Uganda Service Delivery Survey (SDS)
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Dear members,
I have read with interest the discussion on the HMIS and references to
health reform. I thought I would share a summary of work done in Uganda
under the supervision of Dr Anne Cockcroft -- a Senior Research Fellow in
CIET -- in the health and agriculture sectors.
CIET is a non-governmental non-profit organisation dedicated to building
the community voice into planning and governance. It is an international
fellowship of professionals, most with academic backgrounds, who take
scientific research methods to the community level. We use sentinel
community surveillance (SCS) which involves communities in information
gathering and analysis. The method facilitates the gathering of both
quantitative and qualitative data, its analysis in term of impact, coverage
and costs, and community-led solutions that are sustainable and locally
relevant. While facilitating community access to appropriate measurement
technology, the process builds national and local evaluation capabilities
in reiterative cycles.
Reactions welcome.
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PERFORMANCE AND PERCEPTIONS OF HEALTH AND AGRICULTURAL SERVICES IN UGANDA
"Since we have no technical advice, we have reverted to primitive ways of
farming... ... we want to be taught about farming."
Commissioned by the Government of Uganda, in November/December 1995 a
baseline Service Delivery Survey (SDS) was undertaken by CIET
international. Health and Agricultural services to rural communities were
selected as the focus of the baseline SDS. The objectives of the baseline
survey were:
- To develop a suitable methodology for an on-going series of SDS surveys
in Uganda.
- To gather baseline data on key services to demonstrate the process and
form a basis for actions to reform these services.
- To build evaluative capacities and awareness within central and local
Government in Uganda.
Methods
CIET used the cross-design methodology known as Sentinel Community
Surveillance. This included a household survey (5,564 households and
27,196 people) asking experience of use of services, costs, opinions,
suggestions for improvement and willingness to pay for services; focus
group discussions, key informant interviews and institutional reviews to
obtain qualitative data about local conditions and views of services; and
interviews with District Administrations to seek their views about their
services and support from central Government. These tools were applied in
40 representative communities (sites) in 9 Districts. Both district level
and national aggregate results were produced.
Results
* One-quarter of households used Government health services in the last
month, but nearly a third used some other health service during the same
time. Overall, two-thirds of households are willing to pay for improved
health services; those who have used government services are one and a
half times more likely to be willing to pay.
* Asked to rate the Government health services in their area, 38% thought
it was good, 30% average (neither good nor bad) and 22% bad.
* Main problems identified with the health service were lack of drugs and
poor access to facilities.
* Only 11% of households reported they had ever had a visit from an
Agricultural Extension Worker. This proportion was no higher in
Districts where the Agricultural Extension Project (AEP) was operating.
The low coverage of Extension services and the lack of better coverage in
districts with AEP could both be related to corruption: recording of
visits that did not happen and possibly misdirection of the substantial
funding allocated to the AEP.
* About half of the households are willing to pay for an improved extension
service. The main complaint about the existing services is that they are
not available. Focus group discussions revealed that people want an
agricultural advisory service.
* District Farm Institutes (DFI) which provide training and materials were
only known to exist by 40% of households. Less than a third of households
were able to give at least one function of a DFI and only 2% had ever
been on a course at a DFI.
Conclusions
The results of the SDS should help managers at central and district level
to plan their services rationally and to monitor their progress towards
measurable targets. Subsequently, all districts have discussed their
results and some have incorporated the findings into their official
district plans.
The Government of Uganda serves as a role model in its efforts to increase
programme effectiveness and make itself accountable to the Ugandan Public.
The Government now plans to extend the SDS to all 39 districts in 1997.
*This study was funded by the Economic Development Institute of the World
Bank and the Canadian International Development Agency.
The full report can be downloaded from our Website:
Enquiries:
e-mail:CIETinfo@compuserve.com
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Sharmila Mhatre
mailto:SMhatre@compuserve.com
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