Proof that democracy works? Health Services and Community-Based Monitoring in Uganda

Jun 12, 2008

Recent research by Martina Bjorkman and Jakob Svensson for the Centre for Economic Policy Research investigatez the impact of community based monitoring on the quality and quantity of health services in Uganda.

As communities began to monitor local health service providers, both the quality and quantity of health servicesimproved. One year into the program, Bjorkman and Svensson found large increases in utilization, significant weight-for-age gains of infants, and markedly lower deaths among children.

A Citizen Report Card methodology was used to record the experiences and preferences of communities and fed back to service providers. Communities also monitored whether their recommendations and desires were implemented. This mechanism created the incentives for improved health service delivery.

The results suggest that community monitoring can play an important role in improving service delivery when traditional top-down supervision is ineffective.

This project was designed by staff from Stockholm University and the World Bank, and implemented in cooperation with a number of Ugandan practitioners and 18 community-based organizations. The 50 project facilities (all in rural areas) were drawn from nine districts in Uganda and reached approximately 55,000 households. Thus the project has already shown that it can be brought to scale.

Macro-level research by political scientists has underlined the importance of the so-called ‘democratic dividend’. While the link between democracy and concrete benefits to citizens can seem tenuous on a large scale, this project demonstrates that the links are much clearer at a local level.

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  1. Community-based monitoring is a wonderful idea, provided the people being monitored and the authority responsible for them are willing to be part of it and to respond to any criticism or suggestion. I’m not sure that this will be the case in SA. If the calloussness and laxity of staff in state hospitals are used as indication, I would think not. Add to that a government in general and a Ministery and Department of Health in particular that tolerate no criticism and our situation looks rather hopeless. I’m sorry if I sound totally pessimistic today, maybe I’ll feel better tomorrow!

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