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Global Health
Initiatives, Civil Society
and the Evolution of
Accountability
Carlos Bruen, Annie Parsons & Rachel Hammonds
Coordinated on behalf of the INCO-GHIs
Consortium
www.globalhealthobserver.org/

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Workshop Format
 3 Presentations
 NGO Accountability - Introduction
 NGO Accountability in the Global Context
 NGO Accountability in the Country Context
 Facilitated Group Discussions
 Open Floor Discussion

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‘GHIs in Africa’ Study
 GHIs – global health initiatives that fund ‘global’ diseases
independent of country context
 Focus: Impact of GHIs on country health systems
 Research at national, provincial and district levels in Angola, Burundi,
Lesotho, Mozambique & South Africa
 Incl. the impact of GHIs on the health workforce
 Research at global level on how the GHIs were formed, evolved and
responded to health systems challenges and an increasingly complex
global health governance environment
 Methods:
 Interviews, focus groups, surveys
 Funding from EC 6th Framework INCO-Dev Program (2007-2011)

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Global Health
Initiatives, Civil Society
and the Evolution of
Accountability
PART I
NGO Accountability:
An Introduction
Carlos Bruen
Royal College of Surgeons in Ireland
carlosbruen@rcsi.ie

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What is Accountability?
… “the responsible use of power.” (Humanitarian Accountability Partnership
- HAP)
… “about keeping beneficiaries informed in such a manner that they have
the necessary tools to hold us accountable.” (Niels Bentzen, global
accountability focal point, Danish Refugee Council)
… “really about systems and processes. Do you have the right staff? How do
you communicate? What are your participation methods? Boiling
accountability down to feedback mechanisms is a bit of a cop-out.”
(Gregory Gleed, member of roving team, HAP)
… “about bridging the gap between listening to what affected people say
and taking action based on that feedback.” (Ground Truth program)
… “leadership/governance; transparency; feedback and complaints;
participation; design, monitoring and evaluation.” (Inter-Agency Standing
Committee Sub-Group on Accountability to Affected Populations)
Source: Irin News ‘Whats in a Word?’

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Civil Society – Defining Features
 The realm where citizens associate voluntarily to advance
their interests, ideas or ideologies
 Separate from political and economic society, i.e. the realm where
the strategic purpose and function of actors is in seek to control
and manage state power and economic production
 Non-profit making
 Can include NGOs, CBOs, social movements, faith-based
organisations, professional or academic associations etc
Jordan and van Tuijl (2006)

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NGO – Defining Features
 NGOs
 Embedded in civil society
 May provide services or advocacy to promote particular issues, e.g.
human rights and other social objectives
 Usually non-membership based and linked by networks or alliances
 An intermediary organisation with a defined legal body and
organisational shape qualifying them to receive finances from donors
 Distinguished from
 community-based organisations – comparable to NGOs, but small,
local and less absorbed into broader networks and alliances
 Social movements – effective capacity to engage mass-based
constituency of support and are not characteristic of organisations
 Both can articulate the interest of supporters, operate within less
formal structures and receive less external financial assistance
Jordan and van Tuijl (2006)

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History of NGO Accountability
 Capacity Building Phase (1980 – 1995)
 1980-1989 – A by-product of performance management activities
 Focus: financial accountability, organisational capacity, efficiency and performance
delivery
 1989-1995 – Rise of civil society accompanied by increased calls for accountability
 Focus: quality of internal governance, and formalisation of organisational intent and
behaviour (eg codes of conduct, mission statements)
 Governance Phase (1995 - )
 1995-2002 – Mainstreaming of ‘good governance’
 Focus: legitimacy, self-regulation and independent accreditation mechanisms
 Trend: NGO consultancy and observational status in global institutions
 2002 onwards – i) State resurgence; ii) a rights-based discourse
 Focus: i) screening credibility and promotion of external (state) controls and
regulatory frameworks; ii) balancing multiple responsibilities to different
constituencies and stakeholders, with preference for accreditation over regulation
 Trend: consultancy and observation coupled with increased governance role
Jordan and van Tuijl (2006)

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NGO Accountability in Question
 Questions of accountability arise as NGO & civil society
involvement in advocacy, service delivery and governance
increases.
 Do unelected civil society organisations have a right to
participate in global public policy?
 Despite being largely undemocratic, are NGOs legitimate
advocates for demanding greater democratic practice in global
and country governance?
 What is the impact on public services and populations of an
increased role for NGOs in the delivery of social services?

