By Joan Esther Kilande
The public health sector exists to serve the health needs of the population, for instance availability and accessibility of essential medicines and health supplies (EMHS). However, existing evidence indicates that demand for EMHS exceeds supply.
Uganda’s societal setting has been nurtured in a way that vulnerable communities are on a receiving end, with majority expecting the government to always provide resources for their basic necessities.
However, with the limited budget constraints, it is time to think outside the box and involve them in contributing to quality health service delivery.
Stakeholders are not paternity about advocacy and yet they are partly to blame for poor service delivery. For instance, in case there are stock outs of essential medicines and supplies in health units, there is a need for health workers and community members through different relevant channels to advocate and address the situation.
How, through considering inter- health unit drug borrowing, reporting to the district health officers, the National Medical Stores regional offices and also using the toll-free lines and other regulatory bodies than seating back and feeling sorry about the situation.
Furthermore, in some rural up country districts, communities have used a community scorecard tool (CSC) to advocate for better service delivery, and members have defined factors contributing to maternal mortality death and discussed a way forward through dialogue with health facility officials with support from health activists.
This system has so far worked out and delivered tangible results for health centre IIIs in some districts like Budaka and Pallisa.
As a health activist, I have been directly involved in designing and implementation of the CSC tool, and I will share a story on how community intervention may derive results.
During a community dialogue, this year, in one of the above mentioned health units, expectant mothers reported that they were paying for delivery services despite a ban on such charges in public health units.
At Lyama Health Centre III in Budaka District, delivery charges are paid depending on the sex of the baby, with the male child charged Shs9, 000 and the female Shs10,000. At Kibale HCIII, Shs5,000 and Shs4,000 are charged for a baby boy and girls respectively and the gloves go for Shs2,000. However, through interface meetings between community, public health workers and district leaders, the habit of money extortion for mothers’ delivery has been addressed except in a few incidents of stock outs of essential supplies where a client is required to improvise.
Many other cases of stock outs of Reproductive Health essential medicines and supplies like SP (Fansidar), Septrin, and poor attitude of midwives, unclear grievance redress mechanisms, and lack of transparency in the expenditure of primary healthcare funds among others have been addressed by the community through the CSC approach.
A good example here is that of Kasodo HCIII in Pallisa District, where the in-charge threatened to close the facility for being dirty especially the pitlatrine blocks which were dilapidated. However, through community engagement the district has considered improvising a toilet structure for one month and a new block is under construction.
At Ikiiki HCIII on the other hand in Budaka District, has no bathroom for patients, mothers shower openly at the health facility compound, which is a violation of other patients’ rights.
But community members have directly advocated for the construction of the facilities and the district council has planned for a new bathroom in the next Financial Year 2013/2014 and community members are yet to follow up. Communities have offered suggestion boxes as the first stage of complaint redress mechanism at the health unit and Kibale subcounty community promised to give the health centre – one Mahogany tree to be cut down to provide timber for making benches and a suggestion box for the health unit. We need to take on our responsibilities and ownership on health issue, in our respective communities and involve in monitoring health service delivery whereas holding duty bearers accountable. “Remember, your vote counts”.
Ms Kilande is a programme officer,Action Group for Health, Human Rights and HIV/Aids Uganda.