The Coalition for Health Promotion and Social Development (HEPS UGANDA) Uganda is successful in implementing the Citizen’s Engagement initiative to Stop Medicine Stock Outs (COME) that aims to fostering action, engagement and participation of the community. This initiative which was kick started in March 2014 has today shown that the community engagement can increase social accountability. Community leaders are forging a path towards advocacy of health rights for all. This includes ensuring every citizen has access to essential medicines in every public health facility, where the availability of essential drugs is adequately provided and above all health care services are improved to serve the community.
The focus of the initiative was to get the public health facilities in Lira and Kiboga districts up to health care standards. Citizen Report Card (CRC), a social accountability tool was used to provide feedback received from the users of public services to the public health agency. The feedback was received through the sample surveys that were conducted on different aspects of service quality. This enabled the public agencies to identify strength and weaknesses in their work. The CRC was further used to identify key gaps, with a way-forward, a plan to fix the gaps that came up during the discussions between the community, service providers and duty bearer.
A woman drops a suggestion in the suggestion box that was provided during the implementation of the community action plan. This resulted in community dialogues and interface meetings at Katwe HCIII, Dwaniro Sub County, Kiboga District.
The Uganda Government recognizes the importance of community involvement in the successful fulfillment of the right to health. The National Development Plan (NDP), the overall Government development strategy, sets and prioritizes the empowerment of individuals and communities for a more active role in health development and the implementation of the Uganda National Minimum Health Care Package (UNMHCP).
During the project life-cycle, it was heartening to see collective action at work, especially when a community gets together to demand for their entitlements. Such is the chronicle of the residents of Dwaniro Sub County, Kiboga District, who observed that a lack of adequate and standard infrastructure compelled them to lobby for a positive change in the status of their health centre, eventually achieving 50% of service enhancement of what was originally targeted.
In Kiboga District, inadequate infrastructure is affecting access to services in all the health facilities. For example, the district hospital is a 100 bed capacity but the intake of patients is over 150 which puts the pressure of hospital management at risk. This means that the current ward capacity which has limited capacity cannot match with the volume of admissions. It is often a common sight to see patients sleeping under beds, or in the veranda. Male and female patients are put-up in the same ward. These are reasons to believe that the health consumers are shunning away from public health facilities as they lack adequate care. The community work experience in Dwaniro Sub County is an ideal example to showcase how monitoring service delivery can yield positive outcomes through the process of social accountability and community participation. During the interface meetings facilitated by HEPS Uganda between the health workers, community leaders and community members in the last quarter 2014, Katwe community members identified issues that were affecting their health centre and these were prioritized in the community action plan. The health centre lacked a clear complaint and redress mechanism, a placenta pit, and had poor accommodation facilities for staff. The General ward and OPD department were of substandard, a situation that had affected the access to services in this health facility.
The community members of Dwaniro Sub County in collaboration with the health unit management committee members and the health facility in-charge agreed to submit a proposal to the sub county, district headquarters, politicians and development partners to solicit for support to improve the health facility infrastructure. In addition, community fundraising conferences were held to supplement the development works at the health centre.
The district councilor Nelson Agaba, informed community members of Dwaniro Sub County during a quarterly community action plans review meeting that due to the lobbying, the staff quarters were included in the district work plan for the year 2015. In this regard, through community fundraising meetings, the community members also contributed money, bought building materials to help in the construction of the health workers staff houses.
The health centre beefed up its health education programmes to keep to the goal of information dissemination, now to include health rights and responsibilities of clients and the use of rational medicines among others.
In Uganda, the range of health services varies with the level of care in public and private health facilities. Public health facilities up to Health Centre III (HCIII) offer basic services as per the minimum health care package. HCIIIs in particular the lowest facilities accessed at village level render a comprehensive health care package. At HCIIIs there are provisions for laboratory services for diagnosis and it is the first referral cover for the sub county as the third lowest unit of local government. But, access to services in these health facilities is limited due to a number of factors such as sub-standard health care facilities, unavailability of drugs and lack of awareness of community about their rights and standards of service.
Healthcare promotion in Uganda is strongly dependent on availability of adequate infrastructure, facilities, and technology. To a large extent, the infrastructure, equipment, furniture and vehicles define the capacity of a health centre to deliver health services to the population. However the state of the current infrastructure is below the standard of the adequate infrastructure set by the Ministry of Health.
ABOUT AUTHORS
Joan Esther Kilande holds a bachelor’s degree in Social Sciences and majored in Gender Studies. She has a certificate on Primary Health Care. She has certificates in Reproductive Health and Human Rights, Policy advocacy and Social media campaigns. She has been working with Journalists for the last 5 years in various health and human rights campaigns and has skills and experience in using social accountability approaches specifically the Citizens Report Card (CRC), Community Score Card (CSC) and the HEAR model.
Wakabi Eric is an all-round communication specialist and journalist with more than three years of experience in, health policy advocacy and communicating development issues to various Newspapers, Magazines, and Internet Productions, NGOs in Uganda and South Sudan. He holds a B.A Mass Communication degree of Makerere University and currently pursuing Bachelor of Laws at the same University. He’s currently a communications officer at HEPS –UGANDA