For five years, Nurse Akiya Pauline Grace solely operated Madi Kiloch Health Centre II in Padibe Sub County, Lamwo District. Nurse Grace offered services to the community as the in charge, nursing assistant and midwife—all at the same time. This situation went on ‘unnoticed’ until 2012.
A community led monitoring visit in 2012 to Madi Kiloch Health Centre II revealed that Nurse Grace was the only person working at the Health Centre serving about 1,000 people. The monitoring visit did not only unveil the inadequate staffing problem at the health centre but also brought to light the lack of infrastructure at the health centre.
It was revealed that the health centre did not have a water source and patients had to fetch water from a borehole 2kms away. It was also revealed that the health centre did not have labour beds and mothers would give birth on the floor. Further still the solar panels at the centre were not working , hence no lighting. “Mothers give birth using candles or phone light or torches” commented a community member.
The community monitors led by the Organization for the Development of Women in Lamwo (ODOWOL) wrote a report of the findings which they presented to the District Leadership including the District Health Officer and the Local Council V Chairperson. A second visit together with the district leadership was then organized to the health centre.
The situation at Madi Kiloch Health Centre II attracted the attention of journalists from Mighty Fire FM in Kitgum who made a public appeal to seek support for improving the standards at the health centre. The appeal did not fall on deaf ears, the Rotary Club of Kitgum heard the appeal and came to the rescue of the Padibe West community members.
The Rotary Club of Kitgum provided 40 Mama Kits, 1 labour bed and 2 resting beds (after birth) to the health centre. The club also supported the recruitment of 3 extra staff who were posted to the health centre. These staff recruited include 1 enrolled nurse, 1 midwife and 1 nursing assistant.
Local Actions for Quality Service Delivery
For positive social change to happen, communities need to get involved in service delivery and exercise their role. Community monitors, civil society organizations and local groups have campaigned against the poor service delivery in their own communities.
The documented local actions have taken different forms. Some have happened in small, everyday actions and others in creative ways using large–scale or far reaching avenues like the media. Rooted within the community, the community members create a push from the inside—their actions being the most powerful in improving service delivery in their localities.
Empowering the local communities has revealed the power of demand–side approaches in enhancing governance through the concepts of citizens’ voice, accountability, and responsiveness. It has provided lessons on the establishment of social accountability mechanisms, thereby empowering the local communities, who represent a majority of society.
Far from being passive observers of development and governance discourse, an increasingly vigilant civil society is critiquing, monitoring, and contesting the role of the state and its institutions in shaping and controlling the forms of governance. Working against heavy odds, many civil society groups have demonstrated the power of ordinary people in bringing about changes in service delivery.