ICT 4 Health Service Delivery “Upscale Project”
Background
Transparency International Uganda is a member organization to ICT for Democracy in East Africa network. The ICT4Democracy in East Africa Network is premised on the recognition that Information and Communication Technology (ICT) enhances communication and the right to freedom of expression, as well as the right to seek, receive and impart information. In this respect, ICT has the potential to increase citizens’ participation in decision-making processes, thus strengthening democratization. The network received funding from SIDA through CIPESA to upscale ICT projects in Uganda, Kenya and Tanzania, up scaling projects that were piloted with funding from SPIDER (Swedish Programme for ICT in Developing Regions) funding,
its through this funding that ICT for Health service delivery have been up-scaled to cover all health centers in Lira and Oyam district.
Project Purpose
To promote transparency and accountability in health service delivery through ICT.
Goal.
To contribute towards improvement of health service delivery in Northern Uganda
Objective
- To reduce the rates on absenteeism of health workers
- To increase community participation in demanding for Transparency and Accountability functionality of health centers
- To empower communities in reporting cases of absenteeism through ICT.
- To promote Local government Advocacy in health service delivery.
TIU since July 2011 has been implementing ICT Health project in northern Uganda as an ideal response to challenges hindering effectiveness and quality of health service delivery. Project approach is empowering, unit and engage different stakeholders towards collective efforts to improve systems and health service delivery; mainly focusing on Lira and Oyam District. The project was piloted in 8 government aided health centers in both Lira and Oyam and have now be upscale in the entire health centers in Lira and Oyam.
ICT platforms (Toll free Call Center, Social Media and FM Radio programs) are being used as technological for both empowering and promoting community participation in monitoring health service redelivery at their respective health centers. Increasing community participation in demanding social accountability of health workers has always been key in realizing expected results and building a working relationship between service providers and service users. To realize lasting solutions to the poor health service delivery, TIU has always worked hand in hand with respective district Local government in advocating for improved health service delivery in both Oyam and Lira district.
The toll free call center (0800200188) which is the main technological platform being used is providing a great deal of community engagement and participation, a platform were community health users call the organization for free to report health service delivery challenges; when complains are reported, followed-ups are made to verify and ensure evident based reporting before respective authorities are engaged to take actions. Social Media (www.facebook.com/StopAbsenteeism ) is also been used to share and inform global internet users regarding project findings, results and knowledge sharing.
Transparency International Uganda encourages health service users and different stakeholders to monitor health service delivery at respective government aided health centers in Northern Uganda and report their findings through the toll free call center which intern the organization will make follow ups and engage relevant authorizes to address respective complains.
ICT for Health Service Delivery :Project Story
In Northern Uganda “ICT 4 health service delivery” project used technological approach to empower the communities. Through the empowerment, the communities were able to engagement and participate in monitoring and demanding for better health service delivery. The main awareness media technological tools that were used included the local FM radio programs which informed, educated and empowered over 7000 people in and out of the target districts in a period of 12 months, TIU managed a Toll free call center that the communities used for reporting health centre irregularities, for onward action by duty bearers.
Health services remain a great need for many communities and the only facilities that most of them can afford are government health centers which provide free health care services. Most health centers like Ogur, Aromo and Anyeke in Northern Uganda are visited by patients from as far as 24 kilometers. In most cases they ride bicycles to and from the health centers. it is often disappointing for such a patient to reach the health center and find it still locked even by 10:00am. In most occasions, even when the health center is open, some health workers are absent while most drugs are lacking.. Concerning drug stock out, most health service users allege that the drugs are stolen by health workers, while the health workers allege that they always never received enough consignment of requested drugs, however during voluntary accountability committee (VACs) members and Health management committee joint review meetings that were held in the target health centers, health management committees pointed out that drugs supply have improved both in quantity and delivery period which is now one month compared to the past years where it would take 3 months to receive drugs consignments, VACs and health management committee members who participated in verification of delivered drugs confirmed that drugs supply have increased.
