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Greetings from Gulu: Meeting with District Health Office

March 20, 2010

(Blog entry for Wednesday, 3/17/2010, posted on Saturday, 3/20/2010 due to lack of internet connectivity)

Today, our team traveled 328 km northwest of Kampala to Gulu.  Our first impression of Gulu is that the weather is much hotter and the climate is much drier compared to the very green and cooler Kampala.  Gulu is the largest town in Northern Uganda with a population of roughly 113,000.  Although the town is quite safe now, it was heavily influenced by civil war and rebel conflicts for decades. Many internally displaced persons (IDPs) flooded to this town from neighboring areas of conflict.  Only in the past few years have they slowly moved back to their villages.  The past presence of IDPs is still noticeable in the many huts, “manyatas”, that scatter the region, not to mention the many IDPs who decided to remain in Gulu instead of returning to their villages.  Another piece of recent history that shaped many of our discussions was the October 2000 outbreak of Ebola in the district, which claimed about 160 lives and sparked the interest of collecting data on epidemic diseases in the region and creating protocol for rapid response.

With this history as a background, our mission in Gulu was to meet with representatives at the District Health Office and discuss the SMS-based pilot project that is currently being implemented there.  The pilot project, as mentioned in previous post, allows health centers (HCs) to submit their reports to the district level via SMS instead of the traditional paper system. We received a warm welcome from three representatives to discuss their experience in switching over to the SMS-based system.  Besides learning more about the structure of data flow from the village to ministry-level, below are some key points to consider from the perspective of Gulu District Health Office:

1. Advantages of SMS system: a) fast, easy, and no transportation costs for sending paper reports; b) no need for paper because keeping constant stock of forms have been a problem; c) paper records take up a lot of space in the office

2. Advantages of paper system: Although slower and requires more resources (forms), the paper system offer advantages in terms of data accuracy and validation.  The traditional paper system allows each level time and opportunity to review the data.  This was a key reason why some hospitals / health centers in this district had refused to participate in the Rapid SMS system. They fear that information may be transmitted and shared too quickly without proper validation through the levels of the traditional chain of data flow.

3. Possibility for best of both worlds: Using the SMS system, find a way to allow different participants in the traditional chain of data flow to validate or make comments on the information via the internet.  However, this will require each level to have internet access and be trained for this new process of validation.

4. Ways for information to flow back to community: a) display submitted reports online for all levels of the data chain to see how they are performing and how they are doing in comparison to others, b) display a summarized version of the reports and distributed via a paper bulletin or SMS message, c) utilize quarterly review meetings to display and discuss summarized reports at the various levels.

All in all, it was a very productive meeting, which will greatly prepare us for our meetings to the Awach Health Center III tomorrow with representatives from the HCs, members of the VHTs and some IDP households that are in the nearby area.  We are super excited to learn more about their roles and their perspective on this project.

Signing off from peaceful Gulu,

Ruby (Uganda Team)

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