SOCIAL AUDITS – AN EFFECTIVE TOOL FOR IMPROVING ACCOUNTABILITY FOR NUTRITION SERVICE DELIVERY IN INDIA?

India’s state-provided nutrition services have improved steadily over the last ten years, yet major challenges remain in both quality and coverage of these services at the community level, which means improvements in nutrition outcomes have not been uniform across socioeconomic status, castes, ethnicity, gender, or geography. With a long history of trialing and promoting social accountability approaches to empower citizens to demand improved state service provision, the country is using social audits to help bridge these gaps.

Social audits have become a popular accountability tool introduced and institutionalised in India. Through a structured process of interactions between the state and the community, which provides information and feedback on the quality of services received, the goal is to empower citizens to better understand and demand their rights and entitlements to specific services the state is mandated to provide. An important emphasis is placed on formal complaints procedures and exerting pressure on state actors at various levels to address service bottlenecks, such as delivery of subsidised foods, and improve access to the more marginalised individuals or groups who may have a weaker voice.

But how effective are social audits at improving delivery of food and nutrition programs? Our team based at the Institute of Development Studies (IDS), have released findings from a recent independent evaluation of the ‘Collective Action for Nutrition’ (CAN) social audit programme in the Indian state of Odisha, in partnership with Development Corner Consulting (DCOR), India and supported by A4NH. The program itself was designed and implemented by the Society for Promoting Education and Rural Development (SPREAD), an Odisha-based NGO, in partnership with the Government of Odisha. It targeted 240 communities across six of the state’s poorest and most marginalised districts. Odisha remains one of the lowest-ranked Indian states in terms of human development indicators, and major inequalities in health and nutrition outcomes exist across ethnicity, caste, and gender. The state government has shown strong interest in formalising and scaling up the use social audits to address these challenges and inequalities, in particular with a view to improving maternal and child nutrition.

Read an issue brief about the project here.

Social audit verification process is underway. Photo: SPREAD (spread@spread.org.in)

The CAN social audit process was designed to increase knowledge of and demand for entitlements to food and nutrition services covered under the National Food Security Act (NFSA). The Act incorporates a range of child development and school feeding programs, maternity care and benefits, and subsidised food distribution targeting food insecure households. Our evaluation examined the three key stages of the social audit process which was led by community-based volunteers recruited by SPREAD, which incorporated community sensitisation meetings, home visits, inspection of sites where health and nutrition services were provided, document checks, a formal public hearing (to present and discuss audit findings and actions with community members, service providers and local government representatives) and community-level follow up on grievance redressal.

Encouragingly, our evaluation found the social audit model improved some aspects of local governance, delivery, and uptake of services at community level. We also identified some areas that would benefit from greater focus to maximise impact. Key findings included:

• The well-implemented social audit model was seen as a positive experience: community members saw it as a useful tool to voice concerns and involve themselves directly in resolving grievances, while state service providers found it to be a positive and well managed process.
• Increased knowledge and awareness of NFSA government services, entitlements and grievance mechanisms, including for food distribution, take-home food rations, and maternity entitlements. Impacts were greater in communities where the audits had a few months to take effect.
• Improved access to, uptake of, and level of satisfaction with, some NFSA services, including:
  • Children were more likely to be provided with special foods following growth monitoring and referred to rehab centers;
  • ‘Village health and nutrition days’ – significant improvement in incidence and awareness of these monthly events, which cover antenatal and postnatal care, maternal and child health counselling, child immunisations, etc.;
  • Maternity entitlements - significant increases in pregnant women enrolling to receive benefits, and satisfaction with service; and
  • Subsidised food distributions - improvements seen across all groups, especially for men, as well as satisfaction with, and quantity of, food rations.
• Greater community involvement in local governance (civic engagement, political participation and motivation to take part in community committees) for both men and pregnant women, though not among primary caregivers

A woman verifies data during a social audit. Photo: SPREAD (spread@spread.org.in).

Few other studies on Indian health and nutrition services have captured positive changes at the same scale observed by the SPREAD evaluation. The social audit model has the potential to strengthen local state governance structures and improve demand for, and uptake of, nutrition services at scale in Odisha, if implemented well and through existing community institutions and committees. The model could also be trialed and scaled up across other states in India, and potentially in other countries facing similar challenges of inequitable service access and nutrition outcomes.

While we also saw positive improvements in dietary diversity for women and children, there was not strong enough evidence to link it to the social audit (as it could also have been due to seasonal changes in income or food availability) – but assessing longer term impacts on diet and child growth should be a goal for further programs building on this research. Wider questions about the social audit model – including the length and frequency of social audit processes, immediate versus longer term effects (which in some cases our evaluation suggests might be non-linear, e.g. an initial negative shift in confidence to raise issues with service providers that is offset as time passes), the intensity of resourcing requirements, extent of organisational leadership and policy engagement required at different levels of governance (e.g. community, district, state) – also remain to be explored.

To learn more about this research, please visit the project page, or read the issue brief. Banner photo courtesy SPREAD (spread@spread.org.in).