Community Power in Evidence !

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Community Power in Evidence !

Organization type: 
nonprofit/ngo/citizen sector
$250,000 - $500,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

This idea highlights bad and good practices at hospitals through a combination of hospital users voice through community representing body and decentralized structures decision makers. It unlocks capacity laid down government strategy for health district development to enable social control at district level. It does this by scoring health units and using results to influence decision making.

About Project

Problem: What problem is this project trying to address?

Public hospitals in most sub saharan Africa usually provide healthcare at affordable price to their communities, however the quality of service is not always the best. Thus the poor have to resort to selling property in order to afford private healthcare or use services of traditional doctors or die. This is usually as a result of governance issues by health authorities. Good governance will positively affect quality of service - lack of accountability and citizen participation was shown to increase the rates of unsafe injections, poor hospital waste disposal and questionable hospital supplies contracting protocols. In a study carried out in 4 DHS in Cameroon by SNV, 44% of injections were unsafe; 90% of hospital waste disposal methods were environmentally corrupt; 60% of healthworkers did not change gloves; and the most common excuses (92%) included patient affordability, stock outs, and ideology. These excuses are not plausible; eg, patients paying for consultation or labs fees are entitled to a pair of gloves and should therefore not buy gloves. Healthcare workers economize for corrupt reasons. Unsafe injections are estimated to result in 67 new HIV infections per year per DHS

Solution: What is the proposed solution? Please be specific!

The approach is easy to use and cheap to develop. It is user centered and is controled by community representing bodies. The quickly evident results are easy to understand and usually presented in a manner that is easy to monitor over time for improving outcomes. It operates at decetralized level - the health district service. It provides evidence needed for influencing decision at district level and has potential to influence response of health district authority through involvement of media discusions, debates and dramas. Due to its simplicity, it is easy for replication by local capacity building organizations. It is accessible to both non literate and literate patients unlike suggestion boxes which require that patients know how to write. It consists of a set of 39 questions covering hospital accountability, access, equity, quality of service, empathy and rule of law. The project will help ensure patient protection which at the moment is non existent in most Sub Saharan African countries. It will also help healthcare workers to do the right things right which is the main principle of evidence based healthcare.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

Increased community (patient) participation in managment of 2 district health services (DHS) A total of 66 hospital practices have been influenced with hospital managers responding to 31 of these resulting in improvement of quality and efficiency of services after about 5 months of using this innovation. The community are now contributing to evidence informed policy amking at district level. Increased hospital quality of service; 1 DHS passed laws on illegal drugs sales to patients by nurses, 2 DHS passed laws all patients payments must be accompanied with receipt issuance in order to reduce patient extortion, reduce unsafe injections and ensure quality drugs are sold, 1 inneficient chief of centre at Baba I was replaced, outreach to innaccessible communities were initiated leading to an 80% increase in efficiency. Increased utilization of public health services has been noticed at district level as more efficient staff are moved to more demanding departments like maternirties and children wards. Improved hospital hygiene as seen in 1 health unit respecting recommendation to build an outpatient toilet, 2 out of 3 hospitals respecting recommendations to employ a yard cleaner, 1 out of 3 health units respecting recommendations to introduce beddings on hospital beds. Some Quotes from the field: ‘We are happy that a small tool like this one can direct us on the best improvements to make’ John Boneke, Chairman of Ndop DS. ‘This is what we will need to make decisions with the decentralization process’ Ntoh Daniel, Mayor of Ndop Municipality. ‘If the people reject you the government will also reject you’ Divisional officer of Ngoketungia on being asked by the DMO for his authority for him to use results of CSS to replace the chief of center for BABA I. ‘This tool will now be used not only for public hospitals but also to private hospitals in the health district, wherever there is failure action will be taken’ DMO of Ndop DHS.
About You
Netherlands Development Organization
Section 1: You
First Name


Last Name



Netherlands Development Organization (SNV)



Section 2: Your Organization
Organization Name

Netherlands Development Organization

Organization Phone


Organization Address


Organization Country


Your idea
Country and state your work focuses on
Do you have a patent for this idea?


Development of a tool for measuring quality of care by assessing users satisfaction with quality of service was supported by SNV.
A medical school was contracted to assist community representatives in developing the idea into a tool for assessing and using users voice.
Capacity was built in community representative bodies to use (implement and analyze) tools in 2 health districts of Ndop and Ndu in Cameroon.
SNV continued field monitoring of innovation as well as ensuring skills were being transfered from health district level to health area level.
SNV continued coaching community representatives on scaling out; exploring new avenues and educating their peers in innovation naive DHS.
SNV is facilitating development of media DDDs (Discussions, Debate and Dramas) from results to increase patients information on their rights to health
SNV is working with government partners to broker knowledge developed from the innovation with the hope of passing the baton to the ministry of public health.
SNV is looking into options of making the innovation mobile with the use of mobile phone text messages to patients through a secure server which can be accessed by community representatives


Increased community participation in decision making at district level will replicate accross the country and leading to more user centered decisions being made by hospital authorities. This will lead to improved quality of care to patients, reduced number of hospital acquired infections, more environmentally friendly hospital waste disposal, more affordable healthcare and increased efficiency in staff.
These results can be measured both qualitatively and quantitatively by this innovation; this is because a hospital's score can be monitored against the number of measures taken in response to scores over a period.
An investment into a national introduction of this innovation will result in about 80% improvement in efficiency and quality of healthcare services; it will also reduce about 60200 new hospital acquired infections (calculated on HIV, HBV and HCV only) annualy.

