheregoodgovernance, citizen empowerment, and improvedservicedeliveryareimmediatelyanddirectlyfeltbythepeople,especiallythepoor.

Forthispurpose,ten(10)aimagsub-projectswerechosen for capacity-building, funding and technicalsupport,andprovidedopportunitiestobuildeffectivecollaborationwiththeirrespectivelocalgovernmentunits,serviceproviders(inthehealthandeducationsectors), other local organizations and citizens at

large.KeyinterventionsattheMASAMprojectlevelinvolved:

1. Design and implementation of a SocialAccountabilitycertificatecourseincollaborationwithinternationalandnationaltraininginstitutions(Affiliated Network for Social Accountability inthe East Asia and the Pacific and the NationalAcademyofGovernance).

2. Provision of grants for the implementation ofsocialaccountabilitymechanismsandinitiativesto tackleand resolve local issues in thehealthandeducationsectors.

3. CoachingandtechnicalassistancesupportfromnationalNGOs.

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The Social Accountability Course for Implementers

The MASAM Sub-projects

Priortotheimplementationofthesub-projects, a total number of forty six(46) participants coming from twentysix (26) national CSOs, ten (10) localCSO representatives/coordinators,and ten (10) government counterpartsfromtheparticipatingaimagsattendeda 3-day training-workshop on SocialAccountability.

The workshop was designed andimplemented jointly by ANSA-EAPand NAOG in order to enhance theparticipants’ capacity “to identify,discern,andselectcontextappropriatesocialaccountabilitytoolsthatwillhelpthem engage their local governmenttowards an improved health andeducationservicedelivery.”

During the training, participants wereexposed to topics and sessions thatwilldeepentheirunderstandingofandappreciation for social accountabilityandthetoolswithinthePublicFinanceManagementcyclethattheycandeployfortheirrespectivesub-projects.

Participation to the coursewasmeantto help the nationalNGO partners andrepresentatives from participatinganimals in the development andimplementation of their socialaccountability initiatives as part of thecapacity-building interventions underMASAM.

Key Topics and Sessions covered during the Social Accountability Workshop (October 2016)

• ExperiencesofworkingwithGovernmentorCivilSociety

• SocialAccountabilityasanapproachtoGoodGovernance

• ToolsofSocialAccountability

• SocialAccountabilityTollsinthecontextoftheAimagsub-projectproposals

Ten (10) aimags were chosen aspriority areas for MASAM at projectincep-tion, based on a mixed criteriaofpoverty incidence, readiness forSA,andhealthandeducationdevelopmentindicators. These aimags are Dornod,Gobi-Altai,Govisumber,Khentii,Khovd,Khuvsgul, Selenge, Sukhbataar, Uvsand Uvurkhangai. Stakeholders in theaimagswere convened to de-sign andimplement their social accountabilityinitiativebasedonaseriesof capacitybuilding activities. Guidelines forselecting sub-project topics werebased on stakeholder consensus ona local issue or “felt need”. Aimagstakeholders met with and decidedon a national NGO partner, whoserved as theirmentor throughout theimplementationprocess.

Of the ten sub-projects, 7 are in theHealthsector,while theother3are inthe Education sector. Majority of theprojectssoughttoengagepublicsectorcounterpartsbyassessingservicesandproviding feedback through the useof the Citizen Score Card (4); two (2)projectsdeployedtheassess-menttooldeveloped by theMongolian Education


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Association called the “ParticipatorySchools”model; two (2)otherprojectssought to measure stakeholderfeedback and satisfaction based onstandardssetbylawsandgovernmentpolicies (on procurement and primaryhealthcaseservices);onesub-projectconducted 3rd-party monitoring; oneproject deployed the “Good School”assessment tool developed by thenational civil society coa-lition, named“All4Education”.

In terms of approach to socialaccountability, all sub-projectsharnessed multi-stakeholdercollaborationandcoordinationtogatherfeedback on ac-cess to and qualityof health and education services ingeneral,tospecificandtargetedserviceprovision for tuberculosis patients,temporaryresi-dents,andoralhealth.

Assessment results were gathered,consolidatedandpresentedasfeedbackto decision-makers and serviceproviders as basis for action and/or service improvement. Most actionplans(5projects)weredevelopedwithdirectparticipationfromtheCSOswhile4 other pro-jects were by the serviceproviders themselves (4 projects),but includingsome levelof inputsandrecommendations from the CSOs. Oneproject was unique in that it soughtto influence the improvement of theprocure-mentprocessbytakingpartinplanningandcontractimplementa-tion/delivery.

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In terms of approach to social accountability, all sub-projects harnessed

multi-stakeholder collaboration and coordination to gather feedback on ac-

cess to and quality of health and education services in general, to specific

and targeted service provision for tuberculosis patients, temporary resi-

dents, and oral health. Assessment results were gathered, consolidated

and presented as feedback to decision-makers and service providers as

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

some level of inputs and recommendations from the CSOs. One project

was unique in that it sought to influence the improvement of the procure-

ment process by taking part in planning and contract implementa-

tion/delivery.

The sub-projects profiles are summarized in the table below:

Sector Aimag Tool Used Approach

Health DornodCitizen Score Card Participatory assessment and

Service improvement planning

Education Gobi-altaiGood School model Participatory assessment and

planning

Health GovisumberCitizen Score Card Participatory assessment and


Health Khentii

Standards of HHC Checklist and Stakeholder satisfaction survey

Participatory assessment and Joint service improvement planning

Education KhovdParticipatory Schools model

Policy analysis, Participatory assessment and Joint (school-level) planning

Health Khuvsgul3rd-Party Monitoring Participatory assessment and


Health SelengeCitizen Score Card Participatory assessment and Joint

service improvement planning

Health SukhbataarCitizen Score Card Participatory assessment and


Health Uvs

Procurement/Contract award checklist and Stakeholder satisfaction survey

Participatory procurement planning, monitoring and assessment

Education UvurkhangaiParticipatory Schools model

Participatory assessment and Joint (school-level) planning

Thesub-projectsprofilesaresummarizedinthetablebelow:

Thesub-projectswerealsodesignedandimplementedwithtechnicalsup-portandcoachingfromUB-basednationalNGOs.TheDemocracyEduca-tionCenterworkedwith the aimags of Dornod, Selenge and Sukhbataar, the Mongolian EducationAlliance worked with the aimags of Khovd and Uvurkhangai, the MongolianPublic Health Professionals Association worked with Khuvsgul and Govisumber,MonFemNetworkedwithKhentii,TransparencyInternational-MongoliaworkedwithUvs,whiletheaimagofGobi-altaiwassupportedby“All4Education”.

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Part 3:

Assessment of the

MASAM Sub-projects


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This part of the report documents and assesses sub-projectimplementationaccordingtotheessentialelementsforeffectivesocialaccountabilitypracticeasdiscussedinPart1.

Eachsub-projectreporthasthreemainparts:

•Descriptionofsub-projectexperienceaccordingtointent(asdescribedintheprojectproposal)andactualimplementation;

•Documentationofoutputsandoutcomesaccording to theessentialelementsforsocialaccountability(SocialAccountabilitymechanisms,Outcomes as improvements in Governance, Citizen empowerment,andServiceDelivery,andSustainability);and,

•Assessmentofstrengthsandopportunitiesforimprovement.

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Improving Health Services for Vulnerable Groups of People: The Dornod Experience

The sub-project in Dornod isimplemented in partnership with theDemocracy Education Center (DEMO)entitled “Improving health services forvulnerablegroupsofpeople”.TogetherwiththelocalcouncilofCSOsinDornodaimagknowntohavealonghistoryandsufficient organisational capacity, thesub-projectwasmeanttomakehealthcare services available to vulnerablegroupsofpeople.Targetedbeneficiariesarethe2,922identifiedpoorcitizensofthe1st,2nd,and8thbaghsoftheaimagcenterwhoareunabletoreceivehealthandmedicalcare.

