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.