Improve Provision and Quality of Education and Health Services (MN0023)

Status quo or problem addressed by the commitment: Although the quality and provision of the education and health sector have improved in the last few years, a lack of adequate resources is creating obstacles in the development and growth of these sectors. Therefore, there is a need to develop new ways to improve the provision and quality of the primary services provided by the government in the health and education sector especially to vulnerable groups and target populations. Social accountability, which is displayed through a productive and effective partnership between the service provider and beneficiary, is one of the possible solutions to meet this need. Main Objective: Provide easy to access information about education and health services to the public and distribute such information through appropriate media channels. As a result, an efficient and productive feedback mechanism, which fosters mutual respect and understanding will be established. Leading to an improved relationship between the service provider and beneficiary. These steps are necessary for not only improving service and service provision of the health and education sector but also to improve the system within the sector. Brief Description of commitment (140 character limit): Improve the contents of the information about services provided by the two sectors and increase information outlets. Resulting in the implementation of effective partnership initiatives and the fostering of mutually respectful relationship between service providers and beneficiaries.

✪2. Improve quality of and access to education and health services

Commitment Text:

Improve contents of the information about services provided by the two sectors and increase number of dissemination channels to the public. Implement and support initiatives on social accountability and constructive engagements between citizens and service providers.

Status quo or problem addressed:

Although quality and access to education and health sectors have been improved in the last few years, due to lack of adequate resources these two sectors could not be developed in a required level. Therefore, there is a need to develop new ways to improve access to and quality of the primary services provided by the government, in the health and education sectors especially to vulnerable groups and poor citizens without much additional financial resources. Social accountability, and constructive engagement, and partnership between service providers and citizens, are possible solutions to meet this need.

Main Objective:

Develop simple and user friendly information about education and health services to the public and disseminate these information through appropriate communication channels and platforms. Efficient and productive feedback mechanisms, which foster constructive engagement and mutual understanding between services providers and citizens, will be established and encouraged. These steps are necessary for not only improving quality and access to services in the two sectors but also to support institutional development.

Milestones:

2.1. Include local stakeholder identified priorities of the two sectors in the local development program through engagement between local SA champions, and local governors and administrations.

2.2. Implement social accountability initiatives to improve engagement between the parties for improving quality of and access to education and health services in aimags and districts.

2.3. Improve internal and external information systems and encourage feedback mechanisms and fostering mutual accountability and constructive engagement of both sides (services providers and service users/citizens) in selected aimags and districts as demonstrations for scaling up.

Responsible institutions: Central Government Authority responsible for education and health.

Supporting institutions: The Social Development Divisions of the Governor’s offices in addition to education and health service providers in selected aimags and districts. National and rural/local NGOs for social accountability, Project 'Mainstreaming Social Accountability in Mongolia' (MASAM), which is funded with the contributions from the Swiss Agency for Development and Cooperation (SDC) and the World Bank.

Start date: 30 June 2016

End date: 30 June 2018

Editorial note: This commitment is clearly relevant to OGP values as written, has transformative potential impact, and is substantially or completely implemented and therefore qualifies as a starred commitment.

Context and Objectives

While Mongolia has made significant improvements to its health and education in recent years, several key issues in these sectors remain. The World Health Organization lists several challenges to Mongolia’s health care system, including limited domestic funds available for non-communicable disease programs, air pollution in Ulaanbaatar, and geographical barriers for accessing health services in rural areas.[Note43: See Mongolia-WHO Country Cooperation Strategy 2017-2021, http://iris.wpro.who.int/bitstream/handle/10665.1/13684/WPRO-2017-DPM-005-eng.pdf.] According to the United Nations Children Fund, the increase in out-of-pocket payments impacts the capacity of the poor to access services, the cost of medicines is prohibitive for many Mongolians, and migrants from rural areas are particularly disadvantaged by difficulties with civil registration and health insurance.[Note44: United Nations Children’s Fund, 'Analysis of the Situation of Children in Mongolia 2014,' pgs. 33-34, https://www.unicef.org/mongolia/unicef_sitan_english_final.pdf.]

Additionally, Mongolia’s education system continues to face numerous challenges, namely:

•poor quality and relevance of the current curriculum for primary and secondary education,

•inadequate teaching qualifications and skills,

•lack of consistent education standards

•weak learning and teaching environments in schools, and

•supply-driven irrelevant vocational education for youth.[Note45: For more information, see: https://www.unicef.org/mongolia/activities_2191.html.]