According to the proponent’s projectproposal, Dornod aimag is inhabitedby 22,900 households or a totalpopulationof76,500,with56.8%livingintheaimagcenter,11.5%inthesoumcenter, and 31.7% in the countryside.Dornod registers among the lowestlifeexpectancythroughoutthecountry,withdeathratesextremelyhighamongpoor households who are unable toavail of health insurance services dueto their lack of civil registration andidentificationdocuments,nopermanentaddresses,andpoverty.

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At the outset, the CSO council was aware of the significant number of vul-

nerable people in Baghs 1, 2 and 8, according to data from the Social Wel-

fare Service and Social Insurance Departments. However, it was also felt

that apart from the lack of access to decent

and affordable health services, citizens com-

plained of difficulties in setting appointments

with doctors, having to physically wait in line

after 3-4 attempts of securing such a sched-

ule. The project team resolved to use the

sub-project as an opportunity to improve

health service delivery, improve the quality

and coverage for health services, and to en-

sure citizen participation in service delivery.

More concretely for government, the project

became the means to enroll 219 citizens into

the medical insurance system.

In order to achieve above-mentioned objectives, the project team imple-

mented key activities as outline below:

1. In consultation with local project stakeholders, the CSO council decided

to use CSC tool with DEMO, the national NGO partner, conducting a 3-

day training workshop on the use of the Citizen Score Card attended by

40 volunteers. On the last day of the workshop, the participants: 1) identi-

fied the major issues they will conduct the assessment on using the CSC

tool; 2) reviewed laws and regulations; and, went on field to observe how

the social insurance program was being implemented.

2. As agreed with project stakeholders, the CSC survey was focused on

challenges and difficulties in receiving medical services, particularly the

behavior and ethics of medical personnel towards patients. The CSC

survey was designed to assess five areas which were:

• Attitude/ethics of medical staff;

• Workload of medical staff;

• Public health education;

• Setting hospital appointments; and,

• Implementation of related legislation.

The assessment was conducted for and with two Family Health Clinics and

the Regional Diagnostic Center/Aimag General Hospital.

The Dornod Sub-project at a Glance

Lack of access to health services and health

insurance coverage from among extremely poor

households Improved access to quality

health services at the aimag level

Through:

An Assessment of transparency and delivery of public health services

using the

Citizen Score Card

The sub-project proposed to improveaccess to quality health servicesby assessing the transparency anddelivery of public health services byhealthcenters.ItishopedthatthroughfeedbackfromtheresultsoftheCitizenScore Card (CSC) survey, serviceproviders together with concernedstakeholders will develop a ServiceImprovement Plan to make healthservicesandsocialinsurancecoverageaccessible for the extremely poor andvulnerablehouseholdsandcitizens.

Immediately upon the start of projectimplementation,theCSOcouncilsignedaMemorandumofUnderstandingwiththe Aimag Governor’s Office which inturn formally constituted the projectimplementation committee composedofrepresentativesfrom12civilsocietyorganizations,8citizens,3membersofthe local CSO council, and designatedrepresentatives from the Governor’sOffice, Departments of Social Policy,Social Insurance, and Health, FamilyHealth Clinic and Regional Diagnosticand Treatment Center/Aimag GeneralHospital, and the Secretary of theGovernor.

Attheoutset,theCSOcouncilwasawareofthesignificantnumberofvulnerablepeople inBaghs 1, 2 and 8, accordingtodatafromtheSocialWelfareServiceand Social Insurance Departments.However, it was also felt that apartfrom the lackof access to decent andaffordable health services, citizenscomplained of difficulties in settingappointments with doctors, having tophysicallywaitinlineafter3-4attemptsofsecuringsuchaschedule.Theprojectteam resolved to use the sub-projectas an opportunity to improve healthservice delivery, improve the qualityand coverage for health services,and to ensure citizen participation in


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service delivery. More concretely forgovernment, the project became themeans to enroll 219 citizens into themedicalinsurancesystem.

In order to achieve above-mentionedobjectives, the project teamimplemented key activities as outlinebelow:

1. In consultation with local projectstakeholders, the CSO councildecidedtouseCSCtoolwithDEMO,thenationalNGOpartner,conductinga3-daytrainingworkshopontheuseof the Citizen Score Card attendedby40volunteers.On the lastdayofthe workshop, the participants: 1)identified themajor issues theywillconduct the assessment on usingthe CSC tool; 2) reviewed laws andregulations; and, went on field toobserve how the social insuranceprogramwasbeingimplemented.

2.Asagreedwithprojectstakeholders,the CSC survey was focused onchallengesanddifficultiesinreceivingmedical services, particularly thebehavior and ethics of medicalpersonneltowardspatients.TheCSCsurveywas designed to assess fiveareaswhichwere:

•Attitude/ethicsofmedicalstaff;

•Workloadofmedicalstaff;

•Publichealtheducation;

•Settinghospitalappointments;and,

• Implementation of relatedlegislation.

The assessment was conducted forand with two Family Health Clinicsand theRegionalDiagnosticCenter/AimagGeneralHospital.

3.The CSC survey was participated inby 112 hospital/clinic staff and 234people from among the identifiedvulnerable groups of peopleaccording to the Bagh Governor’sOffice.

4.Organized face-to-face meetingsdiscussed the results of the CSCassessment to develop a serviceimprovement plan. The RegionalDiagnostic Center/Aimag GeneralHospital conducted awarenesssessions for their personnel andformulated an action plan with theHospitalDirectorprovidingguidanceintheactionplanningprocess.

5. The implementation of the 3-monthservice improvement plan resultedin specific courses of action meantto resolve issues or areas ofweaknesses as identified duringthe CSC survey and face-to-facedialogues.Mostnoteworthyare:

• On the part of the ServiceProvider (Regional DiagnosticCenter/Aimag General Hospital):Revision of procedures to easethe workload of personnel andmakesettingappointmentseasierfor the patients. Informationon services and procedures foravailingtheseservices(through2newly set-up customer hotlines)

were disseminated to citizens.Senior doctors and consultantshave allocated a day each weektoconductcheckups/visitsintheirrespectivewardsanddepartments,and started to see patients fromrural soums even without priorappointments. Because of thisnew system,medical advicewasprovided to 1,450 vulnerablecitizens. To improve personnelbehavior, the hospital invited atrainer from the National HealthDevelopment Center to give a trainingforhospitalstaff.

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Sub-project Outputs and Outcomes

As discussed in Part 1 of this report,each sub-project was observed andassessed for actual results acrossessential elements for an effectivesocial accountability intervention.The following sections document anddiscussthecaseofDornod:

1. On the SAC Intervention Design to improve supply and demand sides of governance and accountability

The conduct of the CSC survey,participated in by both citizens andservice providers, has allowed for theidentification of issues confrontinghealth service delivery, especiallyon the differing perceptions of thetwo concerned parties regarding thebehavior/ethics of medical personneltowards patients. Despite thedifferences on perception and actualrating, stakeholder feedback from theresults of the CSCwas used as basisandstartingpointfordiscussionsduringface-to-facemeetingsbetweenpatientsandmedicalpersonnel.Specificcriteriaand areas of assessment becamethe springboard for such dialoguesto happen and set the parameters forcollective action planning regarding

behavior of medical personnel,workload, securing appointments forservices, health education, and thesocialinsurancesystem.

