Promising Practices

Inclusive & Accountable Institutions

These approaches promote effective institutions that are inclusive of and accountable to diverse peoples across genders and other identities. This work supports community, community, market and state agencies and actors to integrate gender equality and justice in their leadership, formal rules and institutional practice, and services. This involves working directly with government and community decision-makers, service providers and the private sector, building more inclusive and resilient community governance, and support to social accountability and other processes that bring power-holders and different groups together – centering those most impacted by exclusion and marginalization – to discuss rights and services.

These approaches help citizens engage systematically with power-holders of different kinds – including service providers, government and the private sector– to increase dialogue, transparency and accountability. These approaches often focus on improving services for poor and marginalized people, including citizen oversight and other social accountability activities (i.e. public audits, citizen charters and community scorecards).

In this section you will find:

CARE: Social and Economic Transformation of the Ultra-Poor (SETU, Bangladesh)
CARE: Community health monitors (Peru)
CARE: Community Score Card (CSC, multi-country)
CARE: Community Support System (CmSS, Bangladesh)

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CARE: Social and Economic Transformation of the Ultra-Poor (SETU, Bangladesh)

CARE’s Social and Economic Transformation of the Ultra-Poor (SETU) and the subsequent project, Journey for Advancement in Transparency, Representation and Accountability (JATRA) in Bangladesh engages with Union Parishads (local government) and extremely poor communities, and facilitates spaces for the two sets of groups to engage in dialogue and negotiate entitlements. Among the extreme poor, groups are formed to build solidarity and natural leaders are identified. These natural leaders mobilize communities to negotiate with landlords, or with employers for fairer wages, and represent community needs to Union Parishads. SETU and JATRA projects also helped reestablish Ward Shava budget planning meetings to help influence spending decisions in line with the priorities of the most marginalized communities (para). The project ensured consultations and social audits with local decision-makers and marginalized groups of women to ensure poor women's perspectives are taken into account. [1] Download the Citizen Monitoring in Peru - Guidance Note

What does the evidence indicate?

SETU’s work (and the work of natural leaders) helped to increase diversity of livelihood strategies and greater benefits from government safety net programs. There was less reliance on exploitative labor. This did not lift households out of poverty, but reduced vulnerability to shocks. SETU’s development of self-help groups helped women build assets, and helped communities to lead collective action in fisheries and vegetable/banana cultivation; Union Parishads facilitated access to public lands and ponds. While results from JATRA are still being assessed, the project has seen gains in broader participation among poor women and men in social audit processes and meetings.[2]

The Union Parishad Act of 2009 stipulates that at least 5% attendance. By tracking attendance records, among the 130 wards that conducted Ward Shava budget meetings in year 1 of the project, a study found that a total of 49,761 community members (25,184 men and 24,577 women) participated. And this represents just over 10% of the total voting population of these wards – double the mandated number and significantly more than in other wards. Likewise, there is initial evidence which suggests that a higher proportion of resources has been allocated towards issues women raised in these meetings as a result of this citizen engagement [3].

References:

1.Hinton, R. (2011). Inclusive governance: transforming livelihood security. Experiences from Bangladesh; 2. Hinton, R. (2011). Inclusive governance: transforming livelihood security. Experiences from Bangladesh. CARE International UK; CARE (2016). Results in Citizen Participation in Local Governance. Project Highlights; 3. CARE (2016). Results in citizen participation in local governance: Journey for Advancement in Transparency, Representation and Accountability (JATRA)

CARE: Community health monitors (Peru)

In the remote highlands of Peru, CARE trained community health monitors to regularly visit health centers (generally 2-3 visits per week) and discuss with female patients how they had been treated, how long they had waited to be seen, whether information was provided in their native language, etc. This was part of a citizen monitoring project to promote quality healthcare. This information was documented and then the regular reports were analyzed with ForoSalud (Peru’s largest civil society health network), the regional Ombudsman’s office, CARE and others. This process helped citizens to voice their concerns, hold service providers to account and promote constructive dialogue on the quality of services.[1]

What does the evidence indicate?