The United Nations Development Programme noted in a 2016 report that rural students in Mongolia face particular challenges, such as 'a lack of Internet access, of learning resources for professional development, of opportunities for unsupervised study, and of well-qualified and experienced teachers.'[Note46: United Nations Development Programme in Mongolia, 'Mongolia Human Development Report 2016,' pg. 54, http://hdr.undp.org/sites/default/files/mongolia_human_devlopment_report_2016_english_full_report_2016_06_28.pdf.]

This commitment seeks to 1) improve information content and dissemination for the health and education sectors in aimags (provinces) and districts, 2) to include stakeholder priorities in local development of these two sectors, and 3) to implement feedback mechanisms and public engagement with service providers. The education component of this commitment addresses one of the key recommendations from the previous IRM report: to include a commitment on transparency, participation, and/or accountability in education. Improvement in the health and education information systems is relevant to the OGP values of access to information. The inclusion of priorities identified by stakeholders in local development programs is relevant to the OGP value of civic participation. Also, the establishment of feedback mechanisms for citizens to hold providers of health and education services accountable makes the commitment relevant to the OGP value of public accountability.

A participant in the consultations to develop the action plan confirmed to the IRM that this commitment is being carried out by the World Bank and the SDC as part of a joint project called 'Mainstreaming Social Accountability in Mongolia' (MASAM).[Note47: The World Bank, 'Mongolia: World, SDC Support Civic Engagement to Improve Social Services,' 9 February 2017. http://www.worldbank.org/en/news/press-release/2017/02/09/mongolia-world-bank-sdc-support-civic-engagement-to-improve-social-services.] The primary goal of MASAM is to provide citizens in poor localities with 'increased access to public decision-making processes and quality services through social accountability.'[Note48: http://www.irgen-tur.mn/en/what-is-masam.] The project is being implemented in ten aimags and three districts of Ulaanbaatar between 2015 and 2019. Of the ten aimag sub-projects, seven are in the health sector (in Dornod, Govisumber, Khentii, Khuvsgul, Selenge, Sukhbaatar, and Uvs), and three are in the education sector (in Gobi-altai, Khovd, and Uvurkhangai).[Note49: For the main target areas of the MASAM project, see: http://www.irgen-tur.mn/en/target-areas.] The ten aimags were chosen based on a mixed criteria of poverty incidence, readiness for social accountability, and health and education development indicators.[Note50: Cabrera III, Wadel S., 'Mainstreaming Social Accountability in Mongolia (MASAM) Project: Independent Assessment of Sub-project Implementation,' November 2017, pg. 16, http://www.irgen-tur.mn/sites/default/files/documents/Masam-Project_eng.pdf.]

The information provided to the IRM confirms that the commitment was developed with clear objectives and social accountability projects in mind, specifically the World Bank’s MASAM project, which is listed as a supporting institution for the commitment. However, while some of the activities referenced in the commitment are verifiable, the commitment lacks details on the scope and scale of these activities.

In light of the persistent challenges facing the health and education sectors in Mongolia, the inclusion of stakeholder priorities in development programs could lead to better targeted development and improved allocation of funds. Furthermore, the establishment of feedback mechanisms could help local governments more directly address the issues facing their communities, especially in rural areas. Given that the projects in the MASAM will be carried out in aimags that were determined to have opportunity for improvement in these areas, MASAM could have a potentially transformative impact on social accountability for citizens.

Completion

The World Bank and SDC created a website 'www.irgen-tur.mn,' ('citizen-state' in Mongolian) with information on the project and resources on social accountability initiatives.[Note51: See (in English): http://www.irgen-tur.mn/en.] At the beginning of the project, the government held a workshop in Ulaanbaatar city that included 46 participants, including 26 national CSOs, ten local CSO representatives/coordinators, and ten government counterparts from the participating aimags. Development of the sub-projects then took place during capacity-building workshops held in each participating aimag. According to the World Bank’s independent external assessment of the MASAM sub-projects, 'guidelines for selecting sub-project topics were based on stakeholder consensus on a local issue or 'felt need.'[Note52: Ibid: http://www.irgen-tur.mn/sites/default/files/documents/Masam-Project_eng.pdf.] For nine of the ten sub-projects (all except the project in Gobi-altai aimag), the independent assessment provides descriptions of sub-projects’ outcomes, assessments of strengths, and recommendations for improvement if the sub-projects are to be replicated or scaled up. According to the World Bank’s 2017 MASAM annual progress report, MASAM involved six national NGOs, 93 local CSOs, 32 service providers (24 schools, five aimag general hospitals, and three family health clinics), and directly or indirectly benefited and 83,217 citizens, according to the estimation of local sub-project partners.[Note53: World Bank, 'Mainstreaming Social Accountability in Mongolia MASAM, Annual Progress Report 2017,' 19 September 2017, pg. 10.]