Attendedby52participantsfromvariousgovernment offices, service providers,and CSO council members, the groupendeavored to arrive at a 3-monthservice improvement action plan with25specifictasksforimplementationbyidentifiedaccountableoffices.

2. On Outcomes: Concrete improvements in local governance, citizen empowerment, and health service delivery.

Governance: The Aimag DepartmentofSocialInsurancewasabletoidentifyand register 148 new beneficiariesto the social insurance system andprovided them with information onhow to avail of and participate ingovernment programs. Governmentofficials for their part, realized thatservice delivery is not the sole workof government and that citizenparticipation is important especially interms of identifying problems, takingaction for its resolution, and actingas channels for bringing informationdown to citizens. For theSocial Policy

Department, the sub-project hasallowedthemtopaycloseattention tocomplaints and conflicts confrontingservicedelivery.Onekeylearningpointwas that listening to inputs from CSOcounterparts“pavesthewayformakingpoliciesandprogramsmorerelevanttotheneedsofthecitizens.”

Inordertofollowthroughandcoordinateactivitiesongovernmentcommitments,the Aimag Governor’s office formed ataskforce(albeitadhoc)of7members,includingtheheadsoftheSocialPolicy,Deputy Governor’s Office, and SoumGovernor’sOffice.

Empowerment: Eight (8) local civilsociety organizations with individualmandateswere able to work togetherin the sub-project united by thesole purpose of advancing socialaccountability. Seen by governmentas capable counterparts in doinggovernment’s work, the network andthe individual CSOs are perceived asbeing“abletoseeissuesonthegroundbetter than government officials do”,accordingtoanofficialfromtheSocialPolicyDepartment.Whileonememberof the CSO coordinating team hadsome background in research and theconduct of surveys, all participantswerenewtotheCSCtechnology.Itwas


(MASAM) Project

23

which they secure appointments withdoctors and the behavior exhibitedby medical staff. Officials from theRegional Diagnostic and TreatmentCenterhaveinitiatedstepsandconcreteactiontoaddressissuesidentifiedintheCSCsurvey.

While the formulation of the serviceimprovement plan did not involve theCSOsorcitizens,feedbackwasusedtodetermineareasforimprovementwhichinthesecondroundofassessmentwasrated significantly higher (from 35.6%to 54% satisfaction rating). This wasrealizedthroughactiononthefollowingareas:

•Hospital units now have journalson which citizens can write theirfeedback on services and how theyavailed of medical attention andservices;

• Conducted training sessions toaddress attitude and behavior ofmedicalpersonnel;

(Actual sample of) Citizens’ Rating and Recommendations(SurveypriortoimplementationofServiceImprovementPlan)

Assessment Areas RatingOnservicetoprovidehealtheducation 35.5(Poor)Oncommunication&ethicsofhealth 39.4(Poor)ProfessionalsOnserviceforgettinganappointment 31.9(Poor)Recommendations:•Conductoneamonthtrainingforthepublicinaninterestingway•Regularlybroadcasthealtheducation/trainingonalllocalTVstations•ConductregulartrainingforHCCdoctorsandnurses•Maketheevaluationroutine

noted byDEMO that the implementersquickly learned the tool and wereable to take advantage of their goodcommunication channels and rapportwith local government officials andserviceproviders.

CSO counterparts were instrumentalin making citizens aware of lawsand regulations on: 1) standards forhealthservicedelivery(e.g.,PWDsandSenior Citizens should be immediatelyattended to); and, 2) social insurancecoverage, reimbursement for out-of-pocket expenses. CSO councilmembers realized that participationis an important aspect of governancein terms of identifying problems andseekingtheirresolution.

Service Delivery: After the conductof the first assessment, two areaswere evaluated by citizens lower thanwhat the service providers assessedfor themselves. With this came therealization that patients and citizenswere not satisfiedwith themanner by

•Developed procedures to improveculture for service and developeda system to secure information onmedicalservices;

• Organized an open-door dayto improve health education ofvulnerablegroupsofpeople;

• Funding for the purchase of dentalequipment, establishing a roomfor public health education and forwaitingseniorcitizens.

3. On mechanisms for sustainability.

There is a resolve on the part ofthe service provider to conduct anindependent assessment once a year,on top of the stakeholder satisfactionsurveywhich ismandatedbythestateHealth Department. Although financialresourcesareuncertainatthemoment,itisbeingproposedforinclusiontoandfunding under the Local DevelopmentFund, subject to the approval by thelocalcouncil.

The Social Policy Department, throughits existing monitoring and evaluation(M&E) system, will likewise exploreintegratingCSOmonitoringandincludeit in their 2018 budget proposal. Noothermoredefinitecourseofactionordecisionhasbeen reachedat the timeoftheinterviews.

24

Assessment and Recommendations

It is worth noting that the local CSOshave been credited for establishinggood communication channels andrapport with local officials and theser-vice provider. While the approachand technologyofsocialaccountabilitythrough theCSC tool is new for them,they are said to be technically profi-cient in the conduct of surveys/research.However,forfuturesocialac-countability engagements to becomemoreeffectiveandsustainable,itwillbehelpfultoaddressthefollowingissues:

• While social accountability isunderstandably a new concept andap-proach to governance, it willbe beneficial for CSOs and localstakehold-ers, and for ensuring thetransferof technology tohave thembe respon-sible for formulating theassessment tool, and not just berecipientsof thetool,questionnaire,and methodology as developedby the national NGO partner. Ona more fundamental level, localCSOs can benefit from a deeperunderstanding of and exposure tosocial accountability practices insimilarcontexts.

•Majority of tasks and commitmentsto the Service Improvement Planweretheresponsibilityofthehospital

(serviceprovider)andmeantalmostentirely to improve how medicalpersonnel relate with and behavetowardspatients.

• Action instituted by the Governor’soffice involved creating an inter-agency task force to follow throughonandcoordinateactivitiesbutnoth-ing concrete or sustainable wasidentified as to how the concernedoffices can contribute to serviceimprovement apart from facilitatingthe registra-tion of 148 newbeneficiaries and raising awarenesson laws and regula-tions governingsocialinsurance.

• There is an existing institutionalmechanism for internal monitoringbytheM&EDepartmentoftheaimagaswellasadesiretointegratecitizenmonitoringbutitdoesnothaveclearlydefined purposes and parameters,noradeeperunderstandingofsocialaccountability and its possible con-tribution to governance apart fromusingtheapproachtoinformcitizensofexistingprogramsandservices.

Should local stakeholders in DornodAimag wish to sustain the social ac-countability initiative, the followingarerecommended:

• Greater involvement andaccountabilityover the tooland tooldevelop-ment will ensure not onlyownershipovertheprocessbutalsolocalem-powermentandconfidenceto run a similar citizen monitoringassessment on other governmentprograms and services. Time andresourcesmayhaveunderstandablybeen tight but a more helpfulprocess would have been for thelocal stakeholders to develop thequestionnaireon their ownwith theguidance of a more experiencedsocial accountability practitioner(e.g.,UB-basedNGOorpeers).

• The use of the CSC as a tool foradvancing citizen engagementand so-cial accountability has itsstrengthsandadvantages. Ithas itsownsetoflimitationsaswell.Itwillbebeneficialifstakeholdersundergoamorethoroughprocessofproblemidentification and analysis of issuescon-fronting public sector servicesandprogramstodeterminethemostap-propriate and relevant tool/s touse.WhiletheCSCishelpfulingettingconstituents to provide feedback ongovernment programs, its user willrunintotechnicalissuesofsamplingand making generalizations on


(MASAM) Project

25

Inclusive Health Services in Govisumber Aimag

larger trends of the population andincur unnecessary costs when theapproachtotheproblemcouldhavebeen simpler and faster. If the coreissue that the sub-project soughtto address was the lack of accessto health services due to their non-registration to the social insuranceprogram, a social audit exercise(or even the Community ScoreCard) would have allowed them toidentify exclusion errors and thenimmediately have the concernedagencyenrolcitizenstotheprogram.Whileitwasactuallydoneinthecaseof theDornodsub-project (with148citizens registered to the programasaresultof theproject), therouteto get there may have been costly

and almost unnecessary (surveying1,120 people through the CSC) toidentify 260 vulnerable citizenswhoneededsocialinsurance.

