Accountability and Action: Women Lead the Way for Family Planning in Uganda
By Alyson Lipsky and Anne Jorgensen
From exam rooms in community health clinics to meeting rooms in ministries of health, timely and accurate data are key to developing and implementing family planning policies and programs. But what happens when those tasked with using data for decision making don't make those decisions? Or what if they make decisions based on incomplete or inaccurate data? Who is accountable for data quality? And how are they held accountable? A group of women leaders for family planning in Uganda explored these questions through a participatory assessment shared among family planning stakeholders, and are now showing that they can begin to answer those questions and map a way forward.
After attending a workshop on leadership and accountability for achieving Uganda's FP2020 commitments, hosted by the USAID-funded Health Policy Plus project, the women identified poor data capture and reporting as one of the barriers to achieving the country's family planning goals. Over the last several months, the women leaders conducted interviews in Iganga District to assess relevant accountability relationships, seeking to better understand how family planning data is captured and used at the district level, and then reported up to decision-makers. High-quality family planning data capture is a complex enterprise with involvement from multiple health workers and officials, and is vulnerable to errors and slip-ups. The women found that health workers and administrators within the district, who bear the burden of collecting and using family planning data, are not incentivized to do this work well. While each player understood their own role in capturing and using data, the interviewees were unaware of the contributions made by others. Some didn't even see the relevance of their own work to the bigger picture.
After learning about assessment findings at a recent validation and dissemination meeting, Iganga District officials are already planning to address some of the challenges revealed. Officials are taking some of the steps recommended by the women leaders, and will:
- Organize training for a variety of staff on key family planning indicators
- Establish regular meetings for all relevant partners at the district level
- Sensitize all district leaders on the importance of family planning to development
- Advocate for continued support for village health teams to collect family planning data
Regarding the significance of the assessment findings, one of the women leaders remarked, "This information, it is going to help us learn what we can do better ... Because what we learn from Iganga, we will be able to scale up to other districts. It is high time that FP data management and use gets to the agenda. This is the evidence that we will be able to use to move forward."
The women leaders leveraged their enthusiasm at a stakeholder session in Kampala on June 29, where representatives from government, donors, local nongovernmental organizations, and implementers gathered to learn about the assessment findings and discuss the women's recommendations. Participants acknowledged that the findings from Iganga were representative of other districts. As such, they were interested in expanding the assessment, better understanding the responsibilities of key actors, investing in training for health sector employees to use family planning data, and learning from best practices in continuous quality improvement.
As next steps, HP+ and the women leaders will track Iganga District with excitement as local leaders begin to improve family planning data capture and use, and strengthen the accountability mechanisms required to sustain these improvements. Similarly, dialogue with national stakeholders will continue to identify the most relevant and feasible actions by the women to catalyze improved accountability for high-quality family planning data demand and use.
Those of us who work toward stronger health systems in developing countries are wise to remember that health systems are but a series of intricate, complex, overlapping relationships among a host of diverse stakeholders (Brinkerhoff, 2004). Each actor plays a role in holding the system together and making it stronger. As we are learning, exploring accountability linkages and fostering accountability can catalyze action for policy and program implementation.
For more information on HP+ women's leadership activities, and other similar assessments that women leaders are undertaking in Malawi and Kenya, see http://www.healthpolicyplus.com/womenLeaders.cfm.
Alyson Lipsky is a health governance specialist on the Health Policy Project (HP+) and at RTI International. Anne Jorgensen is a technical director for health at Palladium and technical lead for advocacy and capacity development on HP+.