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Uganda, 5 August 2016: Strengthening civic voice to accelerate the improvement of service delivery

By Maria Nabatanzi

© UNICEF Uganda
Nursing Officer Pauline Nalutaaya collects and sends the week’s public health data to the district headquarters at Butenga Health Centre IV, in Bukomansimbi District, via mTrac.

On 4th August 2016 the President of Uganda, Yoweri Kaguta Museveni, visited a health centre and hosted a community dialogue in Nakawuka, Wakiso district, Uganda. The community dialogue organized by the State House’s Health Monitoring Unit (HMU) with support from Ministry of Health and UNICEF provided a unique opportunity within a larger programme UNICEF is supporting for citizens to raise issues on service delivery at Nakawuka Health Center III.

Among the issues discussed at the dialogue, community members highlighted poor maternity health services as one of the main challenges they face in their district. Pregnant women often turn up at the health center to find no doctors or midwives at the facility. The issue of absenteeism of the health workers at the centre was mentioned by most of the speakers.

The community also noted that mama kits (safe delivery kits) provided by the health centre are sometimes illegally sold and others often lack necessary equipment, because the health workers remove some of the essentials before providing them to expectant mothers.

After listening to the citizens’ feedback, the President noted that he had registered 50 concerns adding that if there was regular monitoring of services provided by the local government structures at the district, sub county and village level, all these challenges would not have existed.

With entire community dialogue broadcast live on national television, the President reinforced the importance of local government leaders being accountable to the communities’ they serve, sending a strong message across the country:

“If things go wrong here in Nakawuka, your leaders including the Chief Administrative Officer and Resident District Coordinator are responsible. There is no way things can go wrong when you have all these leaders. What are they doing? I am going to make an evaluation,” the President said.

To re-echo his message of enhancing service delivery in the current presidential term, the President recommended that all health workers at the Nakawuka Health Centre and the Wakiso District Health Officer be sent away for review by the Health Service Commission. The commission is charged with the recruitment and reassignment of health workers to government health facilities in the country. Only one health worker, whom the community said had only arrived within the month, stayed at the health facility.

The Uganda People’s Defense Forces (UPDF) health workers have since been deployed to treat patients at the health centre. The team is led by the UPDF Director of Medical Services.

As a follow up to the President’s recommendation, the Wakiso District Health Officer who supervises all health facilities in the district, including Nakawuka, which it was alleged he only visited once the past five years, has been interdicted over alleged gross neglect of duty and non-performance. The health officer will defend himself before the Health Service Commission.

The dialogue was attended by Ministers from various sectors including Health, Education, Public Service, and Local Government.

HMU was established in 2009 as a strategic response to the existing challenges resulting in poor service delivery in Uganda’s health care system. To carry out its work, under the mTrac programme, UNICEF is supporting development of Ministry of Health and HMU Call Centers and assisted with the establishment of the national Anonymous SMS Hotline to empower citizens with tools to express both compliments and concerns. Common complaints include extortion, health centers closed during working hours, and theft of medicines and other health center equipment. Actionable complaint reports are assigned to one of our action centres, Local Government receives the majority, but systems related and criminal complaints are forwarded to relevant Ministry of Health Programme Units, the National Medical Store or HMU. An issue tracker on a common online Dashboard is used to provide updates and close each community complaint.

Between November 2015 to March 2016, HMU received 2,123 actionable reports from Ugandan citizens; the highest number of reports received in November 2015 (496) and January 2016 (462). Majority of these messages focused on poor service delivery, medical stock outs as well as appreciation of good services or recent improvements. Out of the 2,123 reports, HMU received 386 actionable reports and to date 84 per cent have been acted on and closed. The Western region of Uganda accounts for 57 per cent of the actionable reports received followed by the Northern region with 8 per cent. One of UNICEF supported HMU strategies that is most effective are community dialogues. They are organized to bring health workers closer to communities, and jointly address concerns through a mutually agreed contract.

A number of success stories from all over Uganda have resulted from the HMU system of citizen led accountability. Citizens in Kamuli District reported poor service delivery at Kamuli Hospital, namely the fact that medical officers worked for only two days of the week. A meeting with the District Health Officer resulted in a new duty roster to ensure a doctor is on duty at all times. Reports from different health facilities in Kamuli also included extortion of citizens for maama kits and medicines, forgery of medicine stork cards and shoddy renovations. Through HMU the authorities have been notified and necessary action has been taken including corrective measures to prevent future transgressions.

In Luweero, one citizen reported being forced to pay 150,000 Ugandan shillings for a caesarean section in a government health facility. A community dialogue was organized by HMU and the accused medical officer had to publically apologize.

At Mbale Regional Referral hospital, staff complained of missing salaries and unexplained deductions to their monthly payments. HMU followed up with Ministry of Public Service and Finance and the health workers were compensated accordingly.

Through HMU, citizens of Uganda are empowered to work with local government leaders to take action in their communities towards improving health outcomes and service delivery in Uganda. With the Presidents recent message to the country: government will no longer be turning a blind eye to mismanagement and corruption, and that nationally systems – with a focus on the supervisory roll of local government, must be improved. UNICEF has a long history in Uganda of strengthening good governance and leadership in partnership with all levels of government through programmes including mTrac and U-Report.

A news video clip of the event on NBS TV can be viewed here.

 

 
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