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.
Tag: Transparency International Uganda
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.
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
Objectives
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.
Challenges
- 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.
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 |
|
|
|
|
| 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. | ||
| Challenges/constraints: | |||||
|
Social Media and Documentation |
|
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 |
|
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.
Project Story: 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.
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 (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.
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.