The independent assessment report indicates that all ten sub-projects concluded their implementation around September 2017. Given the ongoing nature of the MASAM sub-projects, the level of implementation is considered substantial at the end of the first year of the action plan. It should be noted that the World Bank’s independent assessment report for MASAM does not include assessments for the sub-projects being implemented in the three Ulaanbaatar districts of Bayanzurkh, Chingeltei, and Songinokhairkhan, nor are they listed in the main target areas page on the 'irgen-tur' website.[Note54: See: http://www.irgen-tur.mn/en/target-areas.] The World Bank’s 2017 annual progress report notes that a memorandum of understanding was signed between the World Bank and the Municipality of Ulaanbaatar on 27 March 2017, 'to increase citizens’ access to the decision-making process and improve quality of services through the implementation of sub-projects in Bayanzurkh, Chingeltei and Songinokhairkhan districts, which have high levels of poverty incidences.'[Note55: World Bank, 'Mainstreaming Social Accountability in Mongolia MASAM, Annual Progress Report 2017,' 19 September 2017, pg. 17.] However, these Ulaanbaatar sub-projects are not scheduled to be implemented until after the reporting cycle for this report.

Early Results

The World Bank’s independent assessment report describes a variety of early outcomes from each of the ten sub-projects. However, the report found two sub-projects to be particularly successful and thus highly replicable and ready to be scaled up: public participatory schools in Khovd aimag and improving the tuberculosis ward services in the Selenge aimag.

The sub-project in Khovd sought to address the lack of sufficient information and access to decision-making processes on governance, resource allocation, expenditure tracking, and operational planning for ten secondary schools in low income soums (counties) that are isolated from the aimag center. Through the sub-project, education officials and local CSOs drafted and sought approval for an action plan that includes budget allocation for the training of monitors, CSO and parental participation in the school budget-proposal-making process, public reporting of school performance, and making school audit reports available to school councils and the public.

Selenge aimag has experienced high rates of tuberculosis (TB) due to contamination from the aimag’s numerous mining operations. The sub-project for Selenge aimag has led to greater collaboration between the local government, CSOs, and local health specialists to identify urgent needs and incorporating them into budget proposals for 2018, including the building of a dedicated TB facility, procurement of diagnostic equipment, and proposals from four family health clinics. CSO and health sector collaboration led to home visits in 16 out of 17 soums, mobile diagnostics, and the treatment of new cases. Public information campaigns on good health practices to stop the spread of TB were also carried out. Overall, local government officials, health service providers, and CSOs in Selenge aimag have seen notable improvements in citizen participation in developing and monitoring of health programs and services from this sub-project.

Other outcomes from the sub-projects include registering temporary residents for health care services in Khuvsgul aimag, improved access to dental equipment in Sukhbaatar, reduced infant mortality and improved health services in Uvs aimag after a citizen-monitored procurement process for medicines and medical devises, and increased parent awareness and involvement in school activities and programs in Uvurkhangai aimag.

Next Steps

The MASAM project has already led to promising improvements in the health and education sectors in the participating aimags, and it is important to build upon the successes moving forward. The IRM recommends carrying this commitment forward to the next action plan but with greater clarity on what type of health and education information will be provided to the public (and how the scope of this information will be determined). The next action plan could also more clearly describe the new accountability mechanisms envisaged under the MASAM project. For example, this could include establishing specific measures to hold government officials and public sector employees in the health and education sectors accountable to the public. Additionally, future commitments around social accountability could involve scaling up promising sub-projects based on the World Bank’s independent analysis and stakeholder feedback.

✪ 2. Improve quality of and access to education and health services

Commitment Text:

Improve contents of the information about services provided by the two sectors and increase number of dissemination channels to the public. Implement and support initiatives on social accountability and constructive engagements between citizens and service providers.

Status quo or problem addressed:

Although quality and access to education and health sectors have been improved in the last few years, due to lack of adequate resources these two sectors could not be developed in a required level. Therefore, there is a need to develop new ways to improve access to and quality of the primary services provided by the government, in the health and education sectors especially to vulnerable groups and poor citizens without much additional financial resources. Social accountability, and constructive engagement, and partnership between service providers and citizens, are possible solutions to meet this need.