Before this project intervention, health service users were given medication regardless of whether they were sick or not, but depending on the judgment of the health worker because the lab testing tools were lacking. . However the situation is now changing, health centers are now strictly dispensing drugs with diagnosis supported with lab test results; at health centers where either the lab technicians or assistant are missing, efforts are being put in place to ensure that laboratories are fully operational.
In the maternity wards most health centers did not have adequate and skilled midwives, lacked electricity power (Agulurude, Barr, Aromo) supply and alternative fuel power generators. The District was blamed for delays in effecting the required facility repairs and provisions. A case in point was that of Harriet who visited Aromo health center III and lamented that “when we come to deliver at night, the health workers ask us to go and buy paraffin for the lamp which is used in the maternity”.
Health workers also have challenges that they face, that hinder their work. A case in point was Maureen a Midwife at Aromo Health centre III who called the toll free call center and said, “If it were not because of the love for my people and profession I would have left this Job, the pay is too little to cater for my family needs, I work in an area where people do not appreciate what I do for them. I am the only available midwife at this health center, I have to work for 24 hours without any off duty allocation, sincerely which normal human being can cope up with this working condition”
In response to this very urgent need expressed by Maureen through call center, Transparency International Uganda forwarded the outcry to the District Health Officer recommending that additional midwives be provided. As a result two midwives were posted to Aromo health center III, call center (technology) helped Maureen at no cost to report challenges that she and the health center face.
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.
Health Service Delivery: Development Pact signing
The principal objective behind development pact is to ensure transparency, accountability, public participation, standard of services and community inclusion in Health reforms and policy changes. Pact signing involved different stakeholder like district health officers, health workers, sub county chiefs, community volunteers (Voluntary accountability committee), Village health teams, health management committees, health workers, HIV/AIDS focal person and local leaders who pledged their commitments and team building towards improving health service delivery. The development pact therefore mainly empowers existing structures and the entire communities to work together in improving service delivery; in this way they take ownership of project intervention and results.
In December 2012 development pacts were signed in health centers of Lira (Amach HC iv, Ogur HC iv) and in Oyam (Anyeke HC iv, Agulurude HC iii, Loro HC ii and Iceme HC ii) which has already began to register key success by evident engagement of health management committees in Oyam and Lira (Northern Uganda) districts increasingly monitoring their respective health centers; case in point is Amach health center IV where one of the health workers who was scheduled to be on duty was found sitting at her home nearby the health center yet there were many patients waiting to be served and her support was highly being missed, when the health management committee chairperson visited the facility and realized what was happening, He informed the area LC 3 chairman who acted by reporting the health worker to police who later arrested the said health worker only to be later released on police bond. We need leaders who can take up actions when they identify corruption taking place like it was with the health management committee chairperson who took up actions; the health worker was later on tasked to report on duty and resume work at the health center. To health workers across the country they may look at this as hash treatment of health workers neglecting the fact that they are to be socially accountable to the people they serve Transparency International Uganda has empowered the communities through ICT to monitor their respective health centers and ensure that health workers are socially accountable whether with or without the physical presence of civil society organizational interventions.
Progress Report: ICT 4 Health Service Delivery
Project Progress Report: July-December 2012
Title: Empowering Communities through ICT for better Health Service delivery.
Project Abstract
Years after the end of rebel insurgency, Northern Uganda continues to face challenges in terms of health service delivery. This is manifested mainly in high rates of absenteeism of health workers rendering dysfunctional the few available health centers. Medical workers’ absenteeism which is caused by many factors remains key cause of poor health service delivery in the region. According to World Bank, health workers in Uganda operate under de-motivating terms and conditions of service characterized by low pay resulting in either migration to other countries for better pay or absconding from duty to attend to their private clinics/businesses. Other organizations like WHO have attributed absenteeism to inadequate number of qualified health staff. The high level of absenteeism of health workers has ramifications for the quality of service provision (MOH 2008b). In addition, practices such as receipt of bribes, extortion of money from patients for services that should ideally be free, the outside sale of drugs and other public facility supplies and misappropriation of user charge revenue (applicable to referral units) are also common (McPake et.al. 1999). The project is therefore aimed at promoting transparency and accountability in health service delivery through ICT to reduce the rates on absenteeism of health workers, increase community participation in demanding for Transparency, Accountability, functionality of health centers and empower communities in reporting cases of absenteeism through ICT and promote Local government Advocacy in health service delivery.
