The power of participation
June 6, 2016This piece was initially posted on the GPSA Knowledge Platform
By Jillian Larsen, Advocacy and Accountability Advisor, WRA Global Secretariat
Pregnancy should be a time of great joy. But for many women in Uganda, who risk death or serious disability due to low-quality health services, it can also be a time of great peril. According to the 2011 Uganda Demographic and Health Survey, 438 Ugandan women die for every 100,000 live births in the country. This figure compares to 140 per 100,000 in South Africa and just four in Norway.
White Ribbon Alliance Uganda (WRA) has spent years working to protect maternal and newborn health. In the process, it has built a broad-based network of decision-makers, organizations, professionals, and citizens committed to maternal health. Between 2013–2015, WRA enacted a campaign “Act Now to Save Mothers” to hold the Government of Uganda accountable to its commitment to provide emergency obstetric and newborn care (EmONC). The campaign had three objectives: (1) Ministry of Health to request and allocate sufficient funds for EmONC services in three pilot districts by 2015. (2) Minister of Health to allocate sufficient funds to improve recruitment, deployment, and motivation of health workers at designated Level III and IV health centers by 2015. (3) Minister of Health and Head of National Medical Stores to allocate sufficient funds for the procurement and delivery of EmONC equipment and supplies by 2015.
The campaign explicitly pursued a two-pronged approach to get government officials at the district and national levels to prioritize funding for EmONC by simultaneously working from a top-down and bottom-up approach.
From the bottom, communities and health facilities were mobilized to apply pressure on district officials to prioritize funds for maternal health in their budgets, and also to raise these up to the national level. Then working with district health officials, they applied pressure on members of parliament (MPs), Ministry of Health officials, and other government agencies. The key activities to engage, mobilize and connect people across levels from the bottom-up included:
After two years of the three-year campaign, it had already achieved results at the health facility and district levels. For example, in Kabale district- one of the pilot areas, six medical doctors were recruited – one for each of the six level IV health centers. In the same fiscal year, the three districts increased spending on areas improving maternal health services. At the national level, WRA succeeded in getting the inclusion of the Primary Health Care Non-Wage priorities as “unfunded,” with a request for UGX 39.5 billion (about US $11.7 million in 2015) the Ministry of Health Ministerial Policy Statement on the budget for the fiscal year 2015/16, and the inclusion of this issue in the Health Committee report. Getting included as an “unfunded priority” means budget’s prioritization in future years, and sometimes it is used by donors to identify priorities and funding gaps they can contribute to. The Parliament of Uganda responded to the citizen petition by instructing the Committee on Health to investigate the issues in the petition.
For more details on this campaign or to access other campaign case studies and lessons learned, please visit the International Budget Partnership’s website. For more recent updates on this campaign visit the White Ribbon Alliance’s campaign brief.
 Uganda has a tiered health system with levels 1 – 4 providing services at the (1) village, (2) parish, (3) sub-county and (4) county levels.
 For example, construction of maternity wards, rehabilitation of operating theaters and health center facilities, and increased allocation of funds for EmONC medicines.
 Non-wage recurrent funding is used for operational and running costs of health such as medical and office equipment, utilities, training cost, monitoring and supervision, etc.
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