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The Role of Mhealth in Uganda - a Tool to Reach Development?

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The Role of Mhealth in Uganda - a Tool to Reach Development? The Role of mHealth in Uganda - A tool to reach development? Bachelor thesis in Media and Communication with focus on Peace and Development studies. Authors: Martina Mattsson, Safi Sabuni Supervisor: Renaud de La Brosse Examinator: Tanya Elder Course: 2MK50E Semester: Spring 2013 Abstract Title: The Role of mHealth in Uganda – A tool to reach development? Writers: Martina Mattsson & Safi Sabuni Aim of Study: The thesis addresses mHealth in Uganda and aims to map out how different factors affect the field and what challenges there are in using mobile phones. Method: Grunig and Hunt’s five PR-models, Semi-structured interviews Theories: System theory, Network theory, Critical approach and Feminist Community Action, Westernization Material: Interviews collected in February and March 2013 in Uganda Main Conclusions: By using the theories we concluded that the organisational structures is unorganised due to lack in communication and organisation. We also concluded that many factors affect the field and to reach development in Uganda the organisations need to target the whole system of components. Coordination from governmental institutions and a will for collaboration between NGOs and government is important if a sustainable organisational structure and development should be attained. ICTs such as mobile phones can be a useful tool in reaching this goal. University: Linnaeus University, Växjö, Sweden Program: Media and Communication Program with focus on Peace and Development studies. Semester: Spring 2013 Supervisor: Professor Renaud de La Brosse Examinator: Lector Tanya Elder Key words: mHealth, M4D, ICT4D, NGOs, organisational structure, peace and development, communication, Uganda, System theory i Thanks to The organisations we have had the pleasure to visit in Uganda and that made this thesis possible. “Fredsfamiljen” that makes everything easier and is always a source of knowledge and support. ...and all you others that contributed to our thesis! ii Table of Content Abstract………………………………..………………………………….…….i List of Abbreviations and Acronyms…..……………………….………..…....vi 1. Introduction ………………………………………………......……..............1 2. Background ………………………………………………..………..............2 2.1 The History and the Present …………………….……...………….2 2.2 History of Uganda’s Health Care System …….……...……………3 2.3 History of Mobile Phones in Uganda ……….………...…………..5 2.4. Previous Research.…………………………..……….……………6 3. Research Problem……..……………………………….……………………8 3.1 Research Question…………………………….………………...…9 4. Theoretical Framework and Methods..-……………..….…………………...9 4.1 System Theory……………………………….……………...........10 4.2 Critical Approach…………………………….………….………..11 4.3 Westernization and Modernization……………………………….12 4.4 Feminist Community Action…………………………..………….13 4.5 The Five Models of Public Relation...………………………..…...15 5. Methodology...……………………………………..……………….............17 5.1 The Organisations……………………………….………………...18 5.2 Research Design……………………………………….………….19 5.3 A Critical Aspect of Our Role and Method..………………...…....21 5.3.1 Credibility…………………..………..…………...……..22 5.3.2 Planning...………………..…………………..…...…..….22 6. Results……………………………………...…………………..…...…..…..23 6.1 Mobile Phone Usage…………….………………...………..….….23 6.1.2 Mobile Phones and Gender…………..………….………25 6.2 Project Landscape…………….……………………….....…….….25 6.2.1 Implementation…………………………………….……26 6.2.2 Ministry of Health………………………..…………...…27 6.3 Graveyard of Successful Plan…..………………...………..……...28 6.3.1 Feedback………..………………………..……….……..29 6.3.2 Scaling-Up……………………...…………..…….……..30 6.4 Communication………….………………………...………………31 6.5 Corruption…………….…………………..……………....……….32 6.6 Languages and Literacy….……………………..………....………33 6.7 Infrastructure………….………………………………......……….33 6.8 Gender Issues…………….……………..………………...….……34 6.8 Conclusion of Results……………………………………………..36 7. Analysis…………………………………………………............…….……37 7.1 Lack of Coordination.………….………………...………….……38 7.2 Ministry of Health….……….………………………...…….…….39 7.3 Donors and Scaling-Up ……….………………...………....……..40 7.4 Hierarchy and Power…………..……………………...…….…….42 7.5 Corruption in the System ………..…………………...…….……..45 7.6 A Tool or Solution for Development …..……...…………….……46 7.7 Gender Divide…………………………..……...……….…………46 8. Conclusion and Suggestions for Further Research.…………..……….……48 8.1 The Big Picture………………………...……..……………….…..48 8.2 Collaboration before Competition……...…..…………………..…49 8.3 The Fifth Model……………………………………………..…… 51 8.4 Health Care Structure……………………………………………. 52 References………………………………….………........……………..….….53 Appendix 1 – The Organisations….…..………..………………………..…...58 Appendix 2 – The Interview Guides………..……...……………………..…..59 Appendix 3 – The Interviews……...……………..……...