Full text PDF - International Policy Network

112 Fighting the Diseases of Povertyaudits of financial records combined with consequences for staffwere successful in improving financing management, a cornerstoneof government effectiveness (Brinkerhoff, 2005).The nature of accountability and how to structure incentives isnot apparent from the evidence assembled here. Ostensible communityoversight has been assessed in Bolivia, Madagascar, thePhilippines, Uganda. The centralized hiring, promotion and deploymentof public health workers in all countries effectively neutralizesthe role of local supervision. If the consequences ofabsenteeism, taking of bribes and stealing of drugs are beyond theauthority of local boards or community oversight bodies then thoseinstitutions may bring the community together but they will haveno influence over the centrally managed health staffs, or servicedelivery responsiveness and access.Even where systems exist to promote accountability it does notnecessarily mean that they are effective. In Jigawa state in Nigeriahospital management committees meant to oversee and advisehospital managers rarely met, were unclear on their responsibilities,and had little involvement with strategic planning, targeting orbudget control (World Bank, forthcoming). In Madagascar, the factthat local committees were powerless beyond moral suasion ledproviders to ignore their hollow authority and instead respond tosupervisors who had a say in their destiny (Brinkerhoff, 2005). To beeffective community leaders need authority, and at the same timethey need to be accountable to the local citizenry.Local control where it goes beyond simply oversight holdspromise. Under the “Bamako Initiative” that gave communities inselected African countries control over health facilities in exchangefor sharing the financing burden showed impressive health statusimprovements in at least three countries. In Ceara, Brazil the stateinstituted a health worker outreach program with hired healthoutreach workers under contract to the state, and handed responsibilityfor supervision to municipalities. Local control led to betterhealth in the communities covered by the new state program(sources). In Bolivia corruption was lower where local organizing