Current status
The toll free call center is currently being used as a key platform for community involvement and participation in ensuring social accountability and transparency of health workers. TI Uganda in the past six months has widely used atoll free call center was installed in May 2012 as a key platform for community involvement and participation in ensuring social accountability and transparency of health workers. The call center in November received a new twist where the community health users have called to seek for medical consultation, this shows how much the technology can do for the community beyond reporting challenges. The call center network has greatly improved because the telecom inaction service provider due to our request has conducted network maintenance which has reduced the rates of call drops. The community has greatly adapted to technological approach of improving health service delivery which has been realized through their participation radio talk shows and calling the toll free line, some have even gone to the extent of requesting that the project intervention should be replicated in their districts and community.
Radio Talk Shows.
The radio talk-shows which have been implemented in the last six months has fostered community empowerment and engagement in demanding social accountability from their respective leaders, the community members every Wednesdays would listen to and call-in the station live to contribute or comment on the subject matter; there has also been a lot of knowledge sharing through the technology.
Development Pact Signing
This activity was conducted in December from 17th to 20th 2012 in the sub counties of Amach, Ogur, Iceme , Acaba and Loro in the health centers of Amach, Ogur, Iceme, Anyeke, Agulurude and Loro respectively. The stakeholders district health officers, health workers, community volunteers, health center health management committees, HIV/AIDS focal person, sub county chiefs, voluntary accountability committee members, village health teams (VHTs), Radio Q FM, Radio unity FM, Radio Wa FM, youth drama group and community people from the respective sub counties. The health workers together with community leaders, volunteers and district health officers have pledged their roles play in improving health service delivery at the respective health centers
Advocacy Interface meetings
Meetings with the respective district health officers aimed at improving health service delivery and recommending the use of existing policy guidelines towards overcoming health challenges has paid off; for the first time in history Anyeke Health center IV became the first health center IV to recruit and employ a medical doctor, something greatly attributed to SPIDER health project. In Lira district, the district health office/local government has improved staff accommodation in Ogur and Aromo health centers as result of the meeting, this is important because as long as causes of absenteeism are not addressed it would be very difficult to stop absenteeism.
Collaboration and Networking
TI Uganda in the last six months has greatly collaborated with partner civil society organizations in community empowerment. As part of collaboration, Justice and Peace Commission Lira (JPC) participated in development Pact Signing by providing free power generator and public address system that was used in conducting development pact signing, JPC also provided youth drama group who also freely acted drama during the development pact signing. During collaboration with JPC, TI Uganda only provided lunch allowance, generator fuel and microphone battery which made the whole activity cost effective.
TI Uganda also collaborated with Lira NGO Forum and JPC in conducting Radio Talk-Shows where Lira NGO Forum took lead in mobilizing participants, presenting during radio talk shows and registering participants. Their participation in Radio Talk-shows helped in empowering communities by encouraging their respective community knowledge workers and volunteers to participate in health center monitoring and calling the toll free call center number 0800200188 to report challenges and positive results at the respective health centers.
Radio Wa (Local FM Station) has continued to collaborate with TI Uganda by offering 3 free Talk-show airtime for TI Uganda to empower their Radio listeners towards improving of health service delivery in Northern Uganda and from time to time TI Uganda has also been invited to participate in planning session for community empowerment using ICT.
Collaboration with District Health Officers, The district health offices offered government vehicle for activity implementation with continued embracement of project intervention as a great contribution towards improving of health service delivery in their respective districts.
Documentation and Communication
The project has continued to create public awareness and informing sharing through facebook (social media) which has help to draw attention from different internet users from across the world. Social media has helped the project to reach thousands of people where some requested for additional information to enrich their research/studies,
ICT 4 Democracy in East Africa website has also been used in the last six months for information sharing. Blog posts hosted by Transparency International Secretariat in Berlin have been used to post issues of community empowerment and engagement, this blog has also helped to make the project to be widely known.
