Civic Technology and Health System Accountability: Evidence from Uganda
Photo Credit: Arif Riyanto
Civic Technology and Social Accountability
Civic technology refers to digital tools designed to strengthen interaction between governments and citizens. These tools increasingly help improve relationships between citizens and public institutions. Technology tools are sometimes led by the government, such as the “Know Your Budget” portal in Uganda, while others are citizen-led initiatives such as Code for America, whose model has been replicated in several developing countries.
In Africa, technology has entered social accountability narratives as tools that stakeholders and decision makers can use to gather citizen feedback. The Uganda health sector is no exception. In the last decade, there has been a proliferation of tools ranging from facility-based systems for capturing routine health data (e.g., mHealth) and tools that allow citizens to anonymously report drug stock-outs (e.g., mTrac). While these tools have demonstrated effectiveness in pilot phases, over time, it becomes apparent that a gap exists between increased citizen feedback through these channels and improved government response. Understanding why this gap persists is critical for assessing the broader role of technology in strengthening governance and public service delivery.
Technology has the power to reduce barriers between civil society and governments by enhancing transparency. Governments may also have incentives to improve credibility among their citizens by adopting digital tools, including data analysis platforms and social media. Data-driven approaches can lead to better decision-making for policymakers. In Uganda, an encouraging development is that the government has occasionally demonstrated willingness to modify policies in response to rigorous policy analysis, particularly when reforms do not impose high political or economic costs. The Action Group for Health, Human Rights and HIV/AIDS (AGHA), for instance, successfully influenced key stakeholders using results from budget analysis conducted with modern economic and data analysis techniques.
Digital Technology and Health Systems
Access to and distribution of health care services depend on factors including economic organization, ideological forces, available technology, and professional structures (Mechanic, 1975). Most importantly, health care technology has significant potential to improve quality while reducing costs in health services. According to Agarwal et al. (2010), the importance of health technology continues to expand as policymakers worldwide increasingly view digital innovation as a pathway to safer and more affordable healthcare services. However, even in developed countries, technological and data-tracking systems in medical supply chain management remain inadequate. Health workers and researchers believe that improved digital supply chain systems could reduce waste, lower service costs, and improve service delivery efficiency. (LaPointe, 2017).
An effective supply chain requires the timely and reliable movement of health commodities and data across the supply chain, from service delivery points to distribution centers and back. Data generated at service delivery points is particularly critical for supply chain managers to make informed decisions regarding the quantity and type of health commodities required. Over decades of operation, health facilities have developed business processes for managing patient records, stock levels, and administrative information using technology. Whether these processes are consistently implemented remains an open question. Nevertheless, health workers are trained to operate these systems, and their professional responsibilities often revolve around them.
World Bank researchers Qiang et al. (2012) highlight that the versatility of mobile phones has been particularly transformative in healthcare delivery. Mobile connectivity enables families in many parts of the world to access medical advice quickly, often for the first time. Beyond communication, mobile phones also provide access to health information, medication reminders, and remote consultations. For example, a doctor in a rural area can photograph an unfamiliar skin disease and send it to medical specialists for diagnosis. Similarly, medical records can be digitized, and disease outbreaks can be tracked in real time.
Civic Technology in Uganda’s Health Sector
In Uganda, research conducted by The Engine Room (TER), the Anti-Corruption Coalition Uganda, and graduate students from the University of Chicago found that technology has improved aspects of the health system supply chain. For example, the National Medical Stores communicates with districts and health facilities through SMS-based platforms to coordinate medicine orders and delivery schedules. Citizens also share health-related information through phone calls, SMS, and WhatsApp. Technology solutions that gain traction tend to be those already familiar to users, accessible, and compatible with local literacy and technology-use levels. An interesting innovation is the use of biometric systems to address health worker absenteeism. At Iganga Hospital, staff log in and out electronically and are compensated based on verified working hours, an intervention introduced by the hospital superintendent after identifying severe absenteeism.
For technology to benefit emerging economies, both leadership and opportunity are required. While digital tools help bridge the gap between citizens and governments, government responsiveness to technology-generated data remains inconsistent in many developing countries. Technologists must work closely with governments and civil society organizations to ensure that digital solutions lead to meaningful policy change. Citizens should be central to the design of technological solutions, participating not only as users but also as contributors in system design.
Ultimately, collaboration between technologists, governments, and civil society institutions will determine whether civic technology can meaningfully strengthen governance and improve service delivery in emerging economies. Uganda’s experience illustrates both the promise and the limitations of civic technology in developing countries, highlighting the importance of institutional responsiveness alongside technological innovation.
References
Agarwal, R., Gao, G., DesRoches, C., Jha, A. K. (2010). Research commentary: The digital transformation of healthcare: Current status and the road ahead. Information Systems Research, 21(4), 796-809.
FMC and Uganda’s health system supply chain. (2018). Unpublished raw data.
LaPointe, J. (2017). 3 most common healthcare supply chain management challenges. Revcycle Intelligence. https://revcycleintelligence.com/news/3-most-common-healthcare-supply-chain-management-challenges
Mechanic, D. (1975). The comparative study of health care delivery systems. Annual Review of Sociology, 1, 43-65.
Qiang, C.Z., Yamamichi, M., Hausman, V., Miller, R., Altman, D. (2012). Mobile applications for the health sector. ICT Sector Unit World Bank, April 2012. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.918.4342&rep=rep1&type=pdf
