Communities bring positive change in health service delivery in Uganda
Robinah Kaitiritimba
Background We are happy to have the community involved in providing the direction for service delivery‖, remarked the District Health Officer of Oyam district in Northern Uganda. This was during a dissemination meeting for community score card results of the Open Society supported project on improving transparency and accountability in health service delivery in Uganda. Such reactions have been echoed in the other areas where the community monitoring exercise has taken place. The project that is implemented by the Uganda National Health Users‘/Consumers‘ Organization (UNHCO) upholds the Human Rights principal of Inclusion and Participation through the use of the Community Score Card as a social accountability tool. The tool was applied in the project areas of Kiyumba county and Mukungwe sub-county in Masaka district; and Loro and Acaba sub-counties in Oyam district. Prior to the inception of the project, the workload at target health centers was not commensurate to the number of health workers, the attitude of health workers was poor affecting their relationship with the patients and negatively impacting on utilisation and overall status of health, especially maternal health. A small number of individuals knew of the existence of the management committee of the health centers, medicines‘ stock-out periods were longer and often frustrated not only the patients but also the health workers. Apart from seeking the services, the communities did not know that they were stakeholders in determining the healthcare that meets their needs. With the application of the community scorecard , interventions have been either influenced or directly effected by the community members and/or community monitors – the target communities are now more empowered with knowledge and skills on health rights and responsibilities, their entitlements at each level of health care service delivery, and are able to engage duty bearers at sub-county and district levels regarding the quality of services at their respective service points. The community is also energized for participation and ownership of services with specific focus on financial resources and other inputs including medicines and supplies and human resources available, demanding answers and seeing themselves as part of the solution to the problem. Specifically, the communities have influenced the provision of electricity, water and a dental clinic at Mukungwe Health Center, and construction of staff quarters at the Agulurude Health Center. The communities, represented by the community monitoring teams, have also been provided with a platform to share community views regarding service delivery with the district councils.
Working with the Health Ministry, UNHCO has shared its model for applying the community - score-card with the Quality Assurance Department and will be working to influence institutionalization within the health sector framework.
Prior to the inception of the project, the workload at target health centres was not commensurate to the number of health workers, the attitude of health workers was poor affecting their relationship with the patients and negatively impacting on utilization and overall status of health, especially maternal health.
The community is also energized for participation and ownership of services with specific focus on financial resources and other inputs including medicines and supplies and human resources available, demanding answers and seeing themselves as part of the solution to the problem
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ABOUT AUTHORS
Robinah Kaitiritimba is the Executive Director of the Uganda National Health Consumers‘ Organization in Kampala. To know more about the work of UNHCO, please CLICK HERE