Uganda has made important progresstoward meeting the Millennium Development Goals, includinghalving its poverty rate to around 20 percent from more than50 percent in the early 1990s. But healthcare, especially inthe rural areas, is generally of poor quality. Smallclinics, known as dispensaries, provide care to Uganda’srural residents. The clinics offer preventive, maternity,and outpatient care, as well as lab services. All servicesare supposed to be free. Six to 10 people staff mostclinics, including a trained medical worker, nurses, nursingaides, and others. But roughly 50 percent of the staff areabsent on a typical day and patients’ average wait timeexceeds two hours. Uganda’s health sector is decentralizedand Health Unit Management Committees are supposed to be thelink between the community and the facility. In practice,there’s little action on the part of the committees in termsof supervision or support. In 2005, a World Bank supportedteam decided to test the impact of a program to encouragerural residents to get involved in local health caredelivery. Community members and health staff were givenreport cards grading the quality of local clinics, includinginformation about specific clinic operations, absences andthe quality of care. Meetings were facilitated betweencommunity members and health facilities to allow them todraw up a shared vision of what was needed and make a planto achieve this. A year later, the evaluation found that thequality of healthcare improved, as reflected in lower childmortality and improved child weight. In 2007, the teamexpanded the project in order to test whether just bringingpeople together with health providers for meetings andencouraging community monitoring processes, withoutproviding report cards, could be as effective.
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