In Peru, in health centers where social monitoring was introduced, users have four times higher awareness of complaint mechanisms and the percentage of users with complaints was twice as high. Social monitoring has driven a rise in expectations and an improvement in the quality of services, but the latter has not kept pace with the former.[2] Monitors have worked with participatory budgets to successfully advocate for the construction of birthing houses where women can stay before delivery.[3] This work also increased transparency in health facilities: for example, which services and medicines were provided free of charge, and that birth certificates are free. There is also an increased receptivity to user preferences: for example, there has been a two-fold increase (from 194 births in 2008 to 437 in 2009) in the number of vertical birth deliveries (the preferred method of many rural indigenous women). Greater confidence in the quality of care has translated into increased demand for services. CARE’s quantitative assessment in 2010 (comparing data between 2007 and 2009), comparing micro-networks with control facilities in Azángaro, found an increase in:

- pre- and post-natal controls
- women’s access to laboratory exams;
- institutional birth delivery;
- the proportion of women affiliated with the national health insurance programme. In Ayaviri, improvements were found only in women’s access to laboratory examinations. This difference is largely attributed to greater problems in the quality of attention in the Ayaviri hospital, related to a greater staff rotation than in Azángaro. [4]

Citizen monitoring can have an important impact on the quality of service delivery. Beyond empowering monitors themselves, the citizen monitoring model has improved transparency in health facilities, ensured greater respect for users’ preferences in birth delivery, and helped reduce corruption; and this improved quality has generated greater demand for health services. Moreover, in comparison with other social accountability models such as Community Score Cards, the mobilization of community monitors means that there is regular community engagement to check that whatever promises are made by service providers are met[5].

References:
1. CARE International UK (2015). Learning and policy series: Citizen monitoring to defend maternal health rights in Peru. Briefing Paper, 6; 2. Aston, T. (2015). Learning and policy series: Citizen monitoring to defend maternal health rights in Peru. Briefing Paper, 6; 3. Gozzo, G. (2015). The power of participatory monitoring in making the Sustainable Development Goals a reality; 4. Aston, T. (2015). Learning and policy series: Citizen monitoring to defend maternal health rights in Peru. Briefing Paper, 6; 5. Ibid

CARE: Community Score Card (CSC, multi-country)

CARE’s Community Score Card© (CSC) bring together service users, service providers and local government to identify challenges to access, utilization and provision challenges, and generate solutions that can be collectively tracked. CSC facilitators are trained, and then use the CSC with focus groups (i.e. men, women, youth) to identify their issues and experiences using the service that is in focus. In parallel or subsequently, the CSC is used with service providers to record the issues and barriers they face. Then, an interface meeting is held with community members, service provider and government staff, and a joint action plan is developed to resolve the problems identified. The implementation of the action plan is monitored in much the same way, on a six-month cycle.[1] The citizen report card process supported by the World Bank in Uganda follows a similar process, though uses community-based facilitators to ensure representation across gender, age groups, and different abilities to meet and share their experiences with services.[2] The Community Score Cards can help mainstream good governance in women and value chains projects, as well.[3] Download the Community Score Card Toolkit

What does the evidence indicate?

- A review of evaluations of Community Score Card© projects in Malawi, Tanzania, Ethiopia, Rwanda and Egypt reported overall increases in utilization of health services. CSCs improve the user-centered dimension of quality in several ways, including by increasing respectful treatment of patients by health providers. This helps to increase service utilization, and whether women deliver in facilities with skilled providers.[4] Several projects also suggested that the CSC process unlocked resources (i.e. human, material, financial) from the system, improved the ability of citizens to hold providers to account, improved the relationship between providers and citizens, and shifted power to citizens. Several projects also indicated that CSCs providers working in unsupportive work environments found citizen pressure useful to shift resources and be more effective.[5] Some areas for improvement on CSCs are: ensure that marginalized groups participate (e.g. have separate focus groups for women); consider how to not only focus on accountability at the local level, but also at the national level; and build bridges between citizens and public policy-making processes from early on.[6]

- Through the Community Score Card© (CSC) approach, the Maternal Health Alliance Project (2011-2015) empowered community members, health providers and local government officials in Ntcheu, Malawi to identify reproductive health service utilization and provision challenges, to mutually generate solutions, and to work in partnership to implement and track the effectiveness of those solutions in an on-going process of improvement. CARE’s cluster-randomized control evaluation revealed that compared with communities where the CSC was not implemented, the proportion of women receiving a home visit during pregnancy increased by 20%, while satisfaction with health services increased by 16%. Use of modern family planning methods was also estimated to be 57% higher in the intervention area, showing how inclusive governance approaches such as scorecards can make important contributions to the health outcomes that CARE and others are seeking.[7]

- In a review of a Uganda community-based health clinic monitoring and social contract initiative using Citizen Report Cards, treatment communities observed a reduction in infant mortality (33%), increased use of outpatient services (20%) and overall improvement of health treatment practices (immunization rates, waiting time, absenteeism).[8]

SEE: Gender Integrated Value Chains.