Milestones:

2.1. Include local stakeholder identified priorities of the two sectors in the local development program through engagement between local SA champions, and local governors and administrations.

2.2. Implement social accountability initiatives to improve engagement between the parties for improving quality of and access to education and health services in aimags and districts.

2.3. Improve internal and external information systems and encourage feedback mechanisms and fostering mutual accountability and constructive engagement of both sides (services providers and service users/citizens) in selected aimags and districts as demonstrations for scaling up.

Responsible institutions: Central Government Authority responsible for education and health.

Supporting institutions: The Social Development Divisions of the Governor’s offices in addition to education and health service providers in selected aimags and districts. National and rural/local NGOs for social accountability, Project “Mainstreaming Social Accountability in Mongolia” (MASAM), which is funded with the contributions from the Swiss Agency for Development and Cooperation (SDC) and the World Bank.

Start date: 30 June 2016

End date: 30 June 2018

Editorial Note: This is an abridged version of the commitment text. For the full commitment text from the Mongolian National Action Plan, see: https://www.opengovpartnership.org/wp-content/uploads/2017/05/Mongolia-NAP2-Final-Eng_0.pdf

Commitment Aim

Given the persistent problems in both the health and education sectors, this commitment sought to 1) improve information content and dissemination for both sectors in aimags (provinces), and districts of Ulaanbaatar, 2) include stakeholder priorities in local development of these two sectors, and 3) implement feedback mechanisms and public engagement with service providers. This commitment was part of the World Bank and Swiss Development Agency (SDC)’s “Mainstreaming Social Accountability in Mongolia” (MASAM) project.

Status

Midterm: Substantial

The World Bank and SDC created a website http://www.irgen-tur.mn (“citizen-state” in Mongolian) with information on the project and resources on social accountability initiatives. [11] Development of the sub-projects took place during capacity-building workshops held in each participating aimag. The sub-projects in general aimed to gather feedback on access to and quality of services and service provision in the health and education sectors (Milestone 2.3).

The World Bank’s independent assessment report indicates that all 10 sub-projects concluded implementation around September 2017. The report found two sub-projects to be particularly successful and thus highly replicable and ready to be scaled up: public participatory schools in Khovd aimag and improving the tuberculosis ward services in the Selenge aimag. The World Bank’s 2017 annual progress report on the MASAM project notes that a memorandum of understanding was signed between the World Bank and the Municipality of Ulaanbaatar on 27 March 2017, “to increase citizens’ access to the decision-making process and improve quality of services through the implementation of sub-projects in Bayanzurkh, Chingeltei and Songinokhairkhan districts, which have high levels of poverty incidence.” [12] For more information, please see the IRM 2016-2017 Progress Report. [13]

End of term: Completed

The main outputs of the MASAM project during the second year of action plan implementation are:

• Improved technical and organizational capacities of CSOs to implement social accountability projects with poor and marginalized groups in urban and rural areas (Milestone 2.2).
• Targeted CSO networks became more effective in the application of social accountability tools and processes, including evidence-based advocacy. For instance, four NGOs’ external evaluation findings have fed into the Municipality of Ulaanbaatar City’s decisions to improve health and education policy implementation. The NGOs reported that the use of this tool was a result of MASAM’s technical capacity and coaching support. The aimag administrations have considered the survey findings and responded positively (Milestone 2.2).
• Incentive systems are now in place to increase the commitment of social accountability stakeholders to foster inclusion of poor and marginalized groups (Milestone 2.2).
• Strengthened capacity of government agencies and service providers to track and use CSO/citizen feedback/complaints for improving quality of services (Milestone 2.3).
• A number of joint problem-solving activities were formalized between CSOs, local government, and local services providers, with the intention of providing increased citizen access to public resource management issues (Milestone 2.1). For instance, the Gobi-Altai aimag implemented the “Good school” model, to increase citizen participation and social accountability in local education. As part of this sub-project, the local CSOs, led by Altai Swiss NGO, carried out school budget monitoring in four schools (two aimag center schools and two rural soum schools). As a follow-up, the local CSOs in cooperation with the Aimag Governor’s Office and the Aimag Education Department held a public hearing and openly discussed the school budget and human resource issues that emerged through CSO monitoring. This public hearing was the first event on local budget transparency in the aimag since the adoption of the Public Hearing Law in 2015. [14]
• Information relevant to decision making in both sectors was being disclosed by local services providers, line ministries, and relevant government agencies (Milestone 2.1).
• Lessons for effective implementation and sustainability were disseminated to government, CSOs, and other non-state actors (Milestone 2.3). [15]

