Fighting corruption, empowering people in Uganda’s health service

It was another day of fieldwork; the project officer arrived at Amach health centre IV in Lira district, Northern Uganda at 9:15am and was welcomed by the security guard. No health worker had started working yet. He found 15 patients seated waiting for health service. By 10:20am 78 patients had lined up. Patients could not hide their disappointments on how they felt about the delay in accessing health service.

Patients waiting to be served by health workers. Most of the patients are women and children. Most men only visit health centres when they are personally sick but rarely take their children or spouse for medical care.

These women reported for immunization at 10am and waited up to 1:30pm for treatments to start. It is important to support women in accessing health services and also ensuring the health centres effectively execute their duties to enable them to attend to their many other responsibilities.

A young girl sitting with her mother as they wait to be attended to at Barr Health Centre III, Lira district (Northern Uganda). The health users do not understand their rights, and even if they did, they had no avenue of reporting, demanding and ensuring that delay in health services in their health centre is dealt with.

 

After nearly five years of insurgencies in Northern Uganda, access to healthcare is patchy. The sector is generally understaffed and even those employed remain absent from work while still being paid. Our chapter in Uganda is running a project in the Oyam and Lira district of Northern Uganda to stop health workers’ absenteeism. From April 2012 on Transparency International Uganda (TIU) is empowering communities to monitor and improve health service delivery by providing them with a toll free hotline to report on irregularities. This is done in cooperation with the Swedish Program for ICTs in Developing Regions (SPIDER).

TIU is a member of the ICT for Democracy Network in East Africa which promotes social accountability and transparency through the use of ICTs. The network currently has 8 major members. Within the network there are three organizations (TIU, WOUGNET & CIPESA) from Uganda, two from Kenya (R iHub and Kenya Human Rights Commission), one from Tanzania (CHRAGG) and two from Sweden.

TIU project staff together with health workers at Amach health centre IV. By 10:00am these health workers had not yet commenced attending to health users. Health workers were briefed about the need to report on duty by 8:00am with or without patients, work together as a team and improve service delivery. By actively involving the health centre in-charge and health workers, the following day the health centre opened on time with early commence of patient treatment.

Voluntary Accountability Committees are tasked to monitor health service delivery in their respective community health centres, ensuring that health works report on time for duty and are not absent from duty. The above photo shows participants at Loro sub county discussing and coming up with forms of corruption and their causes in group work.

Chekweri Benna and Lamwaka Sunday are the only midwives at Amach health centre IV maternity ward. They are overwhelmed with work: Benna was said to have successfully served 27 mothers who had normal delivery in one week. Each week they register a rate of 10 -15 normal child deliveries, 10-13 cases of pregnant mothers’ malaria cases, abortion prevalence is seen at a rate of 3 to 10 within a given week.

 

TIU believes in working together with women, involving them in community development activities and being their voice at an advocacy level. Women are active and passionate in implementing community programs; they are concerned with the need for improvement of health care service delivery because they interface more with health challenges.

ICTs are viewed as a luxury reserved for the educated and wealthy which can mainly be accessed by people living in urban areas. This view is especially true for women who are often restricted to the domestic sphere which limits their access to training of relevance to them. One of TIU’s partners, Women of Uganda Network (WOUGNET), ran awareness-raising workshops under the SPIDER project on good governance and effective services delivery, as well as ICT capacity-building workshops in the Kole and Apac districts in December 2011. The purpose of these workshops was to equip rural women and men to use computers, the internet, mobile phones, radios, digital cameras, and print media to amplify their voices on issues of bad governance and poor service delivery in their different parishes so that the duty bearers are forced to respond appropriately.

TIU will provide women and men with a tool free call centre hotline to always report irregularities. The technology will be handled and managed directly by TIU. Telephone calls will be recorded and replayed to generate reports which are then shared with partners and the government (district health office) to demand for positive changes tailored towards improving health service delivery.

Nurses and midwives have asked the government to increase their pay and provide accommodation in a bid to improve their welfare. Speaking at the national celebrations for International Nurses Day in Mbarara District, the medics said the majority works 24 hours a day, every year without leave because of the heavy workload due to low levels of staffing.


