Citizens Demand For A Service Charter At Musyenene Health Centre III

Musyenene Health Centre in Nyakiyumbu Sub County, Kasese District is both a government and private supported facility. The government pays salaries for the 8 workers (6 males and 2 females) at the HC and also provides free malaria drugs while the other services like maternity, antenatal, Out Patient Department (OPD), In Patient Department (IPD), free HIV testing and counseling, Post natal, outreach and laboratory services.

Although they had been paying for the health services some community members did not understand why they were being charged for services at what they presumed to be a government establishment, and more so inconsistent charges; for instance birth mothers would be charged different amounts for delivery based on the sex of the baby. Mothers who delivered boys were charged more money than the ones that delivered baby girls. On the other hand some community members were unable to differentiate between the free and chargeable health services.

Tired of the ‘confusing charges’ the community raised the issue during their neighborhood Assembly held at St. Francis Catholic church, Kaghorwe parish. Among others the community demanded for an explanation on why they are charged for services at the HC and for clarity on the charges per service. As an action from the assembly, a team of six Neighborhood Assembly Executive members and KALI program staff met with the HC administration (Staff and health Unit Management Committee) to verify and also discuss the raised service delivery issues.

Responding to the raised issues, the HC In-charge Mr. Charles Bwambale explained that the government funds a small percentage of the HC’s budget which is sometimes unreliable and for the HC to survive it needs to raise money, saying this is the reason why the patients are charged. Mr. Charles said the HC’s charges are determined by the market price and are therefore not high as the community alleges.

He committed to developing and displaying a service charge at the HC and to attend the next Neighborhood Assembly to share/explain the HC’s operations to the community members.

A month after the meeting a service charge sheet was displayed at the HC. 

This has helped in creating clarity on the cost of services and in guiding the community to make informed decisions, that is, on where to go for medication- at Musyenene HC or Bwera Hospital whose services are free because it is a fully fledged government hospital. 

Apparently the community members are happy at the results of their demand.“The HC’s response is a good gesture; it has enhanced transparency in their operations and will definitely strengthen their relations/collaboration with the community. Even though some of us can not afford some of the monies charged, we are impressed” thus remarked Baluku John a community member.

UDHA Makes Impressive Strides in the Promotion of Maternal and Child Health Rights in Mayuge District

“Up to forty (40) years no one among the fishing community on Saguti, Masolya and Jaguzi Islands in Mayuge district had ever been immunised. There was generally a very low uptake of immunization services and low attendance/utilization of other health services like antenatal and family planning. With only three (3) Health Centres built and ill equipped to serve seven (7) islands, limited use and access to health services was the lifestyle of most fishing communities. Apparently no ambulance could work in these places, while health workers too shunned staying on the island. And as a result, mothers relied heavily on the expertise of the traditional birth attendants (TBAs) while the rest lived by self medication and God’s mercy” thus revealed  Michael Gwanjaye, the Project Coordinator of Uganda Development and Health Associates–(UDHA). 

UDHA is an IDF grantee promoting maternal and child health rights among the fishing communities in Mayuge district.

 In collaboration with several stakeholders; District health office, facility medical personnel, Village Health Teams (VHTs), mothers, political and civil leaders, UDHA has been able to reach over 7796 people in the sub counties/islands of Bukaboli, Jaguza and Malongo with information on maternal and child health rights. This has been through routine radio talk shows, radio jingles community sensitization out reaches, door to door sensitization campaigns, quarterly feedback and sensitization meetings with key stakeholders, community dialogue meetings with duty bearers, publication and dissemination of Information Education and Communication (I.E.C) materials in popular versions.

Aimed at increasing the level of involvement of fishing communities in planning, monitoring, and utilization of maternal and child healthcare services, UDHA’s project seems to be making progressive strides towards this goal. Available reports from these interventions and interaction with key stakeholders confirm this; For instance through continued lobbying and advocacy for the improvement of health services at Bwondha HC II, the longtime dilapidated HC was renovated by the district and supplied with a solar panel (that will be installed soon). This has not only improved its look but also attracted more mothers to utilize its services. Umuteesi Safina, the HC In-Charge notes that “in the past we would receive 10-15 mothers monthly while the rest used TBAS. It was even hard to convince them to come to the HC because it was in a poor state, but after its renovation realized through UDHA’s advocacy,  coupled with the continued sensitization, we now receive 28 – 30 mothers monthly, we hope to even get more in the near future”.