Similar to the support on policy evaluation, pilot citizen satisfaction surveys were carried out by local CSOs in two pilot aimags (Bulgan and Darkhan-Uul) in the last quarter of 2017. At the request of the Cabinet Secretariat, the MASAM project facilitated online training sessions on citizen satisfaction survey methodology for 200 civil servants and local CSOs in 21 aimags. A review of their reflections and experiences with the methodology took place in the first quarter of 2018. Following these capacity-building activities, 175 (58 percent female) local and government officials enhanced their knowledge on the participatory monitoring approach and the application of citizen satisfaction survey methodology through training provided by MASAM in Dornod aimag and Ulaanbaatar city. ^[16]

More than 140 representatives from the education departments of Ulaanbaatar city districts, as well as directors and principals of secondary schools, gathered on 11 June 2018 to discuss the findings of an evaluation of policies for secondary education. Discussion topics ranged from the school environment and extra-curricular activities of students to the prevention of noncommunicable diseases caused by unhealthy lifestyles (Milestone 2.2. and Milestone 2.3). The evaluations were conducted for the first time by CSOs, as part of the MASAM project. ^[17]

Some MASAM sub-projects created or strengthened opportunities for citizens to participate in decision making (Milestone 2.2). For example, Uvs aimag continued the participatory procurement planning and monitoring model for purchasing medicines and equipment in 2018. Due to open and transparent procurement practice created by the local CSO network and the aimag health department, stakeholders estimate that 55 million Mongolian Tughrik (Mongolian national currency, MNT) in savings (planned vs. awarded amount) was generated from the local procurement budget in 2018. Healthcare workers and citizens also note that the quality of medicines and medical supplies improved.

In Dornod, the local CSO network has continued to develop the service improvement action plan together with the aimag governor’s office and health department in 2018. The service improvement budget proposal (to purchase urology equipment for the aimag general hospital) is pending for local budget deliberation. Also, as a result of CSOs’ policy advocacy, MNT 50 million was allocated to finance the public health campaign and diagnosis related to sexually transmitted diseases.

A sub-project in Govisumber aimag created opportunities for the public to hold government accountable, through the implementation of the Ministry of Health’s (MoH) regulation on ethical committees. The work of the local ethical committee has resulted in behavioral changes of medical staff and citizens. According to project reports, despite a lack of budget and support from hospital management, the committee—85 percent of whom are youth volunteers—managed to resolve citizens’ complaints and carried out awareness-raising activities to create shared values (customer-oriented service) among hospital staff. The presence of an ethical committee reduced tension and internal conflicts among employees. MoH recognized this practice as one of the best approaches to healthcare management in the country. [18]

Did It Open Government?

Access to Information: Marginal

Civic Participation: Major

Public Accountability: Marginal

The commitment has resulted in marginal improvement of the disclosure of information, including in the area of procurement transparency. In Dornod aimag, officials helped to enhance public awareness on the lack of health facilities and public health issues such as men’s health and sexually transmitted diseases. Also, as a response to citizen feedback, the aimag governor’s office and health department, together with CSOs, have carried out public health information sessions for more than 1,000 people. [19]

More notably, the commitment has led to a major improvement in civic participation, with national NGOs leveraging MASAM support to build capacity for social accountability at the local level. According to project reports, government counterparts in some provinces started to view NGOs and citizens as critical partners in decision making and collaborative problem solving. The Ministry of Education, Culture, Sciences, and Sports (MECSS) also established a working group to formulate sector-specific policy objectives to improve education services, with a focus on the inclusion of citizens. This drew on experiences from the participatory school model in Dornod aimag. The government counterparts also invited local CSOs to take part in a gender sub-program formulation and consultation process. [20]

Although sub-projects such as the introduction of ethical comittees in healthcare institutions, and the strengthening of government capacity to respond to citizen feedback, created new opportunities for a marginal increase in public accountability, the commitment did not result in the introduction of a clear public-facing mechanism for citizens to hold government accountable for decisions. The commitment is therefore limited in scope in this regard.

Carried Forward?

The commitment is not included in Mongolia’s third action plan.