References:

1. CARE Malawi. (2013). The Community Score Card (CSC): A generic guide for implementing CARE’s CSC process to improve quality of services; 2. Fox, J. A. (2015). Social Accountability: What Does the Evidence Really Say? World Development, 72, 346-361. doi:10.1016/j.worlddev.2015.03.011 ; 3. Mondelez International, Cocoa Life, & CARE International. (2016, October). Women's Leadership in Cocoa Life Communities ; 4. Gullo, S., Galavotti, C., & Altman, L. (2016). A review of CARE’s Community Score Card experience and evidence. Health Policy and Planning, 31(10), 1467-1478. doi:10.1093/heapol/czw064 ; 5. Chen, L., Evans, T., Anand, S., Boufford, J. I., Brown, H., Chowdhury, M., Wibulpolprasert, S. (2004). Human resources for health: overcoming the crisis. The Lancet, 364(9449), 1984-1990. doi:10.1016/s0140-6736(04)17482-5; 6. Gullo, S., Galavotti, C., & Altman, L. (2016). A review of CARE’s Community Score Card experience and evidence. Health Policy and Planning, 31(10), 1467-1478. doi:10.1093/heapol/czw064; 7. Gullo, S., Galavotti, C., Kuhlmann, A.S., Msiska, T., Hastings, P. and Marti, C.N. “Effects of a social accountability approach, CARE’s Community Score Card on reproductive health-related outcomes in Malawi: A cluster-randomized controlled evaluation.” PLoS ONE 12(2): e0171316.
8. Björkman-Nyqvist, M., De Walque, D., & Svensson, J. (2014, August). Information is Power: Experimental Evidence of the Long Run Impact of Community Based Monitoring (Rep. No. WPS 7015).

CARE: Community Support System (CmSS, Bangladesh)

Community Support System (CmSS), developed by CARE Bangladesh in 1999, is a community mobilization mechanism that builds community capacity and participation to demand, negotiate and utilize health services. CmSS has been used in Bangladesh to track pregnant women and provide need-based support to ensure pregnancies are safe and timely use of emergency obstetric care. CmSS conducts community surveillance for tracking, registration of pregnancy and violence against women; facilitates birth preparedness; mobilizes local funds and resources to support emergency transport and referral; promotes accountability and responsiveness through community feedback and advocacy; links with local government and health system; and creates an enabling environment for communities to become “watch dogs” to prevent harmful practices.[1]

What does the evidence indicate?

In Bangladesh, the Safe Motherhood Promotion Project sought to develop community capacity to improve safe motherhood practices at the local level and strengthen emergency obstetric care services at sub-district health complexes. The project used community mobilization activities that aimed to increase awareness and demand for maternal health services through the development of the Community Support System (CmSS), and established regular meetings between community members, service providers, and sub-district level policymakers. As a result, women and the community have a greater voice with respect to the governance of the local health system, and service providers are more accountable to the community for the quality of care. An impact study found that CmSS resulted in 71% antenatal care access for women in the lowest wealth quintile compared to 30% in the non-CmSS area.[2]

References:

1. Hossain, J., Dr. (2015, March). Project Summary: Community Support System Experimental Evidence of the Long Run Impact of Community Based Monitoring (Rep. No. WPS 7015) ; 2. Hossain, J., Dr. (2015, March). Project Summary: Community Support System.