An increase in the number of people accessing immunization has also been witnessed; whereas the HC conducts immunization outreach services, mothers who deliver from home or on the way have come up to later bring their babies for immunization. Umuteesi further reveals that “since UDHA’s sensitization and education campaigns, the HC now immunizes between 150-200 babies monthly. These include those who deliver at the HC and from home - they after delivery bring the new born babies to the HC for immunization because they have been made to understand its importance”.

Related to this is the improvement in utilization of family planning services; Available records at  Bwondha HC II show an increase in the number of people accessing family planning from 10-20 people to 50- 150 monthly. On the other hand, male support towards women and child health rights has increased; unlike in the past when men did not find it necessary to participate in health related activities for their wives and children, say escorting them  for antenatal, today, more men have come up to support their wives. At Bwondha HC for instance, over 30 couples are registered monthly for antenatal services as opposed to the past when only 7-10 couples would be received.

Other impressive results from UDHA’s advocacy work are the recruitment and retention of Health workers at the HCs on the islands by the district, appointment of new Health Unit management committees to replace the expired and non functional committees at most of the HCs in the district and orienting of the same on their roles and responsibilities.

Lastly is securing commitment from the District Health Officer to upgrade Bwondha HC II to a HC III facility.  “A lot of change is being witnessed from UDHA’s work; we have been involved in most of the activities and are able to track what is changing. We are impressed by their work, and collaboration with us as a district and the other relevant stakeholders. Certainly the lives of mothers and children in Mayuge district are improving greatly”, noted the District Health educator, Mayuge district during an interview with him about the UDHA-IDF funded project.

Duty Bearers’ Capacities Strengthened to Fight Child Rights Abuses

A baseline survey conducted by Rural Action Community Based Organization (RACOBAO) in 2013 indicated that there were rampant child rights abuses in Lyantonde district. Many girls as young as 14 years among the predominantly pastoralist communities were taken out of school to be given away in marriage.  

Community members were the main perpetrators of the abuses and as such could not report the rights violations, while those that tried were often frustrated by the weak structures such as the police, and local leaders in charge of children affairs; this was because they were either corrupt or outright incompetent. This incompetence was attributed to the lack of knowledge on the existing laws and policies on child rights protection and promotion. Most of the duty bearers were not aware of their roles and responsibilities in protecting and promoting child rights. 

However, through IDF supported interventions, RACOBAO (an IDF grantee) has been able to empower duty bearers with knowledge and skills in child rights promotion and protection. RACOBAO has continued to conduct several sensitization and dialogue meetings with the rights holders (community) and the duty bearers (leaders and service providers) to educate them on the existing laws and policies on child rights protection, and their roles and responsibilities towards the same. Community based interface meetings (barazas) have been conducted to allow for discussions between duty bearers and rights holders on issues of child rights protection. 

 During these, several action plans are developed, implemented by the responsible persons and also monitored to check progress on what was planned.

Duty Bearers of Kaliiro sub-county developing action plans during a dialogue meeting

Reports indicate that the capacities of several community structures of duty bearers/service providers have been strengthened and their vigilance and responsiveness to handling cases of rights abuses reported has increased. On the other hand, increased vigilance on reporting cases of human rights abuse by the community members has also been witnessed. 

A case in point is where some community members  in February 2014 whistle blew to the duty bearers about two arranged early marriages for one Daphne, a 15 year old girl from Kyalwandemu village, Kiyinda parish, Kaliiro Sub County and Babirye Allen a 16 year old girl from Bwamulamira village, Bwamulamira parish, Kinuuka Sub County. The community alerted the police about the planned give away ceremonies for these young girls by their parents. 

The police immediately swung into action, foiled the ceremonies and cautioned the parents and suitors never to repeat such a thing. The girls were later sent back to school and are happily studying. During a recent sensitization meeting, the District Probation and Social Welfare Officer noted “We are recording an unprecedented increase in the number of child rights abuses reported to and handled by my office. We call upon everyone in the community to join hands against abusing children”.

 Adding their commitment to the rest of the duty bearers, some religious leaders in Lyatonde district have vowed to always ask for birth certificates of brides before conducting marriage ceremonies. This is going to check on the number of early marriages conducted in the district. RACOBAO believes that, such measures if sustained will contribute a lot in wiping out the rampant child rights violations from Lyantonde district and consequently contribute to the national goal of human rights promotion and protection and the promotion of school enrollment, retention and completion for many children.