See more photos here

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Simon Peter Ogwang

About Simon Peter Ogwang

Simon Peter Ogwang is Project Coordinator at Transparency International Uganda.

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14 Responses to Fighting corruption, empowering people in Uganda’s health service

  1. Alan Hudson 11 July 2012 at 10:37 pm #

    This is a really great example of how new technologies can help citizens to hold decision-makers accountable and drive improvements in service delivery. More please!

    Alan Hudson
    Director for Transparency and Accountability, ONE

  2. Richard D. Wacha 14 July 2012 at 11:27 am #

    I do understand the health workers are blamed for not keeping time at work. However, in Uganda, be you office, health, district, council worker, no one comes to early becuase they have to organise something somewhere in order to make ends meet. They have to do extra to top upp the income.
    If you want everybody to keep time, please make sure they paid enough salaries. Salaries that can sustain their families otherwise you will not change the habit.
    That’s why when you come to Mulago, Ugandans biggest hospital, you find patiences waiting for hours, while those who pay the doctors can just walk throw as if there is no que!!!!!!.
    You know why? They are doing magendo first before they start with government job, i,e seeing the poor! The nurses are running private clinics. Some need to go to their fields to dig before coming to work. The field work feeds his family.

  3. Simon Peter Ogwang
    Simon Peter Ogwang 16 July 2012 at 9:01 am #

    Richard thanks for your comments, it’s true that financial problem is one of the key challenges that health workers are facing, and as a result they are creating other income generating sources which you have clearly mentioned. Health challenges related to absenteeism and late arrival are cases of corruption because health workers are under contract, they clearly understand the performance need under stipulated in their contract. When a particular health worker is absent from duty, the ones who are present have to cover-up and take up their responsibilities to extend that some health workers (midwives) end up working for 24 hours without day off. Transparency International Uganda is therefore ensuring by joint participation and involvement of community health users should make health workers socially accountable by making sure that health workers are available for duty and they should get pay for what they have worked for. The project has been greatly welcomed by health center in-charge ad district health offices because it’s as well building on great team work that supports healthcare service delivery

  4. Read the Full Document 15 February 2013 at 6:32 am #

    Can I just say what a reduction to find somebody who truly knows what theyre talking about on the internet.
    You positively know methods to deliver an issue to
    gentle and make it important. More folks need to
    learn this and perceive this aspect of the story. I cant consider youre
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  5. Simon Peter Ogwang
    Simon Peter Ogwang 15 February 2013 at 8:14 am #

    Project Story: Empowered and involved

    Years after rebel insurgency in northern Uganda civil society organizations moved in to rebuild the region by improving service delivery and ensuring improved accessibility of resources and service delivery in different sectors, however the use of technology for people empowerment and engagement was hardly seen in the region. The region was blessed to receive SPIDER health project in Lira and Oyam which widely uses ICT for people empowerment. The toll free call center was installed in May 2012 which has greatly improved health service delivery in northern Uganda through community empowerment and , engagement in monitoring health service delivery at their respective health centers; men and women have used the call center/technology by calling in to report challenges of late coming, absenteeism, drug theft, poor hygiene and poor work performance. Call conversations are always so touching, to some people the issues or challenges being reported by community health users are mythical but in reality the hard conditions are deeply felt while this calls are being received; it’s only through empathy that one can truly understand what happens at the health centers. A situation where a midwife worked for 24 hours without resting because her colleague was absent, the poor midwife could only be seen dozing off while she explains to Betty (TI Uganda staff) during health center verification visit, meetings are always convened at the health centers together health center in-charges and other health workers to locally discuss and come up with solutions; during one of the meetings health workers justified their reasons for being absent and reporting late for duty being caused by inadequate accommodation because some of them do not reside within the health center and their request to Transparency International Uganda was that the organization does help present this problem to district officials; one amazing thing about this is that the intervention has provided both the health workers and community health users to freely share their side of the story unlike in the past where only a few community health users and politicians would share their grievances through publicized radio programmes and political campaigns; technology has now enabled the different stakeholders to equally share both health challenges and providing lasting solutions.