Human Rights Education for Political Change

Women for Women: Human Rights Education Program (Istanbul, Turkey)

The Human Rights Education Program (HREP) for Women, a project of Women for Women’s Human Rights and the Umraniye Women’s Center, took part in poor urban areas of Turkey with its first pilot in Umraniye, a poor area on the outskirts of Istanbul. Heavily informed by action research with women across Turkey, the program developed a participatory curriculum that lasts 16 sessions. HREP used a human rights framework to facilitate sessions, touching on civil, economic, political, sexual and reproductive rights, as well as topics like child rights, ending gender-based violence and gender-sensitive parenting. HREP worked with closed groups of women and eventually linked with the state to implement the program via trained social workers who facilitated HREP in community centers in cities across the country. Through this space, women involved In the project organized at the grassroots level to advance their needs and interests, and HREP took an active role to support HREP cohorts in networking, fundraising, capacity-building and linking with broader movements for women’s rights.[1]

In this section you will find:

What the evidence indicates from the Human Rights Education Program (HREP)
Brazilian NGOs: Mulher e Democracia (Brazil)

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What does the evidence indicate?

Evaluations of HREP identified impacts across personal, family and community levels. At the personal level, about 90% of respondents who participated in HREP increased self-confidence and problem solving abilities. Home lives also improved. 72% of participants reported more positive relationships with husbands and 93% reported more positive attitudes toward their children. 73% of women reported greater say in family decision-making. 63% of women who had faced domestic violence before the project reported that they were able to stop it, and 22% reported they were able to reduce domestic violence in their lives.30% of women participants reported entering the workforce while 54% discussed returning to formal and informal education opportunities following the program. At the community level, 88% women participants reported they have become resource people in their communities. In at least 7 cities where HREP was implemented, women started their own associations from which to they organized economic cooperatives, local counseling centers, campaigns to raise community consciousness and support for local women’s leadership.

References:
Amado, L. E., & Pearson, N. L. (2005). The Human Rights Education Program for Women (HREP): Utilizing state resources to promote women’s human rights in Turkey

Brazilian NGOs: Mulher e Democracia (Brazil)

At a broader scale, Mulher e Democracia, a joint effort of 3 Brazilian feminist NGOs (AGENDE, Casa da Mulher do Nordeste and Brazilian National Congress), established a program for women leaders in local, national and state levels of government to undergo a series of trainings on history, political economy and economics with strong feminist analyses and group-based learning. This work specifically sought to build relationships of solidarity among women leaders, and raise consciousness around women’s rights, which they could apply in their roles in public service and decision-making.[1]

What does the evidence indicate?

Results from Mulher e Democracia’s program are still nascent. However, surveys from 1992 and 2012 show that those who have undergone the program have increasingly expressed commitment to represent and support women as a motivation for their work (from 3-13.8%). However, a challenge remains in terms of how women view support from their broader political parties, which have not supported their leadership in practice. As noted by Cornwall, this highlights the importance of pressure groups and organized movements to demand greater commitment and accountability for women’s rights.

References:
Cornwall, A. (2014). Women’s empowerment: what works and why? (WIDER Working Paper 2014/104) [PDF]. Helsinki: United Nations University-WIDER

Gender Integrated Adaptation and Resilience

As natural disasters and climate change affect people in distinct ways based on their status, gender and livelihoods, it is critical to ensure equity remains at the center of decision making, participation, access to resources and services and interventions.

In this section you will find:

CARE: CARE’s Adaptation Learning Programme (ALP, multi-country)
CARE: Disaster Risk Reduction (DRR, Vanuatu)

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CARE: CARE’s Adaptation Learning Programme (ALP, multi-country)

CARE’s Adaptation Learning Programme (ALP) works off a Community-Based Adaptation (CBA) framework that brings together development, risk management, and humanitarian response to work to ensure communities can adapt to, and reduce their vulnerability to the impacts of climate change. This approach is grounded in participatory analysis with village-based groups to identify climate change vulnerability and adaptive capacities, who then develop and implement community adaptation action plans. These plans are also used to influence the local development planning of government structures. Promoting gender equality and diversity is now a large component of the CBA approach. In the Sahel region, a combined CBA/VSLA approach has been investigated as a way to increase long-term resilience of communities to future crises.[1]

What does the evidence indicate?

A 2015 study suggests that combining the VLSA approach with CBA programming appears to offer more sustainable, effective results to building resilience to the crises brought about by environmental changes. Whereas VSLA activities indicate numerous benefits for decreasing the vulnerability of women such as the improved social capital and economic situation of members, it doesn’t in itself strengthen the capacity of communities to adapt to environment change that are significantly impacting food and income security. It appears that combining VSLA with a CBA approach can ensure that environmental changes that are particularly serious for women and marginalized groups.