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Accountable to Whom?
 Membership organisations
 Principally accountable to their membership and use
franchise/voting, reform and dues as accountability mechanisms
 Service organisations
 Principally accountable to their donors and use performance
assessment, evaluation, reporting, laws and regulations as
accountability mechanisms
 NGO networks and alliances
 Accountable to the organisational members?
 Who are the primary actors? Who sets the agendas? Are there
transparent flows of information, decision making and resource
flows?
 A problematic area, given that networks and alliances are the most
common form of organising to deliver services and advocate, yet
beneficiaries do not have many options to hold these actors to
account, as they would in a democratic process

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NGO Accountability Requirements
 Effectiveness: quality and quantity of services delivered
 ‘Upward’ accountability to donors, driven by donor models of
financial accountability
 Organisational reliability: management structures, HR policies
etc
 ‘Horizontal’ accountability to the sector, driven by both donor and
NGO sector-wide associations
 Legitimacy: transparency, ties to the public, representative
status, relationship to the community served and value to society
as a whole
 ‘Downward’ accountability to those effected by the (in)actions and
decisions of NGOs, driven by advocacy partners, political opponents
and affected communities.
Bendell (2006);Jordan (2005)

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NGO Accountability Mechanisms
 Tools and processes
 To powerful external stakeholders
 Include annual reports, financial accounts, performance
assessment, audits, logical frameworks
 Practiced by NGOs
 Include incentivized accountability accreditation and
certification, complaints procedures for external and internal
stakeholders, conflict of interest policies, social and community
audits
 Multilevel governance systems that combine accountability
mechanisms
 E.g. financial, ‘reputational’ etc

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Challenges
 Accountability in a ‘web’ of interconnected
actors/stakeholders
 Multiple accountability requirements
 Differences between international and country NGOs, CBOs,
FBOs…
 Ambiguity of ‘Global Civil Society’
 Tensions between accountability requirements
 E.g. Between donors and NGOs
 Log frame goals vs service user demands from feedback
mechanisms
 Lack of joint or coordinated accountability mechanisms
beyond voluntary codes and good intentions

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References & Further Readings
 Amoore, Louise, and Paul Langley. "Ambiguities of Global Civil Society." Review of
International Studies 30, no. 01 (2004): 89-110
 Bendell, Jem. "Debating Ngo Accountability." New York: United Nations, 2006.
 Brunt, Carol and Willy McCourt. “Do International Non-Governmental Organisations
Walk the Talk? Reconciling the ‘Two Participations’ in International Development”.
Journal of International Development 24 (2012): 585-601
 Doyle, Cathal, and Preeti Patel. "Civil Society Organisations and Global Health
Initiatives: Problems of Legitimacy." Social Science & Medicine 66, no. 9 (2008): 1928-38.
 Ebrahim, Alnoor. "Accountability in Practice: Mechanisms for Ngos." World
Development 31, no. 5 (2003): 813-29.
 Edwards, Michael, and David Hulme, eds. Non-Governmental Organisations:
Performance and Accountability. London: Earthscan, 1995
 IRIN Global. “Accountabilty: What’s in a Word?”. IRIN: Humanitarian News & Analysis.
URL: http://www.irinnews.org/Report/95741/AID-POLICY-Accountability-what-s-in-a-
word (last accessed 4 July 2012)

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References & Further Readings
 Jordan, Lisa. "Mechanisms for Ngo Accountability." In GPPi Research Paper Series.
Berlin: Global Public Policy Institute, 2005.
 Jordan, Lisa, and Peter van Tuijl, eds. Ngo Accountabilty: Politics, Principles &
Innovations. London: Earthscan, 2006.
 Kapilashrami, Anuj, and Oonagh O'Brien. "The Global Fund and the Re-Configuration
and Re-Emergence of 'Civil Society': Widening or Closing the Democratic Deficit?"
Global Public Health (2012): 1-15.
 Moon, Suerie (2007) Accountability in Poverty Reduction Policies: The State, Civil
Society and the World Bank (http://tinyurl.com/moon-acc)
 O'Dwyer, Brendan, and Jeffrey Unerman. "The Paradox of Greater Ngo Accountability: A
Case Study of Amnesty Ireland." Accounting, Organizations and Society 33, no. 7-8
(2008): 801-24.
 Romzek, Barbara S., Kelly LeRoux, and Jeannette M. Blackmar. "A Preliminary Theory of
Informal Accountability among Network Organizational Actors." Public Administration
Review 72, no. 3 (2012): 442-53