TI Uganda involvement of media house in project activities and sharing of information has enabled the project results and activities appear in Local news which has also built both project and organization visibility in Northern Uganda.
http://jkornet.com/2013/01/22/can-technology-help-african-women-to-fight-corruption/
- www.facebook.com/StopAbsenteeism
- http://blog.transparency.org/2012/07/11/community-empowerment-in-uganda-using-icts-for-better-health-service-delivery/#comments
- www.ict4democracy.org
Sustainability
The signed Development pact in the target health centers and radio talk shows held have greatly helped in up scaling community participation and ownership of the intervention where the community are now more informed and engaged in health center monitoring. Efforts are being made to ensure that through development pact, communities are able to continuously ensure that social accountability of health workers is at par.
Risks and risk management
Transport still remains a challenge under the project, the field office only has one motorcycle which is normally used for health field visits, some of the roads become impassable when its rainy season.
Project Coverage, the project coverers a very small geographical area and health centers yet on the other hand community continues to request for the intervention to be introduced and implemented in their sub counties and districts; this continues to remain a big challenge because however much we are willing to stretch out to a wider community, we are limited by funding. Part of risk management taken to mitigate the Risk and challenges has been development and submitting of project concept notes and project proposal of which none of them has yet been successful.
Project Budget Revision
The previously revised budget does require additional adjustment to cater for reallocation balances realized from activities and also to complete the implementation of development pact signing.
9. Response to audit
- Project agreement; Auditors had recommended that we comply with all the provisions of the project agreement and as management we are closely monitoring the project implementation as per the provisions in the agreement.
- Inadequate Coordination; the audit team recommended that TI Uganda administration staff should provide technical support to the field project team ; the Head office finance team has closely worked with the field office in all financial matters as per the financial policy manual and guidelines in place.
- Comingling of funds; it was recommended that the project maintains a separate account for the funds received from SPIDER as per the funding agreement; this issues was resolved and even before the funds were transferred we had discussed this matter with the donor and we were given ago ahead to use an existing account. No other funds have been banked to that account except for SPIDER project.
- Informal Procurement Team; the auditors had recommended that management appoints a formal procurement committee that should be trained in procurement and critical bidding process. Management has put in place a formal procurement committee.
- Bank Reconciliations; the audit team recommended that the bank reconciliations be properly prepared and reviewed by the senior person on monthly basis; Management took this up and on monthly basis all bank reconciliations are reviewed by the executive director and verified by the accountant.
- 5% institutional Development; the auditors recommended that a clear policy be put in place in regard to 5% institutional development; this matter has been resolved and the finance policy has been reviewed.
- Fixed Assets; Auditors recommended that all assets be engraved and included in the asset register; this has always been the practice, the asset register has been updated to cater for all essential information and all new assets have been engraved.
- Insurance Cover; it was recommended that adequate insurance cover be availed against all insurable risks and insurance documents kept safely; Management is still working on alternative sources to cover funding for such costs which have not been taken care in the project budget.
10. Short Story (Attached separately)
Appendix 1 Project Story (http://www.ict4democracy.org/project-story-empowered-and-involved/ )
Appendix 2 Project Photographs (www.facebook.com/StopAbsenteeism )
11. Results Matrix – Activities, Results & Indicators
Departing from your original proposal describe the results of your activities by filling in the table below. Give special attention to any unexpected developments whether positive or negative and how they have been managed.
| Input(resources used in activity) | Activities(what has been done) | Outputs(what has been produced) | Short term outcomes(anticipated & unanticipated) | Medium term outcomes(anticipated & unanticipated) | Indicators |
| Toll free Call center operation | 1749 in coming calls received.1857Out going calls |
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| Challenges/constraintsICT infrastructure accessibility among women is minimal.
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Health Center Verification visits |
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| Challenges/constraints:ICT infrastructure accessibility among women is minimal.
