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Researching strategies to empower communities to strengthen local health service accountability


Future Health Systems is a research consortium working to improve access, affordability and quality of health services for the poor. We are a partnership of leading research institutes from across the globe working in a variety of contexts: in low-income countries (Bangladesh, Uganda), middle-income countries (China, India) and fragile states (Afghanistan) to build resilient health systems for the future. After a successful first five-year phase from 2006-2011 (see our success stories), we are entering a new six-year phase of research, funded mainly by UK aid.

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Researching strategies to empower communities to strengthen local health service accountability

Future Health Systems

By Kakaire Ayub Kirunda, FHS Uganda PIRU Officer

Future Health Systems (FHS) research in Bangladesh and Uganda is assessing how community empowerment strategies can affect service delivery and community capabilities.

The research builds upon previous FHS work in Afghanistan using local-level data to empower communities to engage with and strengthen local service delivery, as well as learning from on–the-ground realities in Bangladesh and Uganda.

In Uganda, FHS partner, Makerere University School of Public Health, has partnered with Kibuku District in Eastern Uganda to develop and test a community and facility score card for maternal and newborn health service delivery.

The feasibility study aims at identifying facilitators, barriers and factors that could influence implementation, institutionalization and scale-up of community and facility score cards in Uganda. The community score card is a two-way and ongoing participatory tool for assessment, planning, monitoring and evaluation of services.

Speaking recently at a stakeholder consultative meeting in Kibuku, the FHS Uganda Team Leader Dr Elizabeth Ekirapa-Kiracho said while Uganda is set to roll out the East African Community reproductive, maternal, newborn and child health score card at district level, Uganda currently lacks a community score card with indicators relevant to local decision making, and which capture community concerns about health care delivery.

“The community score card can also be useful for holding the community accountable for taking actions that are useful for improving their health,” Dr Ekirapa told the stakeholders while introducing this new partnership. “What we want in the end is to be able to propose a model that works not only in Kibuku, but something that can be replicated in the rest of the country. It should be affordable but also puts into consideration what is important to community members.”

Following national and district stakeholder consultations, the study, which is currently at formative research stage, will have three community score card sessions starting September 2017 through May 2018 with an end line evaluation in June 2018.

The Kibuku District Health Officer Dr Ahmed Bumba welcomed the new initiative pledging continued partnership with Makerere University and FHS following the recently concluded Maternal and Neonatal implementation for Equitable Systems Study under the same consortium. “I want to commit that we will be 100 percent on board. We will walk this journey together.”

FHS partners from Uganda and Bangladesh will be joining others in July 2017 to participate in the Unpicking Power and Politics for Transformative Change: Towards Accountability for Health Equity meeting. This meeting is hosted by the Institute of Development Studies’ Accountability for Health Equity Programme, and is supported by Future Health Systems, as well as the ESRC-DFID Unequal Voices project, the Open Society Foundation, and the ESRC-DFID Impact Initiative. It will bring together over 80 researchers, practitioners, advocates, opinion formers and policy influencers from Africa, Asia, Latin America, the UK and the US.