References:
CARE West Africa. (2015). The resilience champions: When women contribute to the resilience of communities in the Sahel through savings and community-based adaptation.

CARE: Disaster Risk Reduction (DRR, Vanuatu)

CARE’s Disaster Risk Reduction (DRR) work in Vanuatu from 2013 to 2015 aimed to increase the resilience of at-risk communities and schools to the impact of natural disasters. This included an explicit aim to build women’s leadership in disaster preparedness and response through setting up and training Community Disaster and Climate Change Committees (CDCCCs) and supporting them over time with planning, capacity building and coordination. The CDCCCs aimed to not only be gender balanced in membership, but to provide training to CDCCC members on gender and protection.[1]

What does the evidence indicate?

An evaluation of the gender sensitive approach of the DRR in Vanuatu found that the inclusion of women in Climate Change Committees (CDCCCs) led to an increased representation of women in community leadership roles, and increased respect for women’s membership and leadership in disasters in comparison to communities without the CDCCCs. The evaluation also found evidence that greater involvement of women in disaster leadership contributed to more inclusive preparedness and response – with specific actions taken to seek out and support women, children and people with a disability in preparing, responding and recovering from the Tropical Cyclone Pam.[2]

Download "Gender Sensitive Climate Vulnerability and Capacities Analysis"

Download "Gender and Inclusion Toolkit for Climate Change/Agriculture Work"

Download "Integrating Gender in Climate Change and Disaster Risk Reduction Toolkit"

References:

1. Webb, J. (2016). Does gender responsive Disaster Risk Reduction make a difference when a category 5 cyclone strikes? Preparation, response and recovery from Tropical Cyclone Pam in Vanuatu. CARE: 2.CARE (2016) Does gender responsive Disaster Risk Reduction make a difference when a category 5 cyclone strikes?

Connecting marginalized groups to services and safe spaces

UNHCR: LGBTI Protection strategy (Multi-country)

Since 2014, UNHCR worked with Organization for Refuge, Asylum and Migration (ORAM) to develop a LGBTI protection strategy to promote more inclusive and safe spaces for LGBTQI refugees across five field and camp offices in Jordan. This involved trainings with UNHCR staff on rights, risks and needs of LGBTQI refugees. LGBTQI advocates and community members also offered advisement to UNHCR services to shape resources, activities and services tailored to support LGBTQI refugees. As a result, UNHCR and its partners undertook activities to: 1) train UNHCR and partner staff on the rights and needs of LGBTQI people in forced displacement; 2) establishment of a referral system and network of staff trained to work with LGBTQI people and issues of protection; 3) Integration of LGBTI rights across services, propaganda/outreach and assessment of the needs of people in forced displacement. Members of the network of staff trained to support LGBTQI refugees also wore rainbow pins with the phase “you are safe here” to make themselves identifiable. The initiative also conducted trainings to support working with LGBTQI Persons in Forced Displacement with 24 organizations and 435 humanitarian staff. [1]

In this section you will find:

What the evidence indicates from UNHCR: LGBTI Protection strategy
International Rescue Committee (IRC): Mobile/roaming teams (Lebanon)
ABAAD: Al-Dar Emergency Midway House (Lebanon)
Poorani Women’s Shelter: Poorani Women’s home (Northern Sri Lanka)

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What does the evidence indicate?

According to a review by UNHCR on the LGBTI Protection Strategy, results of the initiative included increased access to services for LGBTQI people in forced displacement, and that the trainings supported better assessment and outreach to LGBTQI people. The introduction and use of the rainbow pins have also become familiar to LGBTQI persons in forced displacement to signal friendlier service providers. [1]

References:
UNHCR (2017). Gender Equality Promising Practices: Syrian refugees in the Middle East and North Africa.

