White Ribbon Alliance



January 7, 2016
In Uganda, community members assessed their own health facilities, finding them dangerously lacking in health staff and other essentials. Since then, services have dramatically improved – and the community continues to monitor funding, explains Samuel Senfuka.

The goal of our campaign was for our government to fulfil its promise* of life saving emergency services for pregnant women and newborns (see below).

We focussed on three rural districts, which have 43 health centres between them. First, we assessed the gaps in services. In one district, Kabale, we found a shortfall of 57 midwives and seven doctors. Now, 57 midwives were posted there in October 2014, as well as 7 doctors – and they have stayed.


Our campaign has also greatly improved the procurement planning for lifesaving drugs and supplies in all 43 health centres. In contrast to previous years, by the end of our campaign we found no stock-outs (absence) of injectable antibiotics for sepsis, injectable oxytocin for postpartum haemorrhage, injectable magnesium sulphate for preeclampsia/eclampsia. Delivery kits (mama kits) were also in place. Basic Emergency Obstetric and Newborn Care is now being provided in all of the health centres. Women are being treated, the drugs are available.

We have had very positive feedback from health workers and management who attribute these improvements to the meetings which WRA Uganda held with district officials. It was at these meetings that we realised the planning for drugs needed improvement, giving priority to vital supplies and medicines. The duty bearers have been using our findings to address the gaps. In one district, health officials have committed to include our assessment indicators as a part of their own routine supervision.

We have also had great feedback from women in the communities. We asked them – are you getting delivery kits and other basic services? They said yes. We checked with the medical registers and the evidence was well documented there – of antibiotics provided for sepsis and oxytocins given during post partum haemorrhage. Life saving treatments are now being provided.

How did we do it? Our approach was to carry out a participatory health facility assessment so that our campaign was owned by citizens and by government officials. These initial findings of the gaps in services have been important. And because we have worked together, collectively agreeing on our priorities, we have been able to address these needs within the limited funds available, using our limited financial resources more efficiently.


Working with the community members to monitor and track budgets at community level has also been critical. We pushed for increased budgets, but even when money is allocated it can be misused or re-allocated. So we worked with the community members who found the gaps in the first place, and who use the services, so that they continue to monitor the utilization of funds. We have found people who are respected in the community, who are committed to improving health services, and we have trained them as part of Community Based Monitoring and Advocacy Teams to give feedback to implementers.

They are volunteers – with no financial gain – and we give them simple tools to track stock-outs of medicines and provision of Emergency Obstetric and Newborn Care. This is a sensitive issue and the teams need continuous capacity building and confidence building. We have found that we fare better with tracking and monitoring when we are linked to partner organisations and local government. The Community Based Teams are linked to District based structures and not ‘owned’ by WRA Uganda. It is more sustainable if they work with others and through ongoing and new campaigns.

The building of new maternity units, operating theatres and housing for staff have been completed in a number of health centres because of this continuous monitoring by the community. Leaders are really engaged and responding to the feedback of their community members, and that was not happening before the WRA Uganda campaign.

The Community Based Teams include Citizen Journalists, previously trained by WRA Uganda, and they are using their skills in photography and video very well, interviewing women and health workers, continuing to report on health services. And we say to people, if you need support to tell your story, we have Citizens Journalists in every district who can film and report on what is going on, providing support and evidence.

People said that what we wanted to do was ‘next to impossible’ and that we were being too ambitious. But we have succeeded, we have had a big impact.”

* The Government of Uganda in September 2011 committed to provide Basic Emergency Obstetric and Newborn Care (BEmONC) at all levels of maternity care, and Comprehensive Emergency Obstetric and Newborn Care (CEmONC) for half of Health Centres at Level 4 by end of 2015.