• Institutionalizing a mechanism forgenerating and processing citizenfeedback into the existing internalmonitoringmechanismoftheaimaggovernment is a notable concern.While there is an expression ofdesire to do so in the next fiscalyear,thisstillneedstobeformalizedand made more systematic, clearlyindicating roles and responsibilitiesof CSO monitoring and the processwithwhichthiscanbeintegratedintothefor-malM&Esystem.

The sub-project in the aimag ofGovisumber is implemented inpartnership with the Mongolian PublicHealth Professionals’ Association(MPHPA). De-signed to improve theprovision of health services and thereferral system for patient transferacross tiers of service providers, thesub-projectusedstakeholderfeedbackspecificallyon theethics, attitude,andbehavior of medical personnel. Thefeedback was gathered through theCitizenScoreCardassessmentinorderto address citizen dissatisfaction withmedicalservicesandmedicalpersonnel.Targeted to cover the residents andhouseholdsreceivingservicesfromtheAimagGeneralHospital,Soummedicalcenters and Family household clinics,citizen feedback was used to improvethe delivery of services in compliancewithDecree307,2009sothatAGHwardpersonnel provide medical counselingand other services even withoutsecuringpriorappointments.

Page 26

• The use of the CSC as a tool for advancing citizen engagement and so-

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

thorough process of problem identification and analysis of issues con-

fronting public sector services and programs to determine the most ap-

propriate and relevant tool/s to use. While the CSC is helpful in getting

constituents to provide feedback on government programs, its user will

run into technical issues of sampling and making generalizations on larg-

er trends of the population and incur unnecessary costs when the ap-

proach to the problem could have been simpler and faster. If the core is-

sue that the sub-project sought to address was the lack of access to

health services due to their non-registration to the social insurance pro-

gram, a social audit exercise (or even the Community Score Card) would

have allowed them to identify exclusion errors and then immediately have

the concerned agency enrol citizens to the program. While it was actually

done in the case of the Dornod sub-project (with 148 citizens registered to

the program as a result of the project), the route to get there may have

been costly and almost unnecessary (surveying 1,120 people through the

CSC) to identify 260 vulnerable citizens who needed social insurance.

26

According to sub-project proponents,residents of Govisumber are not ableto avail of sufficient health servicesbecause of their lack of informationon, resource allocation for, and weakparticipation in the provision of healthservices. Despite themany and variedreasons why service provision is notup to par with required standards ofquality, the attitude and behavior ofmedical personnel was of primaryimportance to stakeholders becauseofmanifestand felt issues insecuringappointments, weak communicationskillsofmedicalpersonnel, thefailureof self-assessment processes tosurface issues that citizens are nothappy about, the stress, and pressurefrom extended and heavy work hoursbeingpassedontopatients.

Initially put on the defensive, medicalpersonnelresistedtheassessmentandfeedback. They, however eventuallyunderstood that the desire to im-prove service provision, especiallyfor vulnerable households and toprovide the public with the necessaryinformation through organized andcollective feedback of NGOs andcitizens, generated from an objectiveandorganizedprocess.

Sub-project implementation inGovisumberwasledbytheSocialPolicyDepartment of the Aimag Governor’soffice who chaired the working groupat the aimag level. Even as therewasno formally constituted and organizedcouncilorcoalitionoflocalCSOs,sub-project implementationwas supportedby the cooperationof four localNGOs.Through a decree issued by theGovernor, the project task force wasconstitutedbyrepresentativesfromtheGovernor’s office (through the SocialPolicyDepartment),HealthDepartment,Familyhealthclinic,NGOs,andcitizensrepresentative.

In order to improve the quality of andaccess to health services, more spe-cificallytoimprovetheethicalbehaviorof medical personnel through feed-back from the CSC, the following keyactivities were implemented by theAimagworkinggroup:

1.Conducted meetings with localresidents to identify problemsconfronting access to and qualityof health services. There were tworoundsofmeet-ingsheldwith localorganizations and governmentoffices which allowed the group tonarrowitsfocusandidentifythesub-projecttobeimple-mented.

2. Invited the Democracy EducationCenter(DEMO),anotherMASAMPro-grampartnerbutnotforGovisumber,toprovideatrainingontheuseoftheCSC.

3.Organized two survey teams. OneassessedtheAimagGeneralHospital,the other looked into the FamilyHealth Clinics (FHCs) . The AimagGeneral Hospital was assessed

in terms of ethics and behavior ofmedical personnel, professionalskills and capacity, access toinformation on health services andprograms,andtimespentfor/duringmedical appointments. FHCs wereassessed for the ethical behaviorand attitude of medical personnel,sufficiencyofhumanresources,andthe implementation of the referralsystem. A total of 1800 citizensparticipated in the survey, with1003citizensasrespondentsontheAimag Hospital Assessment, 797respondents for the assessment oftheFHCs,andacounterpartof37.6%oftotalcomprisinghospitalstaff.

4.Conducted face-to-facemeetings toformulate the Service ImprovementPlan which was agreed on by 25participantscomposedofrepresenta-tives from the Aimag Governor’sOffice, Health Department, AimagGen-eralHospital,citizens,andlocalNGOpartners.

5. Implemented activities andinterventions as identified in theService Im-provement Plan. Thelocal NGOs organized appreciationevents for hos-pital staff to changetheir attitude towards and get theirsupport for the project. The AimagHealth Department for its part,introducedtheE-HealthRegistrationsystem as a means for citizensto secure appoint-ments withmedical personnel without havingto physically queue up long hoursand conducted a series of trainingformedicalpersonneltomakethemmorecustomer-orientedandpatientwithclients.

Page 28

Inclusive Health Services in Govisumber Aimag

The sub-project in the aimag of Govisumber is implemented in partnership

with the Mongolian Public Health Professionals’ Association (MPHPA). De-

signed to improve the provision of health services and the referral system

for patient transfer across tiers of service providers, the sub-project used

stakeholder feedback specifically on the ethics, attitude, and behavior of

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

that AGH ward personnel provide medical counseling and other services

even without securing prior appointments.

According to sub-project proponents, residents

of Govisumber are not able to avail of suffi-

cient health services because of their lack of

information on, resource allocation for, and

weak participation in the provision of health

services. Despite the many and varied reasons

why service provision is not up to par with re-

quired standards of quality, the attitude and

behavior of medical personnel was of primary

importance to stakeholders because of mani-

fest and felt issues in securing appointments,

weak communication skills of medical person-

nel, the failure of self-assessment processes to surface issues that citizens

are not happy about, the stress, and pressure from extended and heavy

work hours being passed on to patients.

Initially put on the defensive, medical personnel resisted the assessment

and feedback. They, however eventually understood that the desire to im-

prove service provision, especially for vulnerable households and to pro-

vide the public with the necessary information through organized and col-

lective feedback of NGOs and citizens, generated from an objective and

organized process.

The Govisumber Subproject at a Glance

Citizen dissatisfaction with medical services and ethics, behavior and attitude of medical

personnel

Improved provision of health services, referral

system for patient transfer across tiers and access to

information on health services

Through:

An Assessment of service provision by Family

Health Clinics and the Aimag Hospital

using the

Citizen Score Card


(MASAM) Project

27

This sub-project was documented andassessedutilizingtheessentialele-mentsfor an effective social accountabilityinterventionaspresentedearlier.Thekeypointsarediscussedbelow.


