Moving on Up: Multilevel Monitoring and Advocacy for Health Rights

Dear NAMATI colleagues

I hope all of you are having a great start to the new year. I am sharing a recent publication that includes a meta-analysis of social accountability monitoring for health rights. See the publication description below and a link to access the full publication. Regards, Walter

Moving on Up: Multilevel Monitoring and Advocacy for Health Rights

Multilevel approaches to monitoring & advocacy are often used by civil society actors working on social accountability. But they are sometimes overlooked. A new working paper looks at patterns in 10 health rights programs using multilevel approaches

The health rights programs were implemented by CSOs, NGOs and governments in nine countries. All had monitoring or advocacy activity at two or more levels. What patterns emerged?

  • Vertical integration—coordination of civil society action at different levels of public sector decision-making— is a common feature of monitoring and advocacy at the lower end of the health system. But it is often implicit and not articulated in project design or theories of change.
  • Horizontal organizing—the coordination of civil society action across districts or geographies—is a less visible feature of multilevel approaches to health rights programming than vertical integration.
  • Despite the multilevel nature of health monitoring and advocacy in these ten cases, less than half reported working at the regional or provincial level, indicating a ‘missing middle’ between local and national activity.
  • Escalation—the process by which citizens’ unaddressed claims move upwards to those with greater decision- making powers—is an important mechanism for accountability and one way in which vertical integration can happen. But it is not much discussed or theorized, and therefore merits further research.

Follow this link to access the full publication (