Neichu Dz. Angami
This year’s World AIDS Day under the campaign “Stop AIDS – Keep the Promise” is focusing on Accountability as its main theme. The emphasis of accountability and transparency towards communities most affected by HIV and AIDS for which policies, programs and projects are provided often easily get diverted by donor-driven requirements stressing on monetary and managerial aspects; seeking quantifiable outcome measures and targets rather than aiming at improved comprehensive public health policies which will have multiple effects; and may not necessarily be measurable during the lifespan of the project.
Therefore, in the world of increasing inequality and increasingly hard economic conditions for the poorest, the perspective of donors and external agencies must be critically considered. We must ensure that the voice of the people for whom projects and programs are put in place, are not lost in a process dominated by those making monetary and technical contributions.
The UN and its specialized agencies are directly accountable to their member states. Decision making within the UN is based on ‘one state, one vote’ system. Likewise, WHO, which is an organization within the UN responsible for health needs of the world, is accountable primarily to its member states as represented by health ministries in the World Health Assembly(WHA). The accountability of World Bank is primarily to the major financiers on the Board of Governors. The Governments are usually accountable for the outcome of World Bank Projects because World Bank is basically a borrowing agency.
Globally, there is a clear indication that health-care is in the process of moving towards corporatization which contradicts with ‘Access to Health Care as a Social Right’ and WHO’s mandate ‘Health for All’. The increasing role of insurance companies, chains of care- managements, pharmaceutical industries moving towards health care services, further complicates the issue of accountability and protection of the interest of patients.
The increasing role of NGOs, religious groups and voluntary health services should also be seen in the light of retrenchment of the State. However, it is clearly evident that these agencies are much better placed in delivering services to the people and also in ensuring that the rights and dignity of people they serve are protected and enhanced. Much as they are accountable to their donors, these agencies, true to their name and purpose, are critically accountable to the people serve. And therefore, they need to be assessed in terms of their policy aims, accountability and relation to civil society so that mechanism intended to empower and strengthen civil society are not diverted for the promotion of commercial, professional, private or career interests.
Accountability cannot be confined to financial or management reporting. In actual fact, accountability must bring out critical issues in relation to the use of local resources, improvement of local capacities for addressing local questions and needs. The recipient communities must embarked only on policies and prescriptions which are appropriate to their local context and that the changes brought by interventions are not damaging to their community in the long run. There is enough evidence in the world to indicate that when international consultants and agencies depart, often the recipient country is left with ill-defined policy prescriptions and their consequences, in addition to the burden of payment of the loan and implementation of the suggested change.
No wonder, the poor are still burdened with debt and diseases.