Atthebeginningofprojectimplementation,the team endeavored to involve citizensfrom the targeted areas in the initialanalysisofthesituation.

Thiswas to help focus the initiative andidentifythespecificproblemsconfrontinghealth service delivery in the aimag.CitizensandCSOparticipationwasgivenimportance in the formal constitutionof the Task Force. As decreed by theGovernor,thereweremembersnominatedfrom among citizens’ representativesand the local NGO partners, togetherwith representatives from the AimagGovernor’sOffice,theHealthDepartment,and the service provider - the FamilyHealthClinic.

Citizen participation continued to playa significant role in the conduct of the

Sub-project Outputs and Outcomes

CSC survey given the high turnout ofrespondents from among the identifiedpoor and vulnerable households. Citizenre-spondents, as well as their serviceproviders,wereaskedtoevalu-atehealthserviceprovisionusingascoringsystemof0-100,with100asthehighestrating.Theratingwasontheareasforassess-ment agreed upon by the project TaskForce.Thesewereon:Ethicsandbehaviorofmedicalpersonnel;ProfessionalSkills;Accesstoinformationonhealthservicesand programs; Time spent in access-ing services; and the Referral system(specificallyforFHCs).

According to citizens that participatedin the survey, all areas of as-sessment“needed improvement”, compared tothe higher rating that service providersaccorded themselves (e.g., citizensassessment on ethical behavior had anaverageof41pointsor“poor”asagainsttheself-assessmentratingof87points).

On the other hand, formulation of theService Improvement Plan in-volvedrepresentatives from the local NGOs,together with the Aimag Governor’sOffice, theHospital’smanagementteam,and the Health Department. From outof thisexercise, the taskforcewasableto identify eight key tasks and activitieswhich included thees-tablishmentofanethicscommittee,theconductoftrainingactivities to improve the attitude andbehavior of hospital staff, and ensuringsufficiencyofhumanresources(toservetemporaryresidentsontopoftheregularclientsbeingservedbythehospital).

2. On Outcomes: Concrete improvements in local governance, citizen empowerment and health service delivery.

Governance:TheAimagGovernor’sofficehas actively participated in the project.It facilitated activities including face-to-face meetings through the SocialPolicyDepartment.Through the formallydesig-nated task force, theOfficeof theGovernorisdirectlyoversawandfolloweduponactivitiesandcommitmentsmadebythehealthde-partmentandtheserviceprovider as outlined in the Service Im-provementPlan.

In one of the face-to-face dialoguesbetween NGOs and govern-mentoffices, one of the identified needs ofthe hospital was the es-tablishment ofa cardiovascularward. The office of theGovernorhasrequestedforfundingfrominternational donor organizations butwasdeclined.The localgovernmenthasdecided to submit the pro-posal to thecentral government for inclusion to thepublic investmentprogram,assuchcostismorethanwhattheaimaggovernmentcan bear. The request is already in the2018Aimagactionplan,justthesame

TheSocialPolicyDepartmentforitspart,claims to have a clearer understandingof the CSC/citizens’ assessment andmonitoring, and has drafted a localmonitoring regulation to include aCSC compo-nent in its monitoring andevaluationwork.

28

The proposal will be pre-sented forapprovalattheAimagCouncilmeeting.

Empowerment: Prior to MASAM sub-project implementation, NGOs inGovisumberdidnothaveanyexperiencecollaboratingwith each other.While thecoordinating NGO had some experienceimplementing projects for internationalorganizations like Mercy Corps andthe German Agency for InternationalCooperation, it did not have workingrelations with other NGOs in the areaand,moreso,with thegovernment.Forthe NGO counterpart coordinator, sub-projectimplementationmeantthatlevershadtobepushedforlocalNGOstoworkcollaboratively with each other, towardsa common agenda of workingwith andmaking the local government accounta-bletoitsconstituents.

Service Delivery: Despite the manyissues confronting health ser-vicedelivery in Govisumber, stakeholders (ingovernment and the NGOs themselves)haveidentifiedthebehaviorandattitudeofmed-icalpersonnelasthemostpressingissuethattheywantedtoas-sessandgivefeedbackon.

Admittedly for the Health Department,changingbehaviormaytakea longtimeand will also require ad-dressing themore fundamental issues confrontinghealth service delivery (such as fundingand the hiring additional personnel and,perhaps,evensocialinsurancecoverage).They however noted that in the secondround of assessment conducted fivemonthslater,af-tertheconductofface-to-facemeetingsandtrainingactivitiesforhospitalstaff,therehavebeensignificant

improvements according to surveyrespondents. Moreover, they note thatthere is now a nar-rower gap betweenthe assessment scores given by thecitizensandmedicalpersonnel.Customersatisfactionis in fact reflectednot just inthesurveyresultsbutinthedocumentedreductionofcom-plaintsreceived.

Certain action points in the ServiceImprovement Plan have yet to beimplemented, but concrete steps havealready been taken to ad-dress themsuchas the introductionof theE-HealthRegistration system as a means forsecuring appointments and referringclients to/from the Family Health Clinicand the Aimag General Hospital. Thehospital, through its newly establishedEthics Committee has likewise draftedguidelines in dealing with medicalpersonnel report-ed for misconduct orinappropriatebehavior.Inrelationtothis,tohelpensurethatpatientsfeelfullytakencaredofandattendedto,theFHCDirectorhasbanned theuseofsocialmediaandorderedtheblockingoffofaccesstowificonnectionduringclinichours.

AllcommitmentsintheactionplanwillbemonitoredandfollowedthroughtheEthicsCommitteewhichislikewisetaskedwithinstitut-ing preventionmeasures againstandtocorrectviolationsonstaffethics.


The NGOs feel the need for furthercapacity building in gathering andproviding feedback to government. Inassessinghealthserviceprovision,therewashesitationduetolackofinformationon the sec-tormainly because they are

not medical professionals themselves.But given prior work on monitoring theimplementationoftheLocalDevelopmentFund and the experience of sub-projectimplementa-tion that has allowedNGOsto establish a working relationship withgovernment plus an openness to andrecognition of citizen monitor-ing, thereis willingness to continue working withcitizensintheplanning,budgetingforandspendingoftheLDF.

For the Aimag Governor’s Office,mechanisms for sustainability arebeing explored by incorporating citizenmonitoring in the health de-velopmentprogram of the 2018 Action Plan. Pastexperience has been that results ofinternal assessments by the hospitalwasnotreportedtothepublicandweretreated as part of internal proce-dures.Recognizing that citizens are importantstakeholders in policy and decision-making, the Social Policy Departmentwants to make monitoring an annualprovision in the plan, and that resultswill be made public and shared to thelocal council so that such feedback canbe incorporated in plan formulation anddecision-making.

For the Family Health Clinic, there isexpressed willingness to em-ploy theCSCat theFHC level andworkwith thelocal NGO to as-sess the FHC servicestwiceayear.Resultsofwhichwillalsobereportedtothepublic.


(MASAM) Project

29

Havingchosento focusontheattitudeand behavior of medical personnel asagainstthemanyandmorefundamentalissues confronting health ser-vicedelivery in the Govisumber Aimag,sub-project stakeholderswere able toidentifyspecificandconcretemeasuresthat will help resolve such con-cern.However,giventhenarrowandshallowfocus for gathering feedback andmobilizing citizen participation, it hasnot allowed for more strategic andprogrammatic responses to healthservicedelivery,especiallyon thepartoflocalgovernment.

