Case Studies>>Accountability Counts: Health in Iganga, Uganda


Two nurses in the clinic

First published: 2011-03-21

Allyson Thirkell reports on grants funded by the UK Department for International Development to raise the voice of the people and improve the accountability of healthcare officials in Uganda.

Travelling through the grassy villages of Iganga on a bumpy dirt road, you are reminded of how much people rely on their immediate surroundings for all their needs. Nestled in a clump of trees, next to the village water pump, is the local health clinic providing vital medicines, care and maternity facilities.

The clinic is full and people wait with children and babies to see the only doctor. The nurse, dressed in a starched white dress, organises the patients and already, two young children have been admitted with malaria and put on intravenous medication. The maternity room, with three beds and weighing scales is empty - no babies are being born here today. A clinician in a small room with a microscope checks patient blood for signs of malaria, while staff in the nearby store room check-in the newly-arrived medication and equipment.

There are still gaps. Checking the ragged paper list of drugs and equipment requested from the drug stores, there seem to be items that have not turned up - plastic gloves, vital for delivering babies, condoms and some needles. Without these, people and staff are at a higher risk of HIV infection. This clinic seems the model of a well-functioning health facility, but it has not always been like this. Community members tell us that a while ago, the clinic did not open regularly, staff did not show up and there were few medicines. So what has changed in Iganga?

Two Iganga residents outside the clinic

The Department for International Development has funded grants to raise the voice of the people and improve the accountability of officials in Uganda. Iganga has benefited greatly from this. One such grant to the Uganda Debt Network has enabled them to train community members to monitor health facilities and report back on performance as well as the quality of care that they receive. Regular reports were compiled by local people on what was going on and what questions needed to be answered. These reports formed the basis of regular reporting to officials at district level leading to slow, but steady change in the clinic's operations. "At first," reports Stephen, a local monitor, "our relationship with the staff was poor, but now we have a good relationship and the health centre has developed a good record."

Talking with the monitors it seems as though this clinic's reputation has spread. Jo has brought his sick son to the clinic suffering from acute malaria. He has travelled far to attend the clinic, convinced that it offers a better service than other clinics near his home. Jo says "the clinic staff where I live have a poor work ethic and I have heard from patients here, of the good service and staff, they must have a good heart." However it is the work of the monitors and staff together, that has made the difference and Iganga now has a clinic that everyone can be proud of.