Challenge: Due to corruption and inefficiency in the execution of government contracts and services, many Ugandan communities have long struggled to exercise their fundamental human right to adequate healthcare. Despite commendable efforts by the government and other organizations to combat this vice in the sector, significant obstacles remain. This was the case at Lapeta Heath Centre II in Northern Uganda’s Gulu district.
Citizens of Lapeta village, Pakwero Parish, Unyama Sub-County in Gulu city, complained about the lack of adequate health services in their area. The maternity ward at the Out Patient Department (OPD) was very small, dilapidated and infested with bats. The facility lacked electricity and running water. Pregnant mothers from over 20 villages in Pakwelo Parish had to travel to Gulu City (over 20km) to access antenatal services. After persistent lobbying, the leadership of Gulu DLG agreed to construct a standard OPD at Lapeta Health Centre II.
In 2020, the district contracted Coal Covenant Construction Company to construct a standard OPD with a pit latrine and incinerator. The OPD was scheduled for completion and commissioning in July 2021. Between August and September 2021, AFIC monitors tracked the execution of selected projects within the district and Lapeta Health Centre II were one of them. The monitoring sought to assess the performance and delivery of public contracts with in Gulu District for value for money and enhanced service delivery.
Action: As part of its mandate, AFIC has been doing contract monitoring for service delivery in the health sectors in Africa since 2010. The team visited Gulu district in 2021, and selected several health care delivery contracts to monitor both in the district and the city. Lapeta Health Centre, located in Pakwelo Parish, Unyama Sub-County, just a few kilometers from Gulu City, was one of the many Health centres selected.
After requesting and gaining access to the contract for the construction of an OPD at Lapita Health Centre, it was discovered that among other provisions in the contract were a pit latrine and an insulator, both of which had not been built by the time of the AFIC visit in October 2021.
AFIC and its monitors visited Lapeta HC II and identified a number of issues that needed to be addressed before handing over the facility to the community including but not limited to;
- The health centre was said to have been completed but not in use limiting accessibility by citizens.
- The lighting system had not been installed in the health centre, which limited services especially night antinental services as delivery was difficult with no light.
- The contracted provided for contraction of a pit latrine and incinerator but were not constructed at the time of monitoring.
AFIC made these and more recommendation from the findings to the district;
- Urgent installation of water gutters and a tank for water harvesting given that the facility did not have access to piped water.
- Urgent installation of lighting in the maternity ward to ensure that 24-hour service at the facility.
- Construction of a pit latrine and incinerator at the facility as laid out in the contract.
- Provision for a patients’ waiting area where out-patients including pregnantmothers can comfortably wait to be attended to.
- Quick completion of the facility so that it serves the purpose for which it was constructed.
When AFIC presented the findings and recommendations to Gulu DLG for action, the District Engineer rushed to hand over the keys to the new OPD to the Health Centre In-charge in the absence of the beneficiary community, and without fixing the solar light and water.
On learning this, the locals, with the help of AFIC monitors, insisted that the authorities fix the light and water as laid out in the contract agreement before handing over the facility.
The Result: The District Engineer subsequently instructed the contractor to urgently fix the solar lighting, regardless of the cost. On 6th December, the contractor fixed the solar panel at the new OPD under the supervision of the District Engineer. The District Health Office also instructed the contractor to purchase a water tank and have it fixed before the facility is handed over on 20th December 2021. Pregnant mothers from 7 villages that make up Pakwelo parish can now access 24- hour maternity services at Lapeta HCII. They do not have to travel over 20 km at night to access emergency care from Gulu city. Additionally, the authorities of Gulu City Council took over the responsibility of fixing the remaining items which included; piped/ tap water, pit latrine, incinerator, furniture in the waiting area, and hydro-electric power.
As of 25th April 2023, when AFIC made a follow up visit, the furniture for the waiting area had been constructed, there was a new OPD constructed and water gutters had been pu in place. However, the pit latrine had not yet been built, subsequently, AFIC informed district authorities who took i tup.
Besides Lapito Health Centre, Aywee health centre is yet another facility in Gulu district, that was impacted by AFIC’s monitoring work. When AFIC visited the facility in 2021, there were issues with drug outages, there was no emergencytransportation, and no electricity. AFIC made recommendations to district officials. On 25th April 2023, AFIC visited the centre and found that the health center had electricity and a solar backup system. They had also received a medicine supply in February of 2023 and were currently waiting for more. Emergency transportation and adequate equipment had also been addressed.
While there are many areas for improvement, it is vital to acknowledge government efforts in public service delivery and emphasize the need of community empowerment.
Service delivery can be improved by emphasizing transparency and accountability, access to information, and citizen participation in addition to government operations.