    As a result of advocacy meeting with district health officers, some of the health staff houses which had taken quite a long time for construction to be completed were later completed and staffs began to stay within the health center. It is pleasing, that by engaging the district officials in solving these challenges, the project has attained positive results for example; there is a great improvement in staff arrival time because now they reside within health center and have pledged this role-play in service delivery.

    Here comes another interesting bit of ICT for people empowerment; both social media (www.faceboo.com/StopAbsenteeism ) and local FM radio programmes have been used to inform, educate and engage both local communities and global internet users in sharing both knowledge and ideas towards improving health service delivery. One interesting thing about community technological adaptability is the fixation in people’s mind that FM radio stations serves for people entertainment not empowerment which made it very hard in the beginning to win listenership, through daily advertisement of radio programmes and toll free line, the community became more interested to learn and share with presenters the health challenges at their respective health centers; community participation improved so much during and after subsequent radio programmes where many were calling in to share their views, comments and suggestions; it was an appropriate time for the community members to interact through ICT, “we love this program, its educating us and may you continue educating the community because many do not know their health rights” Albina said. “I have listened in most radio programs and it’s amazing how your program is approaching challenges at the health centers, could you please extend the same program to our district as well because they are similar challenges we are facing in Dokolo, I feel empowered and ready to be involved ” said the caller; in response “We would love to even scale up the intervention to every part of the northern Uganda but we are limited by resources, with more funding realized Transparency International Uganda will surely consider your district” Simon said.

    Project sustainability has always been a point of concern for every humanitarian worker, TI Uganda tactically through radio programmes organized for development pact signing (an agreement/framework which enables the local communities able to know and have commitment of the leaders, stakeholders and duty bearers by pledging their commitment towards improving healthcare service delivery) to realize continued participation and involvement of different stakeholders in carrying out project intervention beyond project life time; development pact signing, this was one of the most marvelous activities that the community members have ever enjoyed and participated willingly, it was a moment of pledging commitments by the district officials, local leaders, health workers, voluntary accountability committees, HIV/AIDS focal person, sub county chiefs, village health teams and the general community towards improving health service delivery, creating good working relationship between the health workers and the communities by writing and signing down on paper their commitment; this was a very interesting moment for community members, the activity involved anti-corruption drama which became an eye opener to the communities being so entertaining and educative, it covered late arrival of health workers, staff absenteeism, drug theft, mistreatment of patients and the benefit of development pact signing, this time the community members, the local leaders and the health workers were all free to interact on concerning issues taking place at their community health centers. “Thank you so much Transparency you have opened our eyes, we are now united and empowered”, said community members.

    Technology in its self alone cannot impact on community that’s why Transparency International Uganda values people empowerment and engagement in rightfully using technology for sustainable development, in our different capacities we can use ICT to greatly impact on people’s lives in developing region; we therefore call upon every story reader to promote and support the different projects in developing countries in making the world a better place.

  6. Simon Peter Ogwang
    Simon Peter Ogwang 15 February 2013 at 8:18 am #

    Outcome of Health Service delivery development pact signing

    Development pact has registered key success by evident engagement of health management committee in monitoring their respect health centers, a case in point is Amach health center IV (Northern Uganda) where recently one of the health workers scheduled to be on duty was sitting at her home near by the health center yet there were very many patients waiting to be served and her support was highly being missed, when the health management committee chairperson visited the facility and realized what was happening, He informed the area LC 3 chairman who acted by reporting the health worker to police who later arrested the said health worker only to be later released on police bond. We need leaders who can take up actions when they identify corruption taking place like it was with the health management committee chairperson who took up actions. The health worker was later on tasked to report on duty and resume work at the health center. To health workers across the country they may look at this as hash treatment of health workers neglecting the fact that they are to be socially accountable to the people they serve Transparency International Uganda has empowered the communities through ICT to monitor their respective health centers and ensure that health workers are socially accountable whether with or without the presence of civil society intervention.

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