At the time the interviews wereconducted and at the conclusion ofsub-project implementation, healthdepartment officials were cognizantof the underlying issues why medicalpersonnel behave the way they dotowards patients. While it does notjustify the behavior, hospital staff arepassing on the stress to patients andareunabletoprovidethemtheattentionthat they deserve, due to the fact thatthe hospital and family health clinicsare un-derfunded, understaffed, yetoverloadedwithwork.

In terms of social accountabilitypractice,thefollowingmighthavetobead-dressed inorder formoreeffectivecollaborationsinthefuture:

• Need for greater clarity of purposeand approach to solving systemicproblems (regardless of sector) that


need more strategic and integratedsolutions across governance levels,and not just superficial and band-aid solutions that at best only helpappease citizen dissatisfaction withser-vices. Mobilizing volunteers, theconductofmassivesurveys,gathering,processingandpresentingstakeholderfeedback require not just technicalknowledge and skills but significantmaterialresourcesaswell.TheHealthDepartment already recognized thatthe behavior and attitude of medicalpersonnel at the Aimag GeneralHospitalandFamilyHealthClin-icsarebroughtaboutbyevenbiggerissuesinthehealthsector.Shouldstakeholderswish to involve citizens in morestrategic and programmatic issues,a good starting point will be to focuson the planning for and utili-zation ofthe Local Development Fund wherethere is clearly some level of interestand technical capacity on the part oflocal NGOs to design the appropriatemethodology for gathering citizenfeedback.

•Effectivesocialaccountabilityinitiativesarebuiltaroundacommonandsoundunderstanding of the role citizens andcitizenfeedbackcanplayingovernanceand decision-making. More than justbeingchannelsforcommunicationandinformationdissemination,governmentand citizens groups should seethemselves as partners in decision-making and pro-gram implementationinthespiritofconstructiveengagement.Citizenmonitoringandmechanismsforsustaining the effort in Govisumberis not yet a shared value amongstakeholders. NGOs do not feelcompetent in assessing governmentservices and programs. Governmentsees NGOs mainly as vessels forinformation dissemination. Serviceproviders viewed the sub-project asthemeans tonarrow thegapbetweenmedical personnel and citizens, butonlyinsofarasprovidingthelatteranopportunity to gain understanding ofthestrugglesoftheformersothatthey“will complain lesswhen they are notimmediatelyattendedto”.

Page 35

zation of the Local Development Fund where there is clearly some level

of interest and technical capacity on the part of local NGOs to design the

appropriate methodology for gathering citizen feedback.

• Effective social accountability initiatives are built around a common and

sound understanding of the role citizens and citizen feedback can play in

governance and decision-making. More than just being channels for

communication and information dissemination, government and citizens

groups should see themselves as partners in decision-making and pro-

gram implementation in the spirit of constructive engagement. Citizen

monitoring and mechanisms for sustaining the effort in Govisumber is not

yet a shared value among stakeholders. NGOs do not feel competent in

assessing government services and programs. Government sees NGOs

mainly as vessels for information dissemination. Service providers viewed

the sub-project as the means to narrow the gap between medical person-

nel and citizens, but only in so far as providing the latter an opportunity to

gain understanding of the struggles of the former so that they “will com-

plain less when they are not immediately attended to”.

Introducing a Community Inclusive Monitoring Mechanism Sub-project in Khentii Aimag

Primary health care in Khentii, as in other aimags, is provided by Family

Health Clinics (also referred to as Household Health Centers or HHCs)

30

Introducing a Community Inclusive Monitoring Mechanism Sub-project in Khentii Aimag

PrimaryhealthcareinKhentii,asinotheraimags, is provided by Family HealthClinics (also referred to as HouseholdHealth Centers or HHCs) which areprivate, voluntary health organizationscontracted by government. ServiceprovisionisboundbyacontractsignedbytheAimagGovernorandtheHeadofthe Health Department. This contractincludes provisions for performanceassessments which however do nottakeintoaccountstakeholderfeedbackandisperfunctorilyrenewed.

Focused on working with two HHCs(the first serving the most populouscommunityintheaimagcenterandthesecondfortheremote,morevulnerablecommunities),thesub-projectinKhentiisought to improve service qualityand access to primary health care byintroducing a third-party monitoringmechanism in the performanceassessmentofHHCs.Us-ingstandardsandprovisionsmandatedbytheMinistryof Health and as stipulated in thecontractforHHCs,citizensarelikewiseexpected to evaluate the performanceof the HHC as well as contractualobligationsofthetwoothersignatories– the Aimag Governor and the HealthDepartment.

Theresultsweretakenintoconsiderationandgivenweightintheassessmentandrenewal of contract with the HHC andintheactionplanningprocesswiththeGovernor’sOffice.

Sub-project implementation in Khentiiwas led by UB-based NGO Mon-FemNet,inpartnershipwithlocalNGOsand theirmonitoring teamsorga-nizedfor the purposes of the project, two(2)HHCswhosecontractswereup forrenewal, and the concerned offices oftheAimagGovernor.

The local CSO network has 20 activemembers,outofwhich9organizationswere selected to be part of theimplementation team, complementedby 10 people from the bagh areaswhere the HHCs were located and4 representatives from the localgovernment. Upon signing of theMemorandum of Un-derstanding, theHead of the Social Policy Departmentwas designated to represent theGovernor.

Being part of the local projectimplementationteam,theCSOnetworkcoordinatorwaspartofseveralcrucial

Page 36

which are private, voluntary health organizations contracted by govern-

ment. Service provision is bound by a contract signed by the Aimag Gover-

nor and the Head of the Health Department. This contract includes provi-

sions for performance assessments which however do not take into ac-

count stakeholder feedback and is perfunctorily renewed.

Focused on working with two

HHCs (the first serving the most

populous community in the aimag

center and the second for the re-

mote, more vulnerable communi-

ties), the sub-project in Khentii

sought to improve service quality

and access to primary health care

by introducing a third-party moni-

toring mechanism in the perfor-

mance assessment of HHCs. Us-

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.

Sub-project implementation in Khentii was led by UB-based NGO Mon-

FemNet, in partnership with local NGOs and their monitoring teams orga-

nized for the purposes of the project, two (2) HHCs whose contracts were

up for renewal, and the concerned offices of the Aimag Governor. The local

CSO network has 20 active members, out of which 9 organizations were

selected to be part of the implementation team, complemented by 10 peo-

ple from the bagh areas where the HHCs were located and 4 representa-

tives from the local government. Upon signing of the Memorandum of Un-

derstanding, the Head of the Social Policy Department was designated to

represent the Governor. Being part of the local project implementation

team, the CSO network coordinator was part of several crucial decisions on

the project such as the selection of team members, issue and problem

identification, and sub-project design.

The Khentii Sub-project at a Glance

Poor service quality and access to primary health

care

Improved primary health care services in

compliance with contract stipulations

Through:

Inclusion of 3rd-party monitoring in the

performance assessment of the parties to the HHC

contract (HHC, Aimag Governor, Health Dept.)


(MASAM) Project

31

Sub-project Outputs and OutcomesThe sub-project was documented andassessed for actual results acrossessential elements for an effectivesocialaccountabilityinterventionwhicharedocumentedasfollows:


The main point for engagement isthe tripartite contract for primaryhealth care services entered into bythe aimag Governor and the HealthDepartmentwiththeFHCorHHC.Localstakeholders, with the guidance ofthe national NGO partner MonFemNetreviewedtheexistingprovisionsof thecontract and other related legislationandpoliciesfromtheMinistryofHealth.

