Improving Health Service Delivery through Citizen Engagement in Uganda


Uganda National Health Users/Consumers Organisation (UNHCO)

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Coalition for Health Promotion and Social Development (HEPS-Uganda)

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Basic Project Information

UNHCO and HEPS-Uganda conducted a series of social accountability projects to monitor the provision of health services, assess citizen satisfaction, and improve service provision.


Project Summary


  • Improve service delivery and access to medicines at public health facilities
  • Increase participation of communities in monitoring health service delivery and demand accountability


UNHCO and HEPS-Uganda carried out a three-year program to monitor the quality of service provision and access to medicines, assess citizens’ satisfaction with the quality of services, and facilitate dialogue between service providers and users for joint problem resolution. The program had three main components:
  • A Quantitative Service Delivery Survey (QSDS) to determine whether health facilities have the necessary resources to provide access to essential medicines;
  • A Citizen Report Card (CRC) to assess consumers’ satisfaction with both health services and their participation in health service decision-making;
  • A Community Score Card (CSC) to empower communities, improve patient-provider relationships, and facilitate resolution of key service delivery issues.
The QSDS and CRC revealed inadequate financial and human resources, infrastructure, and stocks of essential medicines. The studies also found weak oversight of facilities, rare citizen use of redress mechanisms, and only minimal opportunities for communities, health facilities, and districts to participate in the planning and budgeting process. A number of service delivery indicators improved between the two rounds of the CSC, but this was partly due to changes in perception rather than changes in service delivery.
Findings from the QSDS and CRC were used to advocate district local governments, the Ministry of Health (MoH), and Parliament, while those from the CSC were used to generate community-led action. Advocacy asks included increased funding for health and essential medicines, an ambitious health worker recruitment and retention plan, improved monitoring to address absenteeism, and a review of the medicine supply and distribution chain to reduce stock-outs and wastage. The organizations also advocated for an increase in the participation of lower health units and users in the planning processes to help identify priorities and resources needs, and to strengthen feedback and redress mechanisms.

Use of Information Communication Technology

Not applicable


QSDS: 60 health facilities
CRC: 600 households
CSC: 800 community members

Target Population

Public health facility users

Results Methodology

Self-reported results (observations and reports from project participants)

Indicators Used

Not applicable

Reported Results

  • Enhanced citizen knowledge, engagement, and demand for better health services
  • Improved relationship between citizens and service providers
  • Greater involvement of local leaders in service delivery
  • Civil society groups invited to participate in HSSIP review process
  • The Ministry of Health is working with UNHCO to develop, pilot and introduce a Reproductive, Maternal, Newborn and Child Health (RMNCH) scorecard in Uganda; the scorecard will be rolled out in late 2015
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