“A single leaf provides no shade,” goes a popular saying here in Uganda. As a Ugandan health advocate working to bring voices from every village of the country to bear on improvements to health, this saying means that one person can achieve very little alone. But together, we can accomplish much.
Our motto at Advocacy for Better Health (ABH) expresses this same sentiment: “Where everyone is accountable, everyone wins.”
Accountability in the highest ranks
In Kampala in late September, as dignitaries exited their cars upon arriving at the country’s first-ever National Presidential Dialogue on Quality of Health Services, I reflected on what “everyone” in our motto truly means. For me, this event—which was organized by ABH in partnership with the Uganda Parliamentary Forum on Quality of Health Services (UPAQHES) and other civil society stakeholders—was evidence that after three years of work to elevate the concerns of citizens, health workers, and civil society, we had finally gained the ear of the president and the country’s most powerful decision-makers.
During the day, more than 400 people supported the call for increased funding for health and interventions to improve the quality of health services—including cabinet ministers, members of Parliament, resident district commissioners, district chairpersons, and other leaders. Speaker after speaker, including the first deputy prime minister, the Right Honorable General Moses Ali (representing the president), and the deputy United States ambassador to Uganda, took to the stage to make commitments addressing the need for a variety of health service improvements. Issues of critical concern included human resources and lifesaving health commodities. The dialogue was covered live on national news media, giving the public an opportunity to participate.
Professor Francis Omasawa, the former director general of Health Services at the Ministry of Health, delivered the keynote address. Speaking about preventable maternal and child deaths, he said, “Unless we in Uganda individually and collectively feel the pain and the shame of poor health services, we will not have the commitment…to correct our situation.”
“Pain and shame”
In many ways, bringing together Uganda’s most powerful decision-makers to address the “pain and shame” of suboptimal health services was long overdue. In Uganda, maternal and child mortality rates are unacceptably high, basic medicines are often unavailable, and high-quality health care in public facilities remains elusive. Corruption sucks money from critical services—and all too often, important health decisions are politically motivated.
At ABH, we use the power of advocacy to break this cycle of neglect. We work in communities to nurture and deploy health advocates who demand high-quality health services and hold duty-bearers accountable. As a result, changes are happening countrywide. Maternity beds have replaced dirty mattresses on floors. Lights have come on where previously there was no electricity. New staff are being posted at health centers to meet patients’ growing demand for modern health care. Budgets are being newly allocated for staff housing, operating theaters, and maternity wards. In 2015, we were able to avert a national stockout on HIV and TB medicines by making the crisis visible to donors and politicians.
These are just a few examples of the people-driven successes that ABH has made possible.
Top of the pyramid
But to truly transform health in Uganda, we need more from those at the top of the decision-making pyramid—and we must connect the dots between the grassroots and those we elect to power. We now have advocates in the highest ranks of government, like the energetic parliamentarians Herbert Kinobere and Rosette Mutambi, who founded and chair the UPAQHES—one of Uganda’s most active and dynamic parliamentary forums, with over 200 members.
Of his motivation, Hon. Kinobere recently said, “As a member of Parliament, people should benefit from me—not the other way around. I believe this forum can be a voice, and that soon we will see real results on the ground.”
A single leaf provides no shade
I am proud of the momentum that ABH has created to gain the attention of the highest decision-makers in the land. But we cannot—and will not—stop there. We have to continue to bring the peoples’ voices to the politicians, to remind them of the pain and struggles their constituents face every day in accessing basic health care. We must now work together as multiple leaves, which will create the “everyone.” Where everyone is accountable, everyone wins.