ICT 4 Health Service Delivery: Project Results
Purpose: To promote transparency and accountability in health service delivery through ICT.
Goal: To Contribute towards improvement of health service delivery in Northern Uganda
Objectives
ICT 4 health service delivery pilot project (Funded by SPIDER) has been implemented by Transparency International Uganda (TIU) in two districts (Lira and Oyam) in Northern Uganda; specific health centers that worked directly with the project included health centers from Oyam which included Anyeke HC (Health Center) IV, Iceme HC II, Loro HC II, Agulurude HC III and four health centers from Lira that included Amach HC IV, Barr HC III, Ogur HC IV and Aromo HC III. The ICT project right from inception used technological approach of community empowerment and engagement/participation in monitoring and demanding for better health service delivery. The main awareness media technological tools that were used was the local FM radio programs which informed, educated and empowered over 7000 people in and out of the target districts in a period of 12months. The Toll free call center was the main platform that was and is still being used for active community reporting.
Through the call center TIU received 3267 calls from community members. The reports pointed out key challenges of Absenteeism, under-staffing, ghost workers, poor hygiene, inadequate accommodation facilities, drugs stock out uncoordinated health workers transfers without replacement. and corruption in Uganda police force. Other callers were requesting for project replication in their communities while others wanted to know more about the project. In response TIU managed to conduct health center verification visits to validate the reports. . Some of the problems were handled and resolved at the community level. The health management committees were able to address the challenges. Challenges that proved to be beyond respective health center management level like ghost workers, inadequate staff accommodation and drug stock out were shared with district health officers who were able to respond by first updating staff employment register at district level tallying it with staff numbers physically present at health centers. The district health department also managed to complete construction of staff accommodation at some health units.
Health workers absenteeism was reduced by 30%, the figure was derived by comparing staff attendance/arrival register statistics during inception and after empowering people and structures working together to stop absenteeism. As a commitment for continuous monitoring and provision of better health service delivery, stakeholders committed themselves through development pact signing which has improved working relationship between health workers and health users. Community volunteers have given testimonies to the positive results/changes realized at their respective health centers.
During the entire period of implementation the Local government district health offices of Lira and Oyam supported and participated in project implementation by providing government vehicles for on spot health center visits and also responded to recommendations from TIU in regards to challenges reported from the health centers.
Toll free Call Center:Community volunteers, health users, health workers and other used the facility to report cases to TIU, after receiving the call center reports, verification visits were conducted to spot check, verify and validate the issues reported. TIU frequently called back to seek for clarifications, remotely follow up on urgent challenges reported and giving feedback to callers.
Radio programs; The Radio programs were used to inform, educate and empower project beneficiaries and stakeholders towards collective efforts in promoting social accountability of health workers in health service delivery. Among presenters of the radio program included, CSO partners like Lira NGO Forum, Justice and Peace Center Lira and Voluntary accountability Committee members. They shared with communities the different ideas for improvement, key examples from of what happens on ground and provided recommendations for improving health service delivery. Radio talks-shows reached beyond Lira and Oyam districts. In order for the toll free number to be known to the different take holders, TIU ran spot radio jingles advertising the number and informing the communities on the reporting guidelines. Empowering people enabled TIU to receive reports from different health centers, pointing out challenges in healthcare accessibility. Due to this, health workers were alert at all times since their misconduct would be reported by just a call away.
Strategies used during Project Implementation
- Using existing structures, leadership & community Volunteers.
- Empowering communities through radio programs.
- Engaging beneficiaries in reporting healthcare using toll free call center (0800200188)
- Development pact signing
- Engaging District Health Authorities toward taking appropriate action in solving identified challenges.
- Social Media (www.facebook.com/StopAdventeeism)
Key Results
- Un-coordinated transfer of health workers with out immediate replacement was solved by the district health offices, most of the transfers are now being done with immediate replace.
- Both Lira and Oyam district health offices made communication to partnering CSOs to coordinate their workshop invitations through district health office which helped to reduced absenteeism, in the past staffs scheduled to be on duty would prefer to attend workshops once invited rather than working at the health center.
