Organisational Accountability
A Critical Issue Of NGOs

By Shankar P. Rajbhandari

ACCOUNTABILITY in organi-sational context is not only imperative but also difficult to articulate. Organisations often fail to maintain organisational efficiency due to the lack of conceptual clarity of institutional accountability. Many organisations become confused to set the hierarchy of accountability. Such a dilemma of accountability by and large prevails in NGO management as well. One very common dilemma that NGOs sporadically fall into is the situation whether they are supposed to be accountable mainly to the people or to the donors. Importantly, people are the prime concern for every NGO whereas many NGOs can hardly survive without a full support or consent of the donor(s). This implies that both the functional relationship of NGOs with the people and enabling relationship with the donors are equally important from the standpoint of institutional survival and sustainability.

In view of the above, an NGO for being pragmatic and moving forward, has to follow a number of points. First every NGO has to define accountability from its organisational spirit. Second, NGOs are needed to articulate the forms of accountability and so as their degree of relationship with the key stakeholders. As survival is the first principle of organisation management, all NGOs may not necessarily be accountable equally to the all organisations or people. In this regard, the forms of accountability should be clarified by NGOs without any confusion. Third, the dichotomy between accountability versus legitimacy should be duly confirmed. In this regard, it is desirable that both the donors and beneficiaries should be satisfied with NGO programmes and services. Fourth, NGOs should be competent enough to eliminate the problems of institutional accountability carefully emphasising to identify the root causes of the problem areas of accountability.

Issues

What does accountability mean in the context of NGO? In search of an operational definition of NGOs accountability, it can be described as mechanisms by which the organisations concerned can be held responsible for their actions and whether they fulfil the agreements and conditions they enter into, including adherence to the values and principles for which they stand.

Following the functional relationship of NGOs with the nature of services and their external variables, three forms of accountability can be perceived: explanatory accountability. Accountability with sanctions and responsive accountability.

Explanatory accountability is a kind of accountability of an NGO being required to give an account to various institutions or to the people or to the government, etc. NGOs are to be transparent enough with their plans, programs, activities, procedures, and budgets. Thus, NGOs are accountable to the people, government, donors, and to the other stakeholders, legally, socially, technically, and professionally.

Similarly, NGO accountability with sanctions is the right to require an account and to impose sanctions. With a view to catering better programmes or services in pertinent subject area(s), NGOs are bound to impose sanctions for the well-being of the community or people. Child right, gender equality, human rights, etc. can be taken as some of the glaring examples of it.

Responsive accountability is the views of those accounted to must be taken into account. NGOs are to be responsive to the target beneficiaries for their pertinent service demands. Also, they are to be responsible to the government, donor agencies, society, and others.

The form of accountability is also linked with the form of resource transfer. The strategy pursued by both NGOs (recipient) and donor (funder) is to diversify the control over the resources they receive, in such a way that the influence of any one donor is marginalized. In several NGO literatures, accountability is linked to the issue of making NGOs more effective. An improved accountability may increase efficiency.

Towards achieving the efficiency and effectiveness of an NGO, the issue of accountability, however, cannot be ignored. Although, accountability is very much good for any NGO, it is sometimes harmful for the legitimacy. In fact accountability and legitimacy are rested, but should not be intermingled. Legitimacy can be based on media legitimacy, elite legitimacy, etc., and does not have to rest on either accountability or legitimacy among recipients.

As a matter of fact, the implicit contract between NGOs and service recipients is a fundamental basis for accountability mechanisms. But due to the strength of donors’ options and beneficiaries’ acceptance or rejection sometime becomes difficult for accountability. From the experience, it implies that the more a project is geared towards the target group, and adapts to the changing local circumstances, the more difficult it will be to be accountable in the way the system expects.

Priority Setting

As mentioned earlier, the most crucial and difficult part of NGO accountability is the art of setting its priority. Virtually, NGOs are related to donors vis-a-vis governments at one end and divergent target beneficiaries at the other. This multi-varied relationship often creates difficulties to ensure accountability for NGOs.

An NGO might formally and rhetorically be accountable to a number of institutions and groups, the question may arise ‘which group comes first?’ - the donor or the target beneficiaries. Even among the donors (in case of having the donors more than one), the question may arise which donor first? This also applies to the beneficiary groups as well. In this regard, one should keep in mind that the one which affects more should be carefully taken into account as multiple accountability is a common slogan but difficult to maintain.