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Radio Talk Shows |
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The number of people calling in during radio talk show. | ||
| Challenges/constraints:District civil servants being too reserved to participate in radion programms. | |||||
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Development Pact Signing |
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The number of community members leaders who have embraced development pact signing. | ||
| Challenges/constraints: | |||||
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Social Media and Documentation |
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The number of people/facebook users who have comented, viewed or liked post from the project facebook page. | ||
| Challenges/constraints: | |||||
Motorcycle fuel (Activity combined with health center verification visits) |
Advocacy Interface meetings |
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District Health officers have contined to requeste the project intervention be replicated in the remaining sub counties/health centers of their respective districts | Testimonies from distict health officers.Actions taken by district health office towards improving health service delivery. | |
| Challenges/constraints: |
ICT 4 Sustainable Community Development
Author: Simon Peter Ogwang
Project Coordinator at Transparency International Uganda
Following the decline and eventual end of the rebel insurgency in Northern Uganda, many civil society organizations moved into the region to rebuild and improve service delivery by ensuring improved accessibility of resources to intended beneficiaries, however what is important to note is that, the use of technology for people empowerment and engagement was hardly available at the time in the region. With the introduction of Transparency International Uganda’s current health project, funded by SPIDER in the Districts of Lira and Oyam, the use of ICT for people empowerment and engagement has been widely embraced.
Targeting health workers absenteeism, the projects currently uses a toll free call center (0800200188) for community reporting of key challenges in health service delivery. When these reports are received from community voluntary accountability committees, frequent health centre verification visits are conducted by TIU to verify information and also ensure evidence based reporting. As a result of using the existing structures localized solutions are realized to counter the said challenges.
In addition, the project uses social media platform (www.facebook.com/StopAbsenteeism) and twitter, as means of sharing community information and also interact with a wider spectrum of communities in addressing local issues to a national and global platform. The project also widely uses the mass media, for instance radio programs in both health and education projects have been instrumental as a platform for empowering and engaging all stakeholders, it is during these talk-shows that people call and immensely contribute by asking questions, giving supplements and sharing specific challenges from their communities regarding service delivery and need for improvement. In using all this ICT platforms Transparency International Uganda greatly empowered and involved a wider community in demanding social accountability of health workers within the target project areas.
Given the public outcry, TIU hope in the near future to conduct maternal health diagnosis radio talk-shows, bringing on board a Government medical doctor to educate the community on prenatal and postnatal healthcare, all geared towards improving mother and child health and this is something other civil society organizations can also start in any part of the country.
There are several ways ICT can be used to create social impact in developing countries however if we are to realize a joint and sustainable impact in a given sector, the selection and use of the technological platform needs to be carefully taken care of by considering literacy levels of target beneficiaries and their adoptability to technological advances, for example short message services (SMS) can hardly work for an illiterate community because they cannot read and write yet they could widely use bulk voice calls which sends recorded voice message, toll free help line and local radio campaigns which can enable them express themselves in the language they best understand.
When selecting a given technological tool by CSOs and government, it’s important to forecast the sustainability of the technology and results by looking at what happens after funding by making sure primary beneficiaries and all other stakeholders understand the value of information always received from them, with reference to what the organization/government has done with the information received through a given ICT platform to positively impact onto the lives of people by taking appropriate actions, this would make the technology end use value their information and even be willing to meet the cost of sharing the information whether through SMS, email or voice calling as long as they are sure something will be done thereafter.
Adaptability to a given technological platform may not only be influenced by inability to use technology but attitude, ignorance and misuse of a given platform by other people and that’s why till today some staff have failed to use social media to promote organizational work. Some people focus more on security concerns before using ICT platform other than putting more focus on how much the technology is able to help them achieve; for all security risk, risk management can be put in place to ensure that security for the user is ensured.
What CSOs, government and private sector can do to build their ICT capacity in using for community sustainable develop is to benchmark from other entities within the similar field of work in order to re-strategize their approach; another way would be creating and joining ICT networks like ICT 4 democracy in East Africa to share best practice in using ICT for sustainable development. Attending and participating in ICT forums and workshops like Internet Governance Forum, Stockholm Internet Forum, mobile communication for development (M4D) among others to share practice experience and learning the impact and use of the different ICT tools/platforms from those already using ICT.