- Knowledge gained and capacity built in using ICT for community participation in healthcare service delivery monitoring
- Health worker’s capacity built and they are more willing to work as a team.
- Community health users empowered and informed of their health rights and are now demanding social accountability of Health workers.
- Hygiene of Amach, Anyeke and Aromo Health center has improved.
- Through Development Pact Signing communities and their leaders acquired new ways of jointly working towards improving health service delivery.
- Through Social media, knowledge shared and gained from global internet users.
- Districts Local government investigated and followed up recommended health care challenges in the health centers that required government role play.
- Indiscipline health workers have faced disciplinary measures leading to their improved code of conduct and others removed from government payroll.
- One health center Kitchen was built at Agulurude Health Center III.
- Staff Houses at Agulurude Health III were constructed.
- District Health officers have continued to request the project intervention be replicated in the remaining sub counties/health centers of their respective districts
- Reduced level of Staff absenteeism: Health workers absenteeism was reduced by 30%, the figure was derived by comparing staff attendance/arrival register statistics during inception and after empowering people and structures working together to stop absenteeism.
- Transfer of empowered health workers and replaced with staff who require to be informed and empowered to work together with other staff and community towards improving health service delivery.
- Civil servants feared participating in radio stalk shows.
- Changing dynamics of health users who either visits the health centers once in two months or Come from distant villages which affects their ability to monitor health services
- ICT infrastructure accessibility among women is minimal.
Sustainability
Project has empowered communities to take up health service delivery monitoring beyond project implementation The community members themselves monitor and demand for social responsibility of health workers. The District local government structures are monitoring the health units and addressing any reported anomalies. TIU is currently ensuring that all pilot projects are up-scaled, proposals are being developed to fund raise and give the ICT 4 Health service delivery life after SPIDER funding.
ICT4Democracy East Africa October Newsletter
The October Newsletter of the ICT4Democracy East Africa Network can now be downloaded HERE. This brochure covers the activities of the network partners and focuses on how they are leveraging different ICT platforms to enhance transparency and civic empowernment. The utilized technologies include crowd sourcing platforms like Ushahidi; social media platforms like YouTube, Facebook, and Twitter; and digital and traditional media like websites and radio.
Highlights in the newsletter include details of KHRC’s human rights violations monitoring, CHRAGG’s progress with the complaints handling system, iHub Research’s MGovernance Field work update, TI Uganda’s toll free line, a report on citizen journalism training by CIPESA and ToroDev and WOUGNET capacity building activities during the month of October.
ICT for Health Service Delivery
Patients at Ogur health Center IV (Northern Uganda
These were just a cross section of patients at Ogur health center IV where health centers open up late (10:00am), high number of patients becomes much more difficult to handle because most health facilities do not work on patients has they come but do wait for patients to turn up in large numbers. Has a solution to this challenge, Transparency International Uganda field staffs have been holding advocacy and management meetings that seek to empower the health workers, informing and involving heath management in taking up key responsibilities in health management. During these meetings, health workers were found to be opening the facilities late because they say patients do report late at the health centers; even if they opened early enough they would have no one to work on, others were found to be attending to their personal businesses and also having negative attitude towards their work, an attitude derived from need for more payments; In response to late arrival/opening of health centers, the health workers were made to understand that they are under contract to open the health facility latest by 8:00am, whether the patients are there or not, the health center should be opened and staffs ready to work, opening and arrival time shouldn’t be dependent on availability of health users. Health workers have also been encouraged to love their job no matter how little the payments may be, conditions may be hard but the work that health workers do is more humanitarian and God given.
We call upon all health workers and health users to take part in health service delivery monitoring at their respective health center, for its all our duty to ensure that people are held socially accountable and health sector is free from corruption. Call Transparency International Uganda for free on 0800200188 and report health challenges at your respective health centers in Northern Uganda.
