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

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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