By Edward Maalo Ssemugenyi & Andrew Kawooya Ssebunya, Coordinator for Mwananchi Uganda.

Working with political realities is a fact of life for civil society organisations trying to create opportunities for citizens to express their views and wishes to their political representatives in low accountability contexts. So when a local MP in Kalangala district, Uganda, used a citizen forum to promise community benefits that seemed more designed to ensure voter support than build sustainable public services, Mwananchi partner the Kalangala District NGO Forum (KADINGO) had to think hard about how to work with the MP to deliver the best outcome for local people.

‘May you heal’ and ‘do not pay for it’ are the words that appear on the front of an exercise book provided to patients that seek health services from public health centers.  Although Uganda’s health services are ostensibly free, patients are required to purchase these books to record their symptoms and diagnoses, a small expense (300 Ugandan shillings or US$0.11) that some are nonetheless unable to stretch to. Books like this one, however, were provided free of charge by the MP for Kalangala district, the Hon. Carol Nanyondo, after a citizen forum organised by KADINGO, where citizens expressed this need.

Hidden costs are not the only challenges and constraints facing Kalangala’s health services: among the 64 inhabited islands of the district, only 12 have health units.  Even there, there are other challenges such as insufficient drugs, medical equipment and irregular attendance of health workers, indeed, Kalangala does not have a single practicing doctor. The situation is even worse for maternity needs, with mothers depending on Traditional Birth Attendants because midwives and maternity services are very inaccessible. 

KADINGO’s Mwananchi pilot project, “Improving access to quality maternal health services in Bujumba sub-county through increased citizens’ engagement with health workers and elected representatives”, builds the capacity of community members to engage their respective elected representative, media and CSOs through the Kalangala Round Table Initiative.  This process brings together all the main governance actors, including elected representatives, civil society and local radio stations, to discuss health issues. 

During a roundtable held in March 2012, the community members of Bujumba raised a number of challenges around access gaps to health services due to distance and absence of health workers, insufficient drugs and medical equipment and facilities such as mattresses.  They also mentioned the issue of the exercise book. In response, Carol Nanyondo MP said that she saw the exercise book as a minor issue that shouldn’t need to be discussed at the roundtable and pledged to provide the stationary and some mattresses – and to leave the district government to worry about filling the other health gaps.

After nine months with consistent follow up from KADINGO, the MP delivered on her promise and provided the stationary and five mattresses to each of the 12 health centres.

By providing a tangible benefit, particularly one marked with her photo, Mrs Nanyondo is clearly building political capital for future elections.  And by choosing to purchase a one-off benefit, rather than work with the district government to improve the local health care structures and supply chain, she is dodging a far more complex problem. But at the same time she has removed one immediate obstacle to free health care facing the poorest citizens of Kalangala.

It is an ambiguous issue and one that should be understood within the national context. Civil society and citizens have found it difficult to work with MPs in the country because of diverging expectations and low engagement from MPs.  Many citizens do not understand that MPs are policy makers, responsible for improving services through policy change, not direct service providers themselves. In other areas in Uganda where the Mwananchi programme has struggled to work with MPs, the reason is often that the elected leaders find the areas of operation have low political capital or the focus of the project has no direct link to political functions.  Civil society has failed to find a way to build on MPs’ desire to consolidate political power by linking it to local accountability. In this sense, the exercise books and mattresses can be seen as stepping stones for further engagement between the MP and citizens.

KADINGO has demonstrated that linking service provision to politics can bring action.  What the project now needs to do is to find ways to build on the initial response of the MP to intervene in other areas of service delivery such as increasing staff attendance and regular medical supplies by engaging duty bearers in the local and national government. They need to link the citizens’ voices to accountable political functions: citizens need to know that it is their right for the elected leaders to give voice to their needs.  They should question the role of the political leaders in transforming their lives not only by giving but through influencing the delivery of basic services.

Creating spaces for accountability in highly unaccountable environments is not easy: Mwananchi is learning from projects like that of KADINGO to find ‘what works’, emphasizing the importance of local context. While the exercise books may not be an example of a well-functioning link between citizen voice, policy-makers and service delivery, they do show how interlocutors like civil society organisations can find ways to work with local realities to start creating change. 

We welcome readers' comments. Do you have any suggestions or questions about how local civil society can work with the grain of political realities to help secure lasting accountability for ordinary people?