Abstract
This article aims to understand the inversion of roles between the state and citizens, by exploring its historical roots and current implications for processes of social accountability in Mozambique, particularly in the health sector. This is a practice-based reflection grounded in the evidence collected through the implementation of Community Scorecards in the health sector in 13 districts of Mozambique. The evidence has revealed a transfer of responsibilities from local governance institutions and service providers to the communities; diluting the frontiers between the state and citizens’ duties and rights, resulting in the inversion of roles. This inversion results in the minimisation of the state’s performance of its duties and accountability in the health sector to respond to local communities’ needs, allegedly due to the lack of financial resources. It also leads to the overburdening of local communities, who assume the responsibility of meeting their own demands, risking participation fatigue.
Highlights
The IDS Bulletin is published by Institute of Development Studies, Library Road, Brighton BN1 9RE, UK This article is part of IDS Bulletin Vol 49 No 2 March 2018: ‘Accountability for Health Equity: Galvanising a Movement for Universal Health Coverage’; the Introduction is recommended reading
State and citizens, subverting the purpose of social accountability. It results in the minimisation of the state’s performance of its duties and accountability in the health sector to respond to the local communities’ needs and rights, allegedly due to lack of financial resources. It results in the overburden of local communities, who assume the responsibility of meeting their own demands, which they place on the health service providers at the local level, risking participation fatigue
Concluding remarks Knowledge of prior relationships and construction of roles of the state and the citizen is a key element for civil society organisations (CSOs) promoting the social accountability approach
Summary
Accountability for Health Equity: Galvanising a Movement for Universal Health CoverageErica Nelson, Gerald Bloom and Alex Shankland. Inverted State and Citizens’ Roles in the Mozambican Health Sector. In the case of Mozambique there are some ambiguities regarding the mandate and competencies of the state This results from changes in its role after independence amongst other political, economic, and cultural factors, which undermine the very essence and operationalisation of the concept of social accountability. An analysis of the evidence collected through the implementation of Community Scorecards in the basic health sector in 13 districts of Mozambique has shown a transfer of responsibilities and tasks from local governance institutions and service providers to communities, and has revealed an inversion of the state and citizens’ duties and rights. It results in the minimisation of the state’s performance of its duties and accountability in the health sector to respond to the local communities’ needs and rights, allegedly due to lack of financial resources. It results in the overburden of local communities, who assume the responsibility of meeting their own demands, which they place on the health service providers at the local level, risking participation fatigue
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