Governance for Community Health Improvement in Uganda: Community perspective


By Robinah Kaitiritimba and Moses Kirigwajjo

As we join the rest of the world to celebrate the Universal Health Coverage (UHC) day, under the theme “Act with Ambition”, Uganda National Health Consumers Organisation (UNHCO) adds the community voice for health production and service utilization as governance issue for community health improvement in Uganda Communities perceive health as a service that should be provided entirely by the state. In contrast, UHC agenda underpins the benefits of community inputs and responsibilities to generating and utilizing health services. Communities can be mobilized and sensitized on their rights and responsibilities to produce health at households and family level through community participation which is the collective involvement of local people in assessing their needs and organising strategies to meet those needs plays a pivotal role in health production by the community.

Community participation in health basically means that communities take responsibility for their own health through: adoption of good health  behaviors to prevent and treat diseases such as good sanitation, hand washing at critical moments, seeking medical attention early from the nearest health facilities, avoiding self-medication, proper nutrition, proper use of mosquitoes nets etc; eeffective participation in disease control activities including bulungi bwansi-general cleaning of the environment and homesteads; contribution to the design, implementation and monitoring of health programmes and provision of resources for health through community trusts, existing informal groups, social enterprises and independent sector providers increasing access to equitable health care.(WHO, 2009). Health will then be viewed by community members as a right as well as a responsibility that promote the general wellbeing of society as product not only as health outcome. Therefore community participation and prevention should inform priority setting in UHC agenda because the biggest burden of morbidity and mortality whether from communicable or non-communicable diseases can be prevented.

Limitation in realising community participation and prevention of diseases has raised household out of pocket expenditures and clinical investment by government. A changed orthodox approach to more collaborative relationships among partners, individuals, families, citizens, patients, care takers, consumers and health care professionals will be required for engagement and streamlining governance. Governance in health is mainly about people and how they live and create health in the context of their everyday lives (Ruger, 2010). Therefore communities can also exert their collective voice to influence policy, strategies, and expenditure priorities at different levels of policy making; which through systematic tracking of processes and activities, individual community members and groups can ensure timely and quality services that address their needs and respond to their expectations through Good governance and Accountability. Involving communities in the governance of their own health awakens their “sleeping power” and empowers them to point out shortfalls in governance. Working with the duty bearers improves responsibility and ownership of programmes, but also follow up and sustainability which restores community confidence in the service providers



The current struggle to guarantee Universal Health Coverage (UHC) to citizens is partly due to the rising levels of household out of pocket expenditure and huge clinical investments by government. Community participation and disease prevention will guarantee community ownership and appreciation to continuous generate their health for good wellbeing.Achieving UHC is a political process that involves continuous negotiations among stakeholders with varied interests. A change from a state-centered model to a collaborative one, in which governance and health is co-produced by a wide range of actors will promote equitable access and financial protection which is the focus for UHC.


Ms. Robinah Kaitiritimba is Executive Director of Uganda National Health users’/Consumers’ Organization (UNHCO). Mr. Moses Kirigwajjo is Programme Officer, Social Mobilisation for Health at UNHCO.