Transparency International Uganda Acquires a Toll Free Line
Transparency International (TI) Uganda has completed the installation of a toll free call centre at its Lira field office. By calling 0800 200 188 toll free from any local mobile phone service provider, citizens can report on corruption and poor service delivery in the health sector in Northern Uganda.
Through the call centre and as part of its ICT4Health Service Delivery project, TI Uganda aims to reduce the rates of health worker absenteeism, increase community participation in monitoring the functionality of health centres and advocate for polices to improve health service delivery in the post conflict region.
Empowering communities through ICT to demand for better health service delivery
Transparency International Uganda (TIU) is empowering communities in Northern Uganda to demand for better health service delivery, Oyam and Lira districts are the project implementation area; a total of 6 sub counties were selected out of the 24 sub counties in the two districts. After nearly five years of insurgency in Northern Uganda, health care systems remains under dilapidating situation, with collective rehabilitation programs by civil society organizations to improve livelihood of the people, the project shares this goal of contributing towards improvement of health service delivery in Northern Uganda. The project acknowledges that health service human resource is under staffed, and even the few are always absent from their duties but continues to get pay for what they have not worked for, this practice of absenteeism therefore besides being corruption puts the lives of health users at a risk and violates health rights.
Under the project; there is much effort being put in stopping health workers’ absenteeism so as to improve health service delivery, and this will be greatly achieved in the coming months (starting month of January and February 2012) when TIU deploys toll free call center and free SMS for community empowerment and involvement monitoring and improving health service delivery . Before deploying ICT tools the project underwent the processes mapping stakeholders, creating partnership, mapping health center accessibility, selection of voluntary accountability committee (VAC) members, training voluntary accountability committee members,
Patients at Barr health center III (Lira District -Northern Uganda)
The Left Photograph: Patients at Barr Health Center III (Lira district- Northern Uganda).
A young kid seating with her mother as they await to be attended to. It was clear here that the health users do not understand their rights, even if they did, they had no avenue of reporting, demanding and ensuring that delay in health services in their health center is dealt with.
The project will therefore provide them with tool free call center hot line to always report irregularities. The technology will be handled and managed directly by TIU. Telephone calls will be recorded and replayed to generate reports, reports are then shared with partners and government (district health office) to demand for positive changes tailored towards improving health service delivery.
Patients at Amach Health Center IV (Lira District)
Health center Visit conducted on 06th-12-2011 at Amach Health center IV
It was yet another day of field work, the project officer arrived at Amach health center IV at 9:15am and was welcomed by the security guard, no health worker had yet started working at the Outpatient wing, found 15 patients seated waiting for health service.
By 10:20am there were 78 patients had lined-up, The project officer shared and empowered patients about their health rights and need for better health service delivery; sensitized patients on the need to jointly help Transparency International Uganda to monitor and report late arrival and absenteeism of health workers. Patients could not hide their disappointments on how they felt in delay of accessing health service.
At 10:25am, the health educator Ogwang Ray of Amach health center arrived joined the project officer in sensitizing patients on issues concerning primary health care and stopping health workers absenteeism. The health educator was requested by the project officer to help in stopping late arrival of health workers and also be the voice of patients at the health center. It was at 10:30am that actual process of attending to health needs of patients started by Ogwal Vincent who is the clinical officer.
The success story here is that, Health workers were briefed about the need to stop absenteeism and late coming, work together as a team and improve service delivery. By TIU actively involving health center in-charge and health workers to ensure early reporting and serving the patients, the following day the health center opened early with early commence of patience treatment.
ICT for Democracy in East Africa: October News
SMS for Human Rights
The Tanzanian Commission for Human Rights and Good Governance (CHRAGG) is due to undertake field studies to gather user requirements this November. The results of the study will go toward the features design of the mobile phone based Complaints Handling Management Information System.