Giventhatthecontractswithtwooutofthe four serviceproviderswereup forrenewal, theywere able to revise andintroduce provisions for integratinga public par-ticipatory assessmentin these two contracts, with theassessment criteria and instrumentannexedtothemaincontract.

decisions on the project such as theselectionof teammembers, issueandproblem identification,andsub-projectdesign.

Particularly for the sub-project,improving primary health servicedelivery was designed to be achievedthrough:

a)Introducing a public participatorymonitoring mechanism in thecontracts of HHCs (in 2 out of 4serviceproviders);

b)TrainingCSOsandcitizenstoconductmonitoring;and,

c)Enhancing transparency andaccountability of HHCs throughconstruc-tiveengagement.

In order to achieve above-mentioned objectives, the projectimplementation and managementteam conducted the following keyactivities:

1. Review of the assessment criteriain the tripartite contract provisions.From out of the review process, itwas resolved to introduce publicpartic-ipatory monitoring as partof the contract agreement wherebycitizenswillbeaskedtoevaluatetheparties to the contract—the FamilyHealth Clinic, Aimag Governor andthe Aimag Health Department—throughasurveythatwillbecarriedoutbythelocalNGOpartners.Resultsof the survey were aggregatedand constituted 50% of the totalassessmentofHHCPerformance.

2. Development of a handbook andguidelines for the conduct ofparticipa-tory monitoring. Integralto this was survey design and tooldevelopment by the partner NGOMonFemNet. Pilot testing of thesurvey design was dont with 40respondents.

3. Setting up of and capacity-buildingforthemonitoringgroups.

4.Thepublicparticipatorygroupofthelocalimplementationteam’sconductof a community mapping exercisethat allowed them to determine thelo-cation and profiles of vulnerablegroups, especially temporaryresidents. Simultaneous to themapping exercise, they conducteda stakeholder satisfaction survey,with criteria and indicators similarto that of the as-sessment tool asannexed to the tripartite contract.These notwithstand-ing that thecontractswerenewlysignedandtheservice providers were not up forassessmentjustyet.

5.Conductofhealthservicemonitoringamong five key groups of citizensaccording to services/programsoffered by the HHC: newborn,pregnantwomen,elderly,temporaryresidents,andvulnerablegroups.

6. Formulation of the Service/PerformanceImprovementPlan.

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From out of the community mappingand thesurvey, thegroupwasable toidentify constraints and issues in thedeliveryofservicesbyHHCsasagainststandardsand indicatorsprescribedbytheMinis-tryofHealth.

Drawing on survey results, HHCstogetherwithcon-cernedstakeholdersfrom the Aimag Governor’s Office, theHealth Department, Bagh Governor,and local NGOs, formulated a ServiceImprovementPlan.Thiswill,hopefully,allow theHHC to have better rating inactual performance assessment asprovidedforintheircontracts.

2. On Outcomes: Concrete improvements in local governance, citizen empowerment, and health service delivery.

Governance:Thesubprojectreinforcedtheaccountabilitiesandre-sponsibilitiesof the Aimag Governor and the AimagHealth Depart-ment in providing otherelements– suchas infrastructureand

Areas for improvement by the HHC according to the stakeholder satisfaction survey:

• DuetoalackofspaceoftheHHC,itshouldfocusoncreatingasmuchcomfortaspossibleintermsoftheorganizationoftheroomsandcorridor;

• Whenprovidingthehealthcareservices,setupadaywheretheelders,disabledpeopleandchildrenwithnutritionaldeficienciesarevisitedregularlyandprovidedat-homemonitoring;

• Decoratetheareaforthepreliminaryexaminationandvaccination;• Upgradethetoolsandequipmentofdoctorsoncall;• Openafitnessroomandmakeitavailableforthecitizenspermanently;• Increasethenumberofdoctorsandnurses,permanentlyemploytheemployeestrainedatthelaboratory;

• Provide capacity building for the already trained volunteers and incentive for furtheremployment

equipment to contracted HHC – andensuring quality public health serviceprovision

WiththeinitialresultsoftheassessmentandfeedbackprovidedtotheGovernor’soffice and its Health department,there has been a greater stake andinvolvement on the part of the SoumandAimaggovernmentunitstoaddressgaps and take on tasks identified inthe Service Improvement Plan thatare simply beyond the accountabilityof the private service provider as theyare clearly contractual obliga-tions bygovernment.

Because of the value placed onstakeholder participation, the 2018Aimag Action Plan being proposed bytheHealthDepartmentcontainsspecificprovisionsonCSOparticipa-tionseekingtoimproveprivate-publicpartnerships,CSO coopera-tion, and allowing forsomefunctions tobedelegatedtoandper-formed by CSOs and professionalassociations.

For the aimag Health Department,citizen monitoring and participa-tionis a new term and approach. Evenas citizen satisfaction sur-veys areregularly conducted (once everyquarter) to assess the performance ofoffices under the health department,the organiza-tions have the benefitof choice to take action (or not) onthe results of the survey. Citizens orcitizensgroups are not involved in thede-sign,administrationandanalysisofthe survey,more so in the reso-lutionof issues and therefore do not haveany means to exact ac-countability intheir current practice. Given projectexperience how-ever, there is anexpressed willingness to replicate themodel and conduct citizen monitoringon other government programs andser-vices(especiallyonhealth).

Empowerment: According to the localCSO coordinator, citizens, especiallytemporary residents are not aware ofandthedifferenceofservicesofferedbyfamilyhealthclinics(atthebaghlevel)andtheSoumhealthclinics.

Their participation in the stakeholdersatisfac-tionsurvey(and,prospectively,in theHHCPerformanceAssess-ment)hasmade themaware of the servicesand has given them themeans to tellgovernmentaboutthelevelorqualityofservicesthatHHCsprovide.

While the tripartite contractsprescribestandards of quality and timelines,citizens are not aware of thesestandards and more so, are not ableto tell government about the quality


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of services they get. Through thesurvey results, citizens were able tocollectively articulate citizens’ needsand influence the formulation of theservice improvement plan for thebenefitofthelargercommunity.

Citizens groups or CSOs involved inthesub-projectbelieveinthepoweroffeedbacksuchthattheyseethepotentialofreplicatingtheeffortinassessingtheservicesoftheAimagGeneralhospital,pub-lic utilities, waste management,and education services. They seethe importance of citizen monitoringin exacting good performance forcontracted services. To them, it is thebeginning of an effort “for citizens to know their rights, trust government and ensure the citizens have access and influence to decision-making.”

Somecitizensusedtobehighlycriticalofallthingsgovernment,butparticipationintheassessmenthasmadethemtakeintoaccounttheirownresponsibilitiesin making government programseffective because, as one respondentput it,“the state cannot solve all the problems of our family health clinic. Our participation is highly important.”

Service Delivery: Asdiscussedearlier,a public participatory mechanism wasincluded in the tripartite contract forHHCsasre-visedandimplementedthis2017. The revised contract introducedanassessmentschemewherebyitemsrated below 80 are catego-rized as“needs improvement” and thereforerequire the parties to take action.

Citizens’ rating comprises 50% of thetotal assessment. For the HHC, theinitialassessmenthascorrectlypointedout gaps in facilities and services thattheyneedtoimproveonyetignoredforthe longest time. Useful feedback andinsightswerebroughtoutbythesurveyandconcernedstakeholdershavesincetried to address the problems throughtheServiceImprovementPlan.

Keyactionstakeninclude:

• Procurementofdiagnosticequipmentto improve laboratory servicesthroughtheLocalDevelopmentFundoftheBaghandSoumgovernors;

• Instituting mechanisms to providefunding for services availed of bytemporary residents (the costs forwhomshouldbecoveredbytheBaghthey come from given their tempo-rary resident status in the aimagcenter,buttheyalsogototheHHCswhose contracts do not stipulatetheiraccomoda-tion);and,

• Setting up an electronic data baseofpatientsbeingservedby theHHCincludingtemporaryresidents.


