ICT 4 Health Service Delivery: Project Results

—Transparency International Uganda (TIU) which is the implementing organization is a registered Non-governmental Organization, TIU envisions a Ugandan society in which the daily lives of the people are free of corruption; Currently working in the sectors of health, education, extractive industries , Private sector and Research. TIU is a member organization of ICT 4 Democracy In East Africa.
Project Title: ICT 4 Health Service Delivery

Purpose: To promote transparency and accountability in health service delivery through ICT.

Goal:    To Contribute towards improvement of health service delivery in Northern Uganda


—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.


Project Summary

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.

Project methods and results
During project implementation TI Uganda used ICT platforms for both stakeholder empowerment and engagement; key technological platforms and tools used were: toll free call center, FM (frequency modulation) radio programs, social media (www.facebook.com/StopAbsenteeism) and mobile phones.

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.


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 HEREThis 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).

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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.

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