Nevertheless, the smartness of an NGO can be assessed in terms of its institutional ability in balancing or convincing the beneficiaries and donors by way of designing effective programmes, delivering efficient services, and achieving the satisfactory level of all sorts of accountability - responsive, sanction type, and explanatory. This should be seriously manifested by all existing NGOs that ultimately help to improve the capacity building of NGOs in Nepal, indeed.

RBMI: Fight Against Malaria

By Ritu Raj Subedi

MALARIA, a global menace, has become a formidable challenge for medical science when it reemerged in the late 70s hitting the poorest rungs of human society. Fifty years ago, the endemic was controlled under the global campaign against it. The health campaigners were of the view that the disease would be eradicated forever. However, their prediction proved wrong as malaria resurfaced in various parts of the world, specially in the Asian and African continents where most of the impoverished citizens of the earth live. This compelled health experts to change their strategy from that of eradication to the control of the disease.

Malaria, a dangerous communicable disease, causes continuous fever, damages the nervous system of the affected people and leads to their death if not treated in time. It is highly transferable through mosquitoes. The malaria parasite species such as P. vivax. P. facliparum, An. Fluviatilis and An. Maculatus are among those recorded as the main vectors.

Health experts have viewed that malaria is not only a medical problem but is also related to poverty. On the one hand it mostly affects the poor people with little access to health care, on the other hand malaria is a major cause of poverty due to decreasing socio-economic productivity and high diagnosis, treatment and surveillance cost.

In the country, we have mixed results marked by success and failure stories in the drive to control malaria. Until early 1950s, it was estimated that there were two million malaria cases occurring annually with ten to fifteen per cent of those resulting in death. When the country launched the eradication campaign against the disease, it saw a tremendous reduction from estimated two million malaria cases during or before 1958 to merely 2,500 cases by 1970. Within 12 years the eradication campaign made an outstanding achievement.

However, due to various unavoidable circumstances, the weak health system of the country could not succeed in eliminating it completely. Sporadically, the endemic made a haunting comeback. According to the data made available by the Health Ministry, malaria cases reached the 45,000 mark in different parts of the country in 1985. By 1995, it was reduced to below 10,000 and remained almost at the same level up to 1999. The achievement somehow gave consolation to the authorities.

The malaria areas were first stratified in 1980 and re-stratified into five eco-epidemiological strata based on epidemiological factors, ecological changes, socio-economic conditions and operational feasibility. The strata are forested inner Tarai foothills (high-risk areas), cultivated plains (low risk Tarai), highland (low risk hill), Upper River valley and very low grade or no transmission areas.

According to the report, out of the total population, 15.9 million (72 per cent) was found to reside in malaria prone areas. Out of that 15.9 million, (31 per cent) were in high malaria prone areas and the remaining 69 per cent in low risk areas. There were more people in Tarai low risk than hill low risk areas.

Considering the fact that malaria could not be completely eliminated, the government under the National Malaria Control Programme launched the Roll Back Malaria Initiatives (RBMI) with the co-operation of local, national and international health institutions.

According to a report of the Proposed Five Year Strategic Plan (2001-2005) of the RBM, the Epidemiology and Disease Control Division under the Health Ministry selected Kanchanpur, Dhanusha and Jhapa as pilot districts to chalk out a strategic plan of RBMI for the next five years. It also has undertaken a situation analysis of malaria and health system in the country. The core group teams for each district were formed with the public health officer and medical superintendent, and representatives from DDC, WDC and VDC of the concerned districts.

The report states that RBM is an integral part of the socio-economic development in the context of health and human development in the country. The RBM shall address the prevention and control of malaria within the context of health sector development in the country. It claims that the malaria control move will be evidence based actions and innovations and not business as usual malaria control programme. The technical strategies are in accordance with the Global Malaria Control Strategy that is adapted to the local situations based on evidence. It will be implemented in three selected districts, and are to be improved and expanded on a nationwide basis from the lessons learnt.

