Project Progress Report: July-December 2012
Title: Empowering Communities through ICT for better Health Service delivery.
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.
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.
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||
|Challenges/constraintsICT infrastructure accessibility among women is minimal.
||Health Center Verification visits||
|Challenges/constraints:ICT infrastructure accessibility among women is minimal.
||Radio Talk Shows||
||The number of people calling in during radio talk show.|
|Challenges/constraints:District civil servants being too reserved to participate in radion programms.|
||Development Pact Signing||
||The number of community members leaders who have embraced development pact signing.|
||Social Media and Documentation||
||The number of people/facebook users who have comented, viewed or liked post from the project facebook page.|
Motorcycle fuel (Activity combined with health center verification visits)
|Advocacy Interface meetings||
||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.|