Community Based Monitoring – Health

10 Dec 2021

Integrity Watch’s Community Based Monitoring-Health program promotes social accountability through community mobilization and social audits. The program empowers communities to monitor health facilities that are implemented in their area. The aim of this program is to empower citizens to hold authorities and aid entities accountable and to create active and responsible citizenship. Communities engaged in local monitoring become more autonomous in solving their problems through this monitoring and continuous dialogue

The program started in 2018 with the health facilities in 10 communities in Kabul Province of Afghanistan. The program has expanded over the years due to its success in empowering citizens to take an active role in promoting integrity and accountability. Around 70 health facilities have been monitored by 70 Integrity volunteers since 2018 in Kabul, Kapisa, Nangarhar, Herat, Balkh Provinces.

Integrity Watch Afghanistan works with communities to identify Integrity Volunteers who volunteer to monitor health facilities on behalf of their communities. The Integrity Volunteers are trained and supported by Integrity Watch which has built up years of knowledge & experience in community based monitoring. Integrity Watch uses carefully designed customized monitoring tools to monitor a series of metrics and phenomenon related to health services delivery which illustrate the quality of health facilities and their impact on the targeted communities. These illustrations are based on the adequacy, consistency and sustainability of the Clinics.

Integrity Volunteers are able to file complaints through the establishment of a Sectorial Monitoring group (SMG) composed of line ministry representatives, Integrity Volunteers, Provincial Council members, media and aid actors. The SMGs trigger the accountability role of local institutions. Furthermore, regular monitoring of clinics helps to ensure that health facilities are impacting the community positively.

The methodology used empowers citizens and increases aid effectiveness at local levels through the Community Based Monitoring-Health program by:

  1. Selecting Communities
    Similar to other Integrity Watch’s initiatives, the Community Based Monitoring of Health (CBM-H) draws on community participation to establish the legitimacy of its objectives. “Community” for this program is defined by Community Development Councils, civil society actors and health service providers. Once a community is chosen, Integrity Watch’s employees meet with the community to explain monitoring and its benefits.
  2. Electing Integrity Volunteers
    Each participating community is asked to select an Integrity Volunteer who should preferably be literate, of good reputation within the community and be able to volunteer several hours each week to monitor health facilities.
  3. Training of Integrity Volunteers
    After their selection, all Integrity Volunteers receive technical and social training from Integrity Watch’s staff. Social training covers the basic concepts of corruption awareness, community mobilization, and problem-solving. Technical training covers the flow chart of the program, monitoring forms, guidelines, how to conduct meetings and to identify & solve problems. The training teaches the Integrity Volunteer how to use the provided monitoring tools, conduct surveys, follow checklists and collect data.
  4. Collecting Information
    The Integrity Volunteer then obtains all  the relevant documents from the clinics by requesting these from government officials and the health directorate. After collecting these documents, Integrity Volunteers conduct a baseline survey of the community. They interview 20 respondents who are stakeholders in their local clinic. This survey helps introduce the monitoring program to the community & collects information on community knowledge and participation in the clinic.
  5. Monitoring the Health Facilities 
    The Integrity Volunteer visits the clinic two times a week, meets with the head of health facility, and checks the environment, the services, the cleanliness and the quality of materials using for the patients and identifies problems. If problems are revealed, the Integrity Volunteer, with the Integrity Leader and Integrity Watch’s Provincial Coordinator first try to resolve the problems and if they are not resolved then discuss these problems with the Health Directorate with the aim of convincing the Head Director to resolve them.
  6. Health Management Shuras (HMS)

Monitoring of health and overseeing the proper functioning of Health Management Shuras (HMS) are the core objectives of the CBM-H Program. As previously mentioned, the IVs will visit clinics at least twice a week and complete monitoring forms. They will also attend monthly HMS meetings and update community representatives on the findings. At this stage information on the relevant clinic is collected and recorded into Integrity Watch’s database. Also, weekly and quarterly monitoring forms are completed by IVs and recorded into the database and a monthly feedback sheet is prepared from the recorded information and submitted to the health management and community representatives. In addition, assigned IVs attend HMS meetings and monitor their performance.

    7. Community Feedback Meetings

These are events where Integrity Volunteers provide their activity feedback to their relevant community. This event is conducted once each month in the clinic by the Integrity Volunteers.

For more details about the program and to access the Community Based Monitoring-Health CBM-H Flowchart, please visit