According to the head of the AimagHealth Department, there was initialresistance tocitizenmonitoringon thepart of the HHC. They were howeverconvinced to support the project withthe explanation that citizenmonitoringwillhelpimprovetheirworkandservice

de-liverybymakingotherpartiestothecontract accountable for their part aswell.Atpresent,allstakeholders(CSO,government offices, service providers)areawareofandareabletoarticulatetheneed formonitoringprogramsandservices financed by government. Thehealth department is determined toimplementtheapproachtootherFHCsaswell aswith SoumHealth Centers,nationalandaimaglevelprograms.

Because prevention and detectionof diseases require public infor-mation and knowledge, they seecitizen participation as an importantcomponent of public health services.As demonstrated by their experiencein the aimag, the Health Departmentwill push for citizenmonitoring in theimplementation of tripartite contractsandwillrecommendforsuchpolicytotheMinistryofHealth.

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Revised contract stipulations integrating citizen participation in performance assessment of HHCs and government offices:

• TheIndependentWorkingGroupappointedbythedecisionoftheStandingCommitteeoftheSocialPolicyoftheAimagCitizens’RepresentativeKhuralshallconcludetheContractbyhalf-yearandfull-year;andshalldecideandapprovemattersregardingtheextension,terminationofandamendmenttothecontract.

• TheIndependentWorkingGroupshalladheretotheindicatorsandrequirementsstatedinthe“Structure and Operations of theHouseholdHealth Center”,MNS 5292– 2011,MongolianStandardaswellasthecriteriaadoptedbythe1stand2ndAppendixofthisCon-tract:

• The operations of the Household Health Center shall be evaluated in conformity with theindicatorsandrequirementsmentionedintheArticle7ofthe“StructureandOperationsoftheHouseholdHealthCenter”,MNS5292–2011,MongolianStandard;

• Asindicatedinthe1stAppendix,theevaluationprovidedbythecitizensinregardsto if theactions undertaken within the framework of the Community Inclusive Monitoring (CIMM)methodologyhavefulfilledsomeoftheindicatorsandrequirementsstatedinthe5thand6thArticlesofthe“StructureandOperationsoftheHouseholdHealthCenter”,MNS5292–2011,MongolianStandardshallbeconvertedtopercentage;

• 50%oftheintegratedevaluationconcerningthe3.3.2-3.3.4indicatorsshallbetheevaluationprovidedbytherepresentativesoftheservicerecipients-citizenswithinthetheframeworkofthePublicScorecard.

The sub-project was successful inmeeting its intended objectives dueto the buy-in and support from thecontracted service provider. Despitebeing tied to the same contractstipulations for the last seventeenyears, the two pilot HHCs acceded tothe proposed contract revisions andallowedforpar-ticipatoryperformanceassessment to be included in theredraftedagreements.Additionally, the

performance contract with HHCs wasastrategicmechanismandentrypointfor integratingcommunityparticipationin the assessment of family healthclinics. Being parties to the contractand performance assessment,accountabilitywas likewise demandedfrom the Aimag Governor and theAimagHealth Departmentwho in turnexpressed support for the adoptionand implementation of the service


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improvement action plan and tofurtherinvolveCSOsinotherprogramsrequiringprivate-publicpartnerships.

Khentii’s model for integrating acommunity-inclusive monitoringmecha-nism is a readily-replicablepractice to other private serviceproviders con-tracted by government(in health and possibly other sectors).It will be ben-eficial for projectimplementersinKhentiitoaddressthefollowingareasaswell:

• The CSO convener may have hadsignificant experience working onpro-jects with international andmultilateral organizations. Howeverthe other organizations formingpartoftheimplementationteamareseemingly bound by more tacticalandproject-based terms.Given thattherevisedcontractagreementshave

alifebeyondtheMASAMsub-projectterm, theCSOnetworkmayneedtorevisit its bases for unity and worktowardsasharedagendaofexactingaccountability fromgovernmentandserviceproviders.

• Project management leadersthemselves have expresseddifficulty in looking for andmobilizing volunteers according tothe criteria recom-mended by thenationalNGOpartner at the start ofimplementation. While initially theywanted to recruit local CSOs andcitizen volunteers that had capacityfor research and communicationskills,theysomehowcompro-misedandrecruitedvolunteersonthebasisof commitment and availabil-ity.If the third party assessment wereto be continued and sustained, the

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• Despite willingness to replicate the experience in other FHCs/HHCs and

Soum Health Centers, appreciation for citizen participation is limited to in-

volving citizens groups in public information and campaigns towards pre-

vention and early detection of 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.

CSO network needs to strengthenits capacity for evidence-baseden-gagement (i.e., research) andsubstantiating objective feedback,perhaps initially with support fromnationalNGOadvisers/consultants.

• There has been no concrete actionreported regarding feedback givento the Aimag Governor’s Office andthe Aimag Health Department, aspar-ties to the tripartite contractand therefore may need furtherdocumenta-tion.

• Despite willingness to replicate theexperience in other FHCs/HHCs andSoum Health Centers, appreciationfor citizen participation is limited toin-volving citizens groups in publicinformationandcampaigns towardspre-vention and early detection ofdiseases. Government counterpartscould greatly benefit from a deeperunderstanding of the value ofcitizen moni-toring and its possibleapplication to other governmentconcerns.

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Public Participatory Schools in Khovd Aimag

Thesub-projectinKhovdaimag,entitled“Public Participatory Schools withAccountability”, was implemented inpartnershipwiththeMongolianEduca-tion Alliance (MEA). The sub-projectsought to address the governance,resource allocation, expenditure, andmulti-stakeholder decision-makingin ten (10) secondary schools that areisolatedfromtheaimagcenter,inlow-income soums, and are, more oftenthannot,unabletoparticipateindonor-funded projects that support schoolactivities.

According to the situational analysisconducted by key stakeholders in theaimag,most, ifnotall, schoolsdonotprovide sufficient information and ac-cess to decision-making processeson governance, resource allocation,expenditure-tracking, and planning fortheir operations. Schools have dete-riorating conditions, are insufficientlystaffedtohandletheschoolpopulation,and lacked support from concernedstakeholders. Moreover, despite the

mandate for setting up parent-teachercouncils which are mostly inactive,the project team felt the need foreffective mechanisms for participationin the planning for and monitoring ofschool operations. To address this,the sub-project deployed the MEA-developed “Community-inclusiveSchools” Assessment tool that couldhelp mobilize community participationin planning, implementation, andreportingofschooloperations,policies,andinternalregulations.

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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,

resource allocation, expenditure, and multi-stakeholder decision-making in

ten (10) secondary schools that are isolated from the aimag center, in low-

income soums, and are, more often than not, unable to participate in donor-

funded projects that support school activities.

According to the situational analysis conducted by key stakeholders in the

aimag, most, if not all, schools do not provide sufficient information and ac-

cess to decision-making processes on governance, resource allocation,

expenditure-tracking, and planning for their operations. Schools have dete-

riorating conditions, are insufficiently staffed to handle the school popula-

tion, and lacked support from concerned stakeholders. Moreover, despite

the mandate for setting up parent-teacher councils which are mostly inac-

tive, the project team felt the need for effective mechanisms for participa-

tion in the planning for and monitoring of school operations. To address

this, the sub-project deployed the MEA-developed “Community-inclusive

Schools” Assessment tool that could help mobilize community participation

in planning, implementation, and reporting of school operations, policies,

and internal re

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