What will it take for your project to be successful over the next three years? Please address each year separately, if possible.

Year One.
Community ownership of the innovation
Government committment to support the project through laws recognizing the legitimacy of the innovation and support for upscaling.
Government or development organizations investments in implementation of tools; this costs about 1600USD per health district as a one time spending.
Year Two
Development of peer reviewed papers on the intervention and publications of results.
Incorporation of users voice utilization into curricilum of medical students and continuing medical education programs.
Year Three
Development of the mobile version of the innovation

What would prevent your project from being a success?

Lack of finances to kick start the project
Lack of community ownership of the project

How many people will your project serve annually?

More than 10,000

What is the average monthly household income in your target community, in US Dollars?

Less than $50

Does your project seek to have an impact on public policy?


What stage is your project in?

Operating for less than a year

In what country?


Is your initiative connected to an established organization?


If yes, provide organization name.

Netherlands Development Organization

How long has this organization been operating?

More than 5 years

Does your organization have a Board of Directors or an Advisory Board?


Does your organization have any non-monetary partnerships with NGOs?


Does your organization have any non-monetary partnerships with businesses?


Does your organization have any non-monetary partnerships with government?


Please tell us more about how these partnerships are critical to the success of your innovation.

Partnerships with government facilitates ownership of this innovation as there is support from the ministry of public health in the form of legitimacy and finance for community representing bodies.
Partnership with academic institution facilitates the incorporation of innovation into medical students curriculum to ensure sustainability and scaling.
Partnerships with NGOs helps with skills transfer to local capacity building organizations; this also includes partnerships with community radios to reach out to populations using hospitals in local dialects and inform them of their rights to health.

What are the three most important actions needed to grow your initiative or organization?

Upscaling the initiative to national level: So far this has been used in 2 disrict health services. These have adequately owned the process and can transfer skills and experience to other district health services.
Development of the Media DDD (Discussion, Debates and Dramas) concept based on results of users voice.
Incorporation of user voice utilization skills into medical students curriculum

The Story
What was the defining moment that led you to this innovation?

When I quit my job as young director at a private hospital, because I felt poor people were being exploited by private hospitals, I thought I could make a difference at a public hospital where healthcare was more affordable. When I started work at a public hospital I found out that it was not lack of money that made people vulnerable to exploitation but lack of information. I found out that healthcare workers were exploiting the ignorance of the community through corrupt means and providing them with bad quality service which sometimes actualy contributed to morbidity and mortality.
Community members were paying for their own death and infirmity in total ignorance. Hospital workers ran the public hospitals without any accountability and took decisions like mini-gods. Injections vials and syringes were reused; gloves were not changed etc despite the fact that individual patients were paying for these. It was extremely difficult to fight this from within as it naturally attracted more patients to your consultations room and bred contempt from other colleagues. I also noticed that just as good practice attracted more patients so did it have the potential of high turn over a concept which healthcare workers had not thought of. After witnessing many patients die because they did not have extra money to bribe the surgeon to get a surgery, I embarked on developing a tool to empower patients to influence governance and quality of service at public hospitals. I therefore sought an organization that shared similar vision (the Netherlands Development Organization - SNV) to serve as advisor in public health.

Tell us about the social innovator behind this idea.

The social innovator behind this idea is a 36 years old medical doctor who has been working in Cameroon and has a 7 year experience of working in resource limited settings. During this period he has worked in military health corps in Nigeria; worked with refugees and displaced persons; volunteered with red cross and american peace corps counterpart; collaborated with research institutes in the North; he is presently focusing on improving quality of care (especially through reducing unsafe injections and bad hospital waste disposal) with SNV through empowering patients to know their rights and demand for quality healthcare from public hospitals. In addition, he also works with citizen sector organizations to advocate for increased government committment to healthcare especially to women, children and minority groups.
He is married with 3 females kids and extremely scared to have these kids live the same harrowing health conditions that many children in Cameroon face. Posterity is one of the driving forces behind his desire to bring about change.
He still hopes to further studies in public health at masters level once he can save enough money or grab a scholarship.
He has a flare for research and mobile gadgets make him tick!

How did you first hear about Changemakers?

Friend or family member

If through another, please provide the name of the organization or company

50 words or fewer