Catalysing Civic Participation and Democracy Monitoring Using ICTS
IT support equipment has been procured for the two grassroots based centres that the Collaboration on International ICT Policy in East and Southern Africa (CIPESA) entered into MOUs with last month. A needs assessment including survey of the knowledge, attitudes and practices (KAPS) to determine the ICT for democracy tools used, user and non-user profiles and their [de]motivations is scheduled for November and December. CIPESA’s analysis of Ugandan policies and practices that enhance (or undermine) eDemocracy is also to be finalised in November.
M-Governance: Exploring Conditions for Successful Mobile Governance in Kenya
The literature review as part of iHub’s exploratory research into the successful conditions for mobile governance in Kenya is complete. The review that aims to identify a Kenyan definition of good governance is to be circulated pending final edits. A workshop to identify issues in Kenya’s governance structures with an emphasis on stakeholder roles and relationships was held at iHub on October 27, 2011. The workshop also explored ways in which technology could facilitate and potentially enhance good governance. Further information is available here. Expert interviews and pilot questionnaires are scheduled for November and December.
Reforms through Citizen Participation and Government Accountability
The Kenya Human Rights Commission (KHRC) has contracted a web developer for their human rights issues crowd sourcing website. Information and work from Human Rights Networks (HURINETS) on the ground is to feed into the website using the Ushahidi crowd-map platform. One of the HURINETS working in partnership with KHRC is the KURIA Human Rights Network. The initiative, under the western region Kuria Reform Agenda Consortium, seeks to address systematic insecurity in the Kuria constituency. KURIA’s recently set up crowd mapping platform can be found here.
Promoting Social Accountability in the Health Sector in Northern Uganda
Transparency International (TI) Uganda in October held a workshop where Voluntary and Accountability Committees (VACs) members of Oyam districts were trained on how to report health worker absenteeism and poor service delivery. So far, the project has seen a slight indication of improvements in health service delivery in Lira and Oyam district. Based on arrival logs, health centre workers are recorded as reporting to work on time. For more information, visit TI’s Stop Health Workers’ Absenteeism facebook page.
Empowering Local People and Communities to Monitor Districts’ Service Delivery Through ICTs
Following the Women of Uganda Network (WOUGNET)’s mobilisations exercises in Gulu and Amuru districts held last month, similar exercises were undertaken in Kole, Oyam and Apac districts during October. The exercises, which involved community meetings, informed stakeholders on how ICT can enable effective service delivery. As per the project scope, the mobilisation targeted more women than men (ratio of women to men being 70:30).
Other news
- A number of organisations have inquired about possibilities of working with the regional network and/or different projects within. Partner organisations are exploring ways in which to collaborate with the interested organisations.
- During the upcoming International Conference on Mobile Communication for Development (M4D2012), the East African ICT for Democracy network will hold a workshop for stakeholders in the ICT for democracy field. The open session will engage practitioners in experiences and opportunities in the mobile component supporting democracy and governance.
ICT for Democracy in East Africa: Project Update
Launched in May 2011, ICT for Democracy in East Africa (ICT4DemEA) is a network of organisations undertaking collaborative projects where Information and Communication Technology (ICT) is used in various ways to promote transparency, accountability and democracy. The network, with seed funding from the Swedish Program for ICT in Developing Regions (Spider) comprises of organisations in Kenya, Tanzania and Uganda. These are the Women of Uganda Network (WOUGNET); Transparency International Uganda (TIU); The Collaboration on International ICT Policy for East and Southern Africa (CIPESA); iHub (Kenya) the Kenya Human Rights Commission (KHRC) and Tanzania’s Commission for Human Rights and Good Governance (CHRAGG).
The projects spearheaded by each organisation leverage on ICT with the aim to fight corruption, enhance the right to freedom of expression, monitor service delivery, hold leaders accountable and encourage civic participation. During the recently concluded Internet Governance Forum (IGF) in Nairobi, September 27-30, 2011, the regional network partners met to discuss the progress of their projects.
iHub, Nairobi’s technical and solutions centre, is conducting exploratory research into the conditions for mobile as a successful tool for improved governance in Kenya. Desk research is underway to identify a Kenyan definition of “good governance” and the weakest areas of governance in Kenya. This is to be based on global indices and will engage the United Nations, Strathmore and Jomo Kenyatta Universities, Huduma and SODNET (Social Development Network), among others. This October, iHub is due to host a workshop with Kenyan Governance experts and iHub’s application developer community, conduct expert interviews as well as pilot questionnaires in five [yet to be decided] areas of Nairobi. Besides, iHub is studying the different mobile and web applications out there as well as lessons learned from existing mobile governance efforts.