Project Story: Empowered and Involved
Empowered and involved
Years after rebel insurgency in northern Uganda civil society organizations moved in to rebuild the region by improving service delivery and ensuring improved accessibility of resources and service delivery in different sectors, however the use of technology for people empowerment and engagement was hardly seen in the region. The region was blessed to receive SPIDER health project in Lira and Oyam which widely uses ICT for people empowerment. The toll free call center was installed in May 2012 which has greatly improved health service delivery in northern Uganda through community empowerment and , engagement in monitoring health service delivery at their respective health centers; men and women have used the call center/technology by calling in to report challenges of late coming, absenteeism, drug theft, poor hygiene and poor work performance. Call conversations are always so touching, to some people the issues or challenges being reported by community health users are mythical but in reality the hard conditions are deeply felt while this calls are being received; it’s only through empathy that one can truly understand what happens at the health centers. A situation where a midwife worked for 24 hours without resting because her colleague was absent, the poor midwife could only be seen dozing off while she explains to Betty (TI Uganda staff) during health center verification visit, meetings are always convened at the health centers together health center in-charges and other health workers to locally discuss and come up with solutions; during one of the meetings health workers justified their reasons for being absent and reporting late for duty being caused by inadequate accommodation because some of them do not reside within the health center and their request to Transparency International Uganda was that the organization does help present this problem to district officials; one amazing thing about this is that the intervention has provided both the health workers and community health users to freely share their side of the story unlike in the past where only a few community health users and politicians would share their grievances through publicized radio programmes and political campaigns; technology has now enabled the different stakeholders to equally share both health challenges and providing lasting solutions.
As a result of advocacy meeting with district health officers, some of the health staff houses which had taken quite a long time for construction to be completed were later completed and staffs began to stay within the health center. It is pleasing, that by engaging the district officials in solving these challenges, the project has attained positive results for example; there is a great improvement in staff arrival time because now they reside within health center and have pledged this role-play in service delivery.
Here comes another interesting bit of ICT for people empowerment; both social media (www.faceboo.com/StopAbsenteeism ) and local FM radio programmes have been used to inform, educate and engage both local communities and global internet users in sharing both knowledge and ideas towards improving health service delivery. One interesting thing about community technological adaptability is the fixation in people’s mind that FM radio stations serves for people entertainment not empowerment which made it very hard in the beginning to win listenership, through daily advertisement of radio programmes and toll free line, the community became more interested to learn and share with presenters the health challenges at their respective health centers; community participation improved so much during and after subsequent radio programmes where many were calling in to share their views, comments and suggestions; it was an appropriate time for the community members to interact through ICT, “we love this program, its educating us and may you continue educating the community because many do not know their health rights” Albina said. “I have listened in most radio programs and it’s amazing how your program is approaching challenges at the health centers, could you please extend the same program to our district as well because they are similar challenges we are facing in Dokolo, I feel empowered and ready to be involved ” said the caller; in response “We would love to even scale up the intervention to every part of the northern Uganda but we are limited by resources, with more funding realized Transparency International Uganda will surely consider your district” Simon said.
Project sustainability has always been a point of concern for every humanitarian worker, TI Uganda tactically through radio programmes organized for development pact signing (an agreement/framework which enables the local communities able to know and have commitment of the leaders, stakeholders and duty bearers by pledging their commitment towards improving healthcare service delivery) to realize continued participation and involvement of different stakeholders in carrying out project intervention beyond project life time; development pact signing, this was one of the most marvelous activities that the community members have ever enjoyed and participated willingly, it was a moment of pledging commitments by the district officials, local leaders, health workers, voluntary accountability committees, HIV/AIDS focal person, sub county chiefs, village health teams and the general community towards improving health service delivery, creating good working relationship between the health workers and the communities by writing and signing down on paper their commitment; this was a very interesting moment for community members, the activity involved anti-corruption drama which became an eye opener to the communities being so entertaining and educative, it covered late arrival of health workers, staff absenteeism, drug theft, mistreatment of patients and the benefit of development pact signing, this time the community members, the local leaders and the health workers were all free to interact on concerning issues taking place at their community health centers. “Thank you so much Transparency you have opened our eyes, we are now united and empowered”, said community members.
