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Betty Nyaketcho is 32 years old and before this year, had never been at a health care unit. Strange, but true. Nyaketcho is one of the many community members of Kiyeyi village that struggled with poor health services.

Back in 2008, there were only three staff and not one midwife at Kiyeyi Health Centre, located in the extreme east borderline of Uganda, 230 kilometers (about 143 miles) from the capital, Kampala. John Lubuuka, the medical officer in charge, said that there were a lot of complaints, personnel arrived late and were overworked, and drugs were regularly out of stock.

Amito Susan Picho, one of the clinic’s nurses, said that the relationship between the community and the staff “wasn’t so good.“

“There would be drug stock outs. So it created a rift between the health workers and the community which meant patients didn’t come in high numbers. [When] I joined here, no outpatient department [staff] turned up, patients were quite few in number, we had few mothers that came for antenatal [care], and few mothers who would come for deliveries and even fewer children that were brought for immunizations,” said Picho.

In this problematic scenario, World Vision’s approach called Citizen Voice and Action (CVA) was implemented. CVA is a methodology that equips citizens with tools to research their government’s commitments to the quality of public services such as schools and health clinics. With this information, communities carry out a series of exercises that compare reality with those commitments. Finally, working collaboratively with government and other key stakeholders, communities press for change.

“There were a number of problems the community could not understand. When they brought us together [through CVA] we could understand what the community was thinking about us and adjust accordingly,” said Lubuuka.

A number of meetings were held at the clinic. Community members were introduced to national government health standards and were able to score their clinic based on community generated measures. The meetings came after many months of education campaigns on government standards, civic obligations and entitlements. The gatherings involved all the clinics’ stakeholders including local politicians, clinic and government staff as well as the community. Since the meetings and the community lobbying that followed, staffing has increased from three to eight nurses and two midwives.

“The relationship is quite good right now because there are so many patients around, the number of mothers who come for deliveries has increased, the number of children coming for immunizations has increased and we also have a very high number of outpatients, [also] so many mothers come for antenatal [care],” said a local health professional.

Currently, the clinic reports that outpatient numbers have increased from 500 a month to 1,500. There is now an average of 15 women a month that give birth at the clinic. This number is still low, but it is triple the number prior to the introduction of the CVA approach.

John Willy Mungoma, Tororo District health and education promoter, said that the joint force of politicians, staff and community members lobbying together influenced the District’s decision to recruit an additional midwife.

“When the complaint came to us, we saw that they really needed somebody else to go there and support them and that is how we decided to post the midwife,” said Mungoma.

“We had a dialogue [through] CVA last year between the community and the health workers, where we brought up a complaint ... We were really so, so impressed when after that short time we raised that issue and immediately a midwife was brought,” said Picho in regard to the addition of a second midwife at the clinic in 2011.

Mungoma said CVA had also assisted the District to plan services and recruitment.

When World Vision staff visited the clinic in January 2012, there were at least 50 people waiting to receive treatment and immunizations for their children. One of those waiting was Betty Nyaketcho. The CVA approach enabled people just like her to improve living conditions in their own community.

“She [a friend that had previously received health assistance] told me that when she came to the clinic, they tested her and she got treatment immediately,” said Nyaketcho, “[On my first visit], the children improved after they received the treatment.”

One of Nyaketcho’s children was suffering from malaria and received drugs for an effective treatment.