KHRC’s has identified and sensitised grassroots based Human Rights Networks (HURINETs) in the use of social media. Through the HURINETs, databases have been developed for an SMS and crowd-sourcing platform. With little ICT expertise, KHRC is facing technological challenges and is in the process of identifying suitable platforms and contracting developers. In the meantime, it is exploring collaboration with iHub (technical) and CIPESA (policy) as well as synergies with CHRAGG.
In its pursuit to empower communities through ICT to demand for better health service delivery in Northern Uganda, TIU, with headquarters in Kampala officially opened its offices in Lira on July 25, 2011. Since then, the selection and formation of Voluntary and Accountability Committees (VACs) which incorporate previously existing Village Health Teams, Health Management Committees, District Health Teams and Baraza structures has been successful. The VACs empowered through ICT to monitor health service delivery in Lira and Oyam districts currently have 199 members and have so far made visits to eight health centres. During October, TIU will be gathering user needs and requirements for the development of a database to support a short code SMS application through stakeholder workshops. TIU is working in partnership with WOUGNET, THETA Uganda, Lira NGO Forum, Plan Uganda, World Vision, Platform for Labour Action and Uganda National Health Consumers Association.
On the other hand, to enhance Ugandan civic advocacy and engagement and increase government transparency and accountability, CIPESA has entered into memorandums of understanding (MoU) with two grassroots based centres. One of the centres, Busoga Rural Open Source & Development Initiative (BROSDI), is a non-profit centre working to improve rural livelihoods and the second is the local government-run Kasese eSociety. The MOUs provide for CIPESA’s training of centre staff in citizen journalism and the undertaking and reporting on surveys, focus group discussions and polls on prevailing governance, political and service delivery issues. The centres are responsible for mobilising organised groups to join a Network of users and advocates in the use of ICTs to improve citizen participation as well as reporting on the activities and developments in the work of mobilised network organisations. The contact details of centre visitors and collaborators are being collected to receive regular informative SMSs and emails from CIPESA on governance issues and how citizens can play a role in them.
An analysis by CIPESA of Ugandan policies and practices that enhance (or undermine) eDemocracy is well underway. The output of this will be briefing papers and fact sheets targeting policy makers and the media. Already published is a briefing note that explains the Open Government Partnership (OGP). The Partnership, launched on September 20, 2011 aims to promote transparency, empower citizens, fight corruption and harness new technologies to strengthen governance. CIPESA’s Open Government briefing (available here) explains the OGP, looks at OGP indicators and prospects in selected African countries (Ghana, Kenya, Liberia, Tanzania, Uganda, South Africa), and explores the role ICT could play in catalysing the achievement of open governance in Africa.
Similar to TIU, WOUGNET has also started its work to empower local people and communities in monitoring service delivery through ICTs. Its project is targeted at five districts in Northern Uganda: Apac, Oyam, Kole, Amuru and Gulu. The project, in its preliminary stages has so far seen mobilisation exercises undertaken in Gulu and Amuru. The sub-counties and parishes to work with in the two districts have been identified. WOUGNET is currently exploring a partnership with Track FM for radio talk shows to be conducted to discuss transparency and accountability in local languages.
In order to ensure citizens understand their basic human rights and the principles of good governance while dealing with the high complaints volume received, CHRAGG built a web based Complaints Handling Management Information System. However, the system is not accessible to citizens in remote areas and towns without CHRAGG branch offices. The Commission is currently developing and implementing additional features to the Complaint Handing System. The features via mobile phone platform are to incorporate text messages, image and video capabilities for informers or complainants. Additionally, the Commission is to send out information and also receive inquiries about its services through the platform. An MoU has been signed with the system design and development partner – Bessbrook International LTD. The Commission has also signed MoUs for collaboration with 10 non-government organisations.
