GPSA MADAGASCAR: STRENGTHENING COMMUNITY AND MUNICIPALITY CO- ENGAGEMENT FOR BETTER BASIC HEALTH SERVICES PROJECT

The Project Development Objective (PDO) is to contribute to improving the quality and utilization of basic health care services through collaborative social accountability mechanisms in target municipalities of Madagascar. The project’s interventions will focus on a twofold objective: 1) Testing, iterating, adjusting and institutionalizing a joint citizen-health management monitoring mechanism to assess health services performance and increasing service utilization and quality. The mechanism’s design will build on lessons learned and on a problem-driven applied political economy analysis. Health committees (COSAN) and health users will be mobilized to assess service performance jointly with key stakeholders, such as Municipal Health Development Committees (CCSDs) and Management Committees (COGE) of basic health centers (CSB). 2) Strengthening the linkage between municipal and health sector planning through the adoption of concerted action plans (linked to financial allocation to CSB reform) and a participatory budgeting process at the municipal level, based on universal health coverage policy standards (quality, spatial coverage, increased access to care, diseases prevention). The project will help local actors identify and target specific issues on a municipality by municipality basis through collaborative social accountability mechanisms, with an emphasis on inclusive participation of the local population and vulnerable groups, and on reinforcing the link between municipal consultation organs such as SLC (Local Consultation Structures) and CCDS. Building on identified gaps from past and ongoing experiences, and on a political economic analysis that will be conducted during the project’s inception phase, revisions to the proposed mechanism will zero in on critical gaps, including: (i) the ability of community agents (CAs) to comply with their mandate; (ii) community agents’ interface with health centers and relevant municipal decision-mking instances; and (iii) links between municipal decision-making and district/regional health sector plans and resource allocation. This would enable municipal decision-makers to better understand health resource allocation and to advocate for more transparency and efficiency from regional and central levels.