Community Empowerment Program

Community Empowerment:

Under community empowerment strategic focus, HEPS empowers health care consumers with knowledge about their health rights and responsibilities, and also imparts skills to claim their health rights and exercise their health responsibilities as well as facilitate a health consumer –health provider feedback mechanism.

HEPS-Uganda works with grass root community leaders to increase their capacity and knowledge and be able to impart this knowledge about health rights and health responsibilities to their local community members using the ToTs (Trainer of Trainers). These leaders commonly known as community trainers are key change agents in the local communities.

Community Empowerment Objective

To educate and empower health consumers, especially the poor and vulnerable, by dissemination of information on health rights and responsibilities, including rational use of medicines (RUM).

The geographical coverage of the community empowerment programme:

  • Central Uganda - Kiboga district and Kawempe Division of Kampala district
  • Eastern region - Pallisa and Budaka districts
  • Western region - Mbarara and Kamwenge districts
  • Northern region - Lira district

Methodology

HEPS uses two methodologies for community outreach and these include:

1. Community empowerment methodology

To increase health awareness and community participation, HEPS-Uganda uses trained community trainers to be agents of change. A series of carefully planned training activities that reinforce each other in dissemination of health messages and training of the target group in the community are used.

HEPS-Uganda has developed and tested community empowerment training materials with easy to read and understand messages. These materials include a facilitator’s guide (for HEPS facilitator), a trainer’s guide (for Community Leaders) and Education Materials. The Trainer’s Guide and Education Materials have been translated into three local languages namely Lugwere, Runyankore and Luo.

2. Community participatory methodology

The Participatory Rural Appraisal (PRA) approach is also used to increase health awareness and community participation in identifying and addressing barriers to access. Several techniques of the PRA are employed, such as case studies, brainstorming and group discussions, ranking and scoring, spider ranking, role play, stepping stones/ wheel chart among others.

This methodology has proved to be effective in working with the community and encouraging participation in identifying problems within the community and suggesting solutions and interventions to address the problems.

This methodology has been implemented in:

  • Kamwenge district under the project, “Community Empowerment and Participation on Maternal Health”
  • Kamwenge and Kiboga Districts under the project, “Consolidating participatory approach to increase community participation in prevention of parent to child HIV/AIDS transmission”.

Components of the Community Outreach Programme

The community outreach programme has two other components namely:

  1. School Outreach
  2. Complaints and Counselling Desk

School Outreach Component

The objective of school outreach is to educate, empower and enable, health care consumers in secondary school and institutions of higher learning to know and demand for their health rights and be able to exercise their health responsibilities with emphasis on access to essential medicines and rational use of medicines (RUM).

HEPS – Uganda works with school and club leaders in secondary and tertiary institutions to increase their capacity and knowledge and be able to impart this knowledge about health rights and health responsibilities to their fellow students and teachers using the ToTs (Trainer of Trainers) technique. In this case, the school and club leaders are the key change agents in the school communities.

Health Complaints and Compliments

The Health Complaints and Compliments (C&C) Desk is an independent mechanism to address violations of health rights of health consumers. The programme is implemented through installation and use of suggestion boxes at participating health units, documentation of health complaints, counselling services, constructive dialogue and mediation between the aggrieved consumers and the accused health facility, and information sharing with stakeholders.

The objectives of the programme are:

  • Build a net work of health providers, professional bodies and government agencies to jointly address questions and complaints from health consumers
  • Provide a channel for health consumers to voice their questions and complaint
  • Offer counselling services to health consumers with questions or complaints on health service
  • Document, categorizes, and publicize health complaints and questions of health consumers and disseminate these health facts to relevant stakeholders at national level
  • Start and maintain a constructive dialogue with policy makers, professional bodies and health practitioners on possible improvements in the health care sector

Redress mechanism

Health consumers are sensitised under other HEPS-Uganda programmes to know and demand for their health rights and live to their health responsibilities. They voluntarily report violations to an independent HPS C&C Desk set up at health centres in the target communities.

HEPS analyses and forwards to, and follows-up the issues raised with the various duty bearers at the health centre for appropriate redress. Although often at first resisted by health workers for needless fears that it could land errant ones in trouble, this feedback mechanism has in the end usually proved to be a mirror upon which the health providers can evaluate themselves and see how to improve, while at the same time enabling the health consumers to appreciate the challenges faced by the health workers.

C&C in Eastern and Northern Uganda

HEPS-Uganda has initiated the C&C programme at health centres in Pallisa,  Budaka in Eastern Uganda, and Lira in Northern Uganda. Suggestion boxes were installed at four health centres, to help in collecting complaints. The collected complaints are processed and a report written and discussed by a technical team HEPS-Uganda set up in partnership with the district health office. Illegal fees and rudeness of health workers have come up as the top complaints from health consumers.

In Lira, HEPS-Uganda sensitised health workers who attended a two-day sensitisation workshop on health rights and health responsibilities of health consumers in 2008. At the end of the workshop, whose major aim was to build a mutually respectful relationship health providers and health consumers, health workers welcomed the idea of a health complaints handling desk being established at the health centres where they work.

As a follow-up, HEPS-Uganda was to proceed with the installation of compliments/ complaints boxes at Ogur Health Centre IV, Orum HC IV, Alebtong HC IV, Lira Hospital and Mbarara Hospital. The boxes are in positions easily accessible to health consumers visiting the health workers and wish to compliment or complain about the services received.

HEPS’ C&C programme has been piloted at selected health facilities in Kampala, Kamwenge, Pallisa and Budaka districts to improve communication between health workers and their patients through a mechanism that collects analyses and seeks redress to complaints from health consumers. Meanwhile for Mbarara, negotiations are still underway with the Mbarara Hospital administration place one there.

However, the implementation of the C&C programme continues to lag behind the other strategic programmes due to lack of an enabling law in Uganda.