Social Accountability and System Strengthening for Water, Sanitation and Hygiene in South Asia

The Declaration of Alma Ata drew attention to the social determinants of health. Over the years, South Asian countries have seen a slow, yet growing awareness of and attention to the social determinants of health in influencing health outcomes, and the role of community participation in demanding access to quality health services. Safe water, sanitation, and hygiene (WASH) are important determinants, given the multi-faceted and complex pathways by which they affect health.

As public services have evolved and matured in South Asia, accountability of duty bearers for public services has not been limited to the upward authorities. Duty bearers are also answerable to the citizens as consumers and right holders, which in turn has resulted in institutionalisation of social accountability and citizen interface mechanisms such as social audits, grievance redress mechanisms, and citizen charters. In practice, this delicate and intricate interface of citizens with duty bearers is poorly operationalised. An empowered citizen engagement with a strengthened system to respond adequately with balanced power relationship of mutual respect at each level, particularly at the local level, requires strengthening of people’s voices, strengthening of service providers, and supporting an institutionalised interface mechanism.

The different case studies featured in this report from Nepal, Bangladesh, and India are an attempt to showcase the building of social accountability mechanisms and system strengthening, which though have been nudged by external agencies and civil society organisation, are built on the state’s own provisions of strengthening citizen’s engagement for accountability.