……………….…..62 Appendix 4 – Ministry of Health Moratorium……….………………...…...116 v List of Abbreviations and Acronyms $ - United States Dollar eHealth - Health supported by Electronic process and communication GDP - Gross Domestic Product HDI - Human Development Index HMIS - Health Management Information System ICT - Information and Communication Technology ICT4D - Information and Communication Technology for Development LRA - Lord's Resistance Army M4D - Mobiles for Development MDG - Millennium Development Goal mHealth - Mobiles Phones and Health MoH - Ministry of Health mTrac - Mobile phones and tracking (Monitoring essential medicine supply using mobile phones) NGO - Non-Governmental Organisation PDA - Personal Digital Assistant SIDA - Swedish International Development Cooperation Agency SIM Card - Subscriber Identity Module Card SMS - Short Message System SPIDER - The Swedish Program for ICT in Developing Regions TIU - Transparency International Uganda UN - United Nation UNDP - United Nation Development Programme UNICEF - United Nations International Children's Emergency Fund US - United States USAID - United States Agency for International Development U-report - Mobile phone users with the tools to establish and enforce new standards of transparency and accountability in development programming and services WOUGNET - Women of Uganda Network VHT - Village Health Team List of Tables 1. Statistics of Uganda 2. Health Center Structure 3. Hierarchal Structure 1. Introduction To start with, we are communication students specializing in peace and development and therefore interested in communication and its impact in low-income countries. When deciding on a topic for our Bachelor thesis the field of Information and Communication Technology (ICT) was interesting to us. Mobile phones are a commonly used tool for achieving development. In addition, mobile phones are an easy accessible communication tool and widely used in low-income countries (Wicander, 2010). Furthermore, another topic that is common in development is health. Health covers three of the Millennium Development Goals (MDGs) and is recognized as one of the main factors of poverty in the world (UN, MDG, 2013), making it, in our opinion, a very important field. The fields combined are called mHealth (mobiles and health) and it refers to all that includes mobile technology that facilitates the communication in the health sector such as reporting irregularities and corruption, creating awareness and informing about diseases as well as reminding patients about health visits, vaccinations and treatments (Unwin, 2009). During the first stages of our research we noticed that there is a knowledge-gap and that many reports was positive towards mHealth but few have described any negative effects of implementing mobile phones in health. That is why in this thesis we try to question what challenges there are in mHealth, how the challenges impact the field and what can be done to improve mHealth. To give a sense of mHealth we will outline how mobile phones are used as a communication tool in different projects. Several interviews have been done in Uganda in order to answer the questions. Uganda is a country that is positive towards new innovations thus creating an acceptable platform for establishing Information and Communication Technology for Development (ICT4D) programs and projects, the country is developing rapidly within the field of ICT4D and therefore we have chosen to conduct the research in Uganda. 1 2. Background 2.1 The History and The Present To understand the situation in Uganda we will present a summary of the modern history of Uganda, and the impact it has had on the situation today. Uganda is called the pearl of Africa because of its green valleys, many lakes and mountains. (Landguiden 1, 2013) In the beginning of the 20th century Uganda was a relatively peaceful nation despite British colonial rule and was a country that had an expanding agriculture. It wasn’t until the 1940’s that dissatisfaction started to emerge in Uganda and the people started to oppose the British rule. The dissatisfaction resulted in independence in 1962 and Milton Obote became Prime Minister. (Säkerhetspolitik, 2013) Obote ruled until 1971 when, in a military coup, Idi Amin gained power. Amin managed to kill much of the wildlife, kill over 300 000 Ugandans and destroy the economy of the country in eight years. In 1978 he tried to take over power in Tanzania but failed, instead the Tanzanian army managed to defend their country. Meantime, the world had grown tired of the political regime of Amin and in 1979 he was overthrown when the Tanzanian army invaded Kampala and forced Amin to surrender. Obote was reinstated as president but the people of Uganda continued to suffer greatly since researchers have shown that just as many people died under Obote’s rule, since Obote
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