Further information is available on individual organisations’ websites as well as the regional network’s social pages: Twitter ICT4DemEA and Facebook ICT for Democracy in East Africa.
ICT4Democracy in East Africa’ Project Launched
This article was published by the Swedish Programme on ICTs for Developing regions (SPIDER) on June 28, 2011, about the ICT4Democracy in East Africa project, which brings together various partners in the region.
Recently, we have seen a number of projects, pilots and tools where ICT is used in various ways to promote democracy. Many of these initiatives have been launched in East Africa: crowd-sourcing platforms such as Ugandawatch2011, uReport and Ushahidi (and variations thereof such as Uchaguzi, Huduma and Map Kibera); innovative SMS applications such as Grid 6464, CU@SCHOOL, 3356 shortcode by City Council in Nairobi and Trac FM; and of course the widespread use of social media such as Facebook and Twitter.
We have also seen some challenges in ICT enabled democracy projects emerge: lack of government involvement, too much government involvement (i.e. surveillance, filtering and censorship), low community involvement and problems sustaining the community involvement over time, expensive marketing strategies and reaching out campaigns, lack of visibility, how to show impact… The list can be made long.
In November 2010, Spider together with Association for Progressive Communications (APC), organized a Governance Stakeholder Workshop in Kampala, Uganda and invited East African organizations who could bring in important and valuable insight to the area of ICT, democracy and development. Following this workshop, Spider received concept papers and project proposals in the field of ICT and democracy and after reviewing the applications, identified several overlaps and areas in the project proposals that could benefit from a collaborative and stronger ICT for democracy program. The aim of the program is to synergize and compliment the individual projects with the ambition of possibly creating a network hub that deals in democracy through the use of ICTs.
A follow-up two-day workshop in Kampala in May 2011, brought together partners with various strengths who all lauded the idea of a program and expanding their individual existing networks. The Partners have different expertise that together will create greater impact:
Kenya Human Rights Commission has been in existence since 1992 and is the oldest partner among the projects. KHRC have for 19 years advocated for constitutional reforms within the area of human rights. As such they are currently looking at incorporating ICTs in their work, and this is an area that their partner iHUB also in Kenya has expertise in and can be of significant assistance. iHUB’s strength and expertise lie in their technical knowledge and solutions which they are now marrying to governance and democracy advocacy in Kenya and area they are relatively new at. Both Kenyan partners expressed interest and support for the idea of a program approach because in this case they can work together to strengthen each other’s weaknesses.
Women of Uganda Network has for the past 11 years worked with women’s groups and organizations promoting the use of ICTs to share information and address various social issues. WOUGNET’s vision is a society in which women are empowered through the use of ICTs for sustainable development. This strong gender-awareness in their ICT programs provides an opportunity for the ICT for Democracy program to ensure that activities and plans by each partner maintain gender sensitivity in their deployment. As these organizations will look at addressing social accountability in various rural regions in the region, Transparency International the Ugandan Chapter, with expertise in awareness and anti-corruption campaigning will be assisting the other partners in this area. TIU in turn expressed the need for help in addressing the communities with a gender-lens.
Towards the end of the workshop, the partners all advocated for regional facilitation of the program, and unanimously selected Collaboration on International ICT Policy for East and Southern Africa (CIPESA). CIPESA by virtue of their experience in collaborative efforts was identified as the ideal partner to facilitate the cooperation and activities planned by the partners. CIPESA similarly look to KHRC, TIU, WOUGNET and iHUB to assist them in working with technology and with grass-root communities, and with CIPESA’s experience in Policy driven research changes, this program should have an all-round impact not just to the local communities where the activities will be anchored for the next 2 years but to overall policy.
Source: SPIDER newsletter, June 28, 2011