International Rescue Committee (IRC): Mobile/roaming teams (Lebanon)

In order to connect individuals with services, the International Rescue Committee (IRC) established 12 mobile/roaming teams in Lebanon to respond to gender-based violence (GBV). Each team comprised of a female case worker, female community mobilizer, and a male driver. Alongside these mobile units, 4 male IRC community mobilizers shared information about IRC services and prevention of GBV with men and boys and connected male survivors of violence to services. The female case workers, supported by local outreach volunteers from project communities, facilitated support groups among women and girls to share about life challenges, healing, and decision-making. These groups also held discussions following the Arab Women Speak Out curriculum. Following participatory assessments and power mapping with adolescent girls (from refugee and host communities), the project also facilitated sessions for girls following the My Safety, My Well-being and Life Skills through Drama curricula. As a group, girls also developed safety plans tailored to the risks they face and also led a community awareness-raising project (through drama) related to GBV. Girls and their mothers also took part in an intergenerational relationship-building and exchange day. The intervention also supported older girls (15+ years old) to take on mentorship roles for other girls within the community and facilitated dialogues on parenting with women and men as gatekeepers. [1]

What does the evidence indicate?

An evaluation of the mobile/roaming health teams intervention found improvements in the well-being of Syrian refugee women and girls, who reported stronger social networks and support from one another, and increased access to social and emotional support, in addition to advice, information and resources. Participants also reported stronger family relationships, through building up communication skills and coping strategies for women and girls within these communities. In addition, respondents felt the initiative helped to alleviate stigma against refugees. [2]

References:
1. UNHCR (2017). Gender Equality Promising Practices: Syrian refugees in the Middle East and North Africa.; 2. ICRW (no date). Reaching survivors of gender-based violence: evaluation of a mobile approach to service delivery in Lebanon.

ABAAD: Al-Dar Emergency Midway House (Lebanon)

In Lebanon, ABAAD-Resource Center for Gender Equality established the Al-Dar Emergency Midway House (MWH) as a space for emergency, non-conditional and temporary shelter for women and girls at risk or experiencing GBV. Through this space, women and girls can access free and immediate housing – regardless of nationality, age, cultural background, sexual orientation or economic status. Social workers connect survivors to transport to an MWH, where upon arrival they receive a 3 week on-boarding to learn about its philosophy, objectives, security measures and code of conduct. Survivors and their children are offered a 2-month stay, which includes basic assistance (food, clothing, hygiene/baby kits), medical care, psychosocial support, peer-to-peer skill-building, livelihood training and case management support. Over the course of their stay, survivors also make plans for exit and integration outside of the shelter. [1]

What does the evidence indicate?

Women who stayed in the Emergency Midway House reported that the shelter offered a safe space to leave abusive relationships and access to vital services at a time they felt they had nowhere else to go. They reported benefiting from the opportunity to connect with others in similar situations and to learn from as well as teach others. Following their stay at MWH, among those surveyed, 60% found housing away from families, mostly in collective shelters; 25% moved in with supportive family members and 15% returned to spouses and parents, with continued follow up with referral agencies.

References:
UNHCR (2017). Gender Equality Promising Practices: Syrian refugees in the Middle East and North Africa.

Poorani Women’s Shelter: Poorani Women’s home (Northern Sri Lanka)

Taking a more radical approach, the Poorani Women’s Shelter (in conflict-affected Northern Sri Lanka) established a shelter for women from across communities to gather, strategize and seek safe spaces. In Poorani Women’s Shelter, which was established by women academic-activists in the conflict-affected north, women came to take shelter from violence, build skills and engage in feminist learning and activism. The space cooperated with neither the state nor armed groups with power in the area, as both represented sources of violence. While writings of this experience show how the shelter offered a space for forging new and equitable norms, the project later was targeted by armed actors and forced to stop. [1]

What does the evidence indicate?

Writings about Poorani Women’s Shelter highlight the power of this model to build safe spaces, mutual support, and collective work across women of a different class, caste, and religious backgrounds. Further, these spaces offered an important opportunity to shift local social norms and envision possibilities toward equitable futures. However, its bold vision, principles and actions also made it a target by armed groups like the Liberation Tigers of Tamil Eelam (LTTE). [2,3, 4]

References:

1. ICRW (no date). Reaching survivors of gender-based violence: evaluation of a mobile approach to service delivery in Lebanon.; 2. Grewal, K.K. (2017). The Socio-Political Practice of Human Rights: between the universal and the particular. Routledge: New York; 3. Hensman, R. (9 December 2014). "Sri Lanka: a tribute to Rajani Thiranagama: a beacon for the left". South Asia Citizens Web.; 4. Perera-Rajasingham, N. (20 September 2009). “Poorani: a women’s shelter in Jaffna”. The Sunday Leader.