Out of the three selected districts, Jhapa and Dhanusha have both forested Tarai (moderate receptivity area) and plain cultivated Tarai (low receptivity area) and Kanchanpur has only forested Tarai area. The findings reveal that all the three districts have An.fluviatilis as the main vector and An.maculatus complex as the secondary vector. In the plain cultivated Tarai areas of Jhapa and Dhanusha, An.annularis is suspected to be responsible for transmission.

All the three districts were malaria epidemic prone and have drug resistance problem. In 1999, in Jhapa, Dhanusha and Kanchanpur, the total malaria cases recorded were 326, 1162 and 398 respectively and were 3.6 per cent, 13 per cent and 4.4 per cent respectively of total malaria cases in the country. Month-wise distribution of cases showed the peak in August in Jhapa and in Dhanusha and Kanchanpur it was September. Study on health behaviour in those districts showed that people still rely on traditional and faith healers than on government health facilities.

The Strategic Plan aims to reduce malaria burden in the country to a level that will not hinder socio-economic development by strengthening existing district Primary Health Care system, adapting malaria interventions to local needs and building partnership at local, district and national level. It targets to reduce malaria mortality by 90 per cent in high Pf prevalent areas of stratum 1 and 2 by the year 2005, and to reduce morbidity by 50 per cent by the year 2005.

The Plan is expected to enable the population at risk of malaria to have access to early diagnosis and effective treatment and to strengthen epidemiological surveillance of malaria including outbreak preparedness and response at the district level.

Whatever the Strategic Plan aims, empowering community on recognition, referral, management of malaria cases and adoption of effective preventive measures are some of major challenges for RBM. Orientation and motivation to health workers along with strong management are keys to combat malaria.

The health policy makers should move away from narrow biomedical approaches seeking technological fixes to much broader social and community-oriented paradigm shift in research, problem analysis and action initiatives.

Nine O’ Clock Means Ten

By PNK

IT’S over a decade that democracy returned to the country with a bang. But what do we see now? Nothing came of the high expectations. people being their own masters was the great dream when the Constitution was promulgated. The Constitution has remained the same without any changes and it has guaranteed many a rights which in the panchayat system were denied to the people.

Freedom, liberty, movement, campaign, human rights and so on made the rounds in conversations of the enlightened and the media wrote profusely on them. It has been a sweating time for the people in general when performance of most of the public enterprises does not work to alleviate the woes of their valued clients.

Freedom, of course, does not mean that you can do whatever you like. But that’s what’s happening. Why blame the political leaders only! There are others who are also enjoying the privileges like a secure job with all the perks that it carries. So isn’t it their duty to serve the customers in the best possible manner. May be in the public enterprises the ‘salesman’ aspect has gone missing. It’s like saying "buy if you like, if not get going". As everyone knows that’s not the way business is conducted if one is to survive in the highly competitive market.

A bit of digression: the government has still not decided whether the two day weekends are to stay or not. For that matter, Gorkhapatra Corporation stepped down from the carriage and reverted to its one off day a week. That may be credible decision. But the others are still "enjoying" the privilege despite the great in convenience caused to the people who have business.

The commercial banks are an example. The joint ventures have stuck to the lucrative urban setting. They have lured more customers with a host of innovative ideas. They take the customers as very special people. One more customer in their list means hundred more to come. That’s salesmanship—service is worship and the customers godsend.

But look at the plight of some of the branches of the second commercial bank. There is one in particular where mockery of everything under the sun, as far as business is concerned, was clearly visible. A customer arrives at 9.30 in the morning. The gate is open. The counters are empty. Many of the staff start arriving half an hour after the scheduled opening time of the bank. Even at ten there are some more arrivals. The customers are waiting. Fidgeting whether the bank has declared a holiday or something like that, the clients see no end to their plight.

It’s already past ten and the bank employees finally take their seat but business doesn’t start even after an hour has elapsed. They talk of their household problems, lack of water, expensive electricity, potholed roads and so on. Suddenly a customer roughly tells them to get down to business. And they get started.

Well, a customer goes to a bank expecting instant service unless there are others waiting before him. But here all business senses have been thrown to the wind. The jagire
mentality prevails. The action part is missing. Isn’t this enough to suggest that getting down to business with all the tricks up your sleeve can do wonders. But, Dhobikhola flowing on its own will never cleanse itself of the garbage and rubbish dumped by the inhabitants all around.