Technology in its self alone cannot impact on community that’s why Transparency International Uganda values people empowerment and engagement in rightfully using technology for sustainable development, in our different capacities we can use ICT to greatly impact on people’s lives in developing region; we therefore call upon every story reader to promote and support the different projects in developing countries in making the world a better place.
Author: Simon Peter Ogwang
Project Coordinator at Transparency International Uganda
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.
3rd International Mobile Communication for Development Conference in India
3rd International Mobile communication for development conference in India (New Delhi 28-29 Feb 2012)
The major theme of the conference centered on how mobile communication could be used for development, presentation from different panelist provided knowledge sharing, giving success stories on how ICT is being used for community empowerment. It was noted that technology alone cannot solve world development challenges but rather the proper use of these technologies to enhance project interventions.
Spider panel presentation involved all network (ICT 4 Democracy in East Africa), the network which consist of different projects in East Africa under Spider funding. All project officers presented their respective ICT projects; the network attracted some of participants who thereafter made approach towards future partnership and knowledge sharing. Within the network, synergies in program implementation were identified with WOUGNET interested in sharing TIU call center to reach out their to target communities in Northern Uganda. Organizations are destined to create a sustainable results for project inventions when they work together and actively involve target beneficiaries to own program results.
Mobile communication in its self can be used beyond communication where mobile phones in Africa are being used for money transfers, SMS knowledge sharing and accessing of educative literature from internet. Organizations venture in different ways to ensure that mobile technology supports implementation of the different program activities and at the same time selection of these technologies for community development should be carefully done putting into consideration the dynamics of community capacity to use the technology.
ICT for Democracy in East Africa consist of skilled project staffs that can provide any assistance to anyone globally for any ICT based community intervention; the network therefore is open to any person who would like to learn or share their expertise/knowledge.
Incompetence of Support Staff (Porters and Watchmen) at health centers
Transparency International Uganda
Porters and watchmen are employed at each health center in Uganda by Ministry of health. Porters are tasked to keep and maintain hygiene of surroundings of their respective health centers. Noticeably these support staff are recruited from the same locality of the health centers, none of them has ever experienced transfers. It has been noted that these individuals according to Health center in-charge at Agulurude Mr. Opio Daniel Patrick, have managed to draw the local community on their side to the extent at which when they are being urged or warned to improve their performance, they claim to the community that they are being witch-hunted; community members have ended up believing in them than acknowledging that the porters who are paid by the government have failed to perform their duties; failure to understand the roles of porters have made some patients’ care takers to participate in health center cleaning.
In Lira District Amach health center IV and Barr Health Center III are under poor hygiene due to outstanding indiscipline of porters, the porters want always to be seen as medical/health workers but not cleaners; they feel belittled to be cleaning the health center while community members see them; yet that wasn’t what they first considered when they first applied for the job. Mr. Okwir Joe according to the health center In-charge (Michael) of Amach health center has continuously failed to change and perform his duties as expected. The next step he/Michael together with health management committee are hoping for is to write a warning letter to Okwir Joe and copy it to District health officer, the chief administrative officer and Transparency International Uganda. TIU pledged to follow-up and see into it that action is taken by the relevant authorities.
In oyam district, Ameny Ambrose and Ojok Tonny who are both porters together with Ayini Dickens (Watchman) at Agulurude health center III have repeatedly abandoned their duty, as a result the health management committee convened a meeting on 28th November 2011 and collectively wrote a letter to the DHO (Dr. Owiny) complaining of “very poor work performances of support staff”, the letter was copied to the culprits, CAO and Sub County Chief Loro. TIU got reach of this document during health center visits and is engaging district health authorities to take actions.
TIU within its program activities is going to empower communities by conducting radio talk-shows in one of the local FM stations in Northern Uganda once every week. The talk-show will involve participation from community health users (calling in), district health officers, health workers, support staff, partner organizations and local leaders together with TIU to have joint contribution towards attaining results.