NARWOA ROLLS OUT COMMUNITY-LED MONITORING (CLM) TO IMPROVE HEALTH ACCOUNTABILITY IN KOTIDO

By Richard Onapatum

*Kotido, April 2026* — Nakere Rural Women Activists (NARWOA) has completed facility-based orientation sessions across eight health units in Kotido District ahead of the rollout of a Community-Led Monitoring (CLM) initiative aimed at improving HIV, malaria, and TB service delivery.

The initiative is supported under the TASO TB/RSSH grant in partnership with CUAMM, with funding from the Global Fund, aimed at strengthening community-driven health accountability systems in Uganda.

WHAT HAPPENED

The orientation sessions were conducted throughout April 2026 at Rengen H/C III, Nakapelmoru H/C III, Lokitelaebu H/C III, Kanawat Health Centre III, Kotido General Hospital, Kacheri H/C III, Kamor H/C II, and Panyangara H/C III.

The engagements brought together health workers, sub-county officials, Health Unit Management Committees (HUMCs), biostatisticians/HMIS focal persons, CBO staff, and community monitors to align on the CLM system, tools, and reporting structures.

The sessions also received support from facility in-charges and technical staff across the participating health units, reinforcing institutional ownership of the process.

Using participatory discussions, presentations, and group exercises, facilitators guided participants through practical aspects of data collection, reporting pathways, and feedback mechanisms.

> “This process has helped us build a shared understanding between health workers and communities,” said Akongo Sofia Lowari, Project Officer at NARWOA. “We are now working as partners in identifying and addressing service delivery gaps.”

During a visit to Kotido General Hospital, the Assistant Chief Administrative Officer (ACAO), Nyanga Fredrick Emmanuel, pledged continued support to NARWOA and the CLM process, noting that community-driven accountability is critical in improving public health outcomes in the district.

> “We welcome initiatives that strengthen transparency and improve service delivery. The district will support this process to ensure it delivers meaningful results,” he said.

clm staff pose for a photo at Kamor health centre 3

WHY IT MATTERS

Health systems in Karamoja continue to face challenges including understaffing, long distances to facilities, drug stockouts, and a high disease burden. HIV, malaria, and TB remain among the leading public health concerns in the region.

The CLM approach is designed to strengthen accountability by ensuring that community experiences are systematically captured and used to improve service delivery.

The orientation focused on:

* Strengthening collaboration between health workers and communities
* Harmonizing monitoring tools across facilities
* Establishing clear communication and feedback systems
* Ensuring data informs real-time decision-making

At Panyangara Health Centre III, the in-charge, Atim Jane, welcomed the initiative, noting that structured community feedback will improve responsiveness at facility level.

At Rengen Health Centre III, the biostatistician/HMIS focal person, Owiny Jim Ronald, emphasized the importance of accurate data collection in strengthening health reporting systems.

> “When community data is properly collected and aligned with facility records, it becomes a powerful tool for decision-making,” he said.

At Nakapelimoru Health Centre III, a mother, Nakong Mary, waiting for antenatal services, described long waiting times and communication gaps as persistent challenges.

> “Sometimes we come early in the morning but leave without clear information on why services are delayed,” she said. “If this system improves communication, it will reduce a lot of suffering.”

Ichumar Tracy, a community monitor, noted that the training sessions have given them confidence to document such experiences and present them in structured forums.

> “We are now able to report issues in a proper way and follow them up without conflict,” she said.

project officer Taso, giving her remarks during an engament at kotido general hospital

HOW CLM WORKS

Under the CLM system, trained community monitors collect data on health service delivery using standardized tools. The data is then compiled, analyzed, and shared with health authorities through structured dialogue platforms.

This evidence is used to identify and address challenges such as drug stockouts, staffing gaps, waiting times, and quality of care issues.

The orientation phase achieved key milestones:

* Standardized monitoring tools agreed across all eight facilities
* Facility focal persons designated for CLM coordination
* Strengthened trust between health workers and community monitors
* Clear reporting and feedback pathways established

CHALLENGES AND CONSIDERATIONS

Stakeholders acknowledged potential challenges including:

* Limited staffing in some health facilities
* Transport constraints for community monitors
* Sustaining consistent engagement from all actors
* Delays in responding to identified service gaps

Despite these challenges, participants reaffirmed their commitment to implementing the CLM system effectively.

NARWOA emphasized that sustainability will depend on continuous capacity building, integration of CLM feedback into routine facility reporting systems, and strong collaboration with district health authorities.

According to Jesca Ruth Ataa, Executive Director of NARWOA:

> “CLM is shifting accountability from a top-down approach to a people-driven system where communities are active decision-makers in health service delivery.”

POLICY IMPACT AND SYSTEM CHANGE

Findings from the CLM process will be shared with district health authorities to inform planning, resource allocation, and service delivery improvements.

The approach is expected to strengthen participatory governance in health systems by ensuring that community-generated data directly influences decision-making.

With the orientation phase completed, community monitors will begin routine data collection across all eight health facilities.

NARWOA and its partners will support data analysis, validation, and structured advocacy engagements with district stakeholders to ensure that identified gaps lead to measurable improvements in health service delivery.

CONCLUSION

The completion of the orientation marks a shift toward more inclusive and accountable health service delivery in Kotido District. Beyond improving service provision, the CLM initiative represents a broader transformation—placing communities at the center of health governance and turning lived experiences into actionable evidence for change.

If sustained, the CLM model could redefine how health accountability is practiced in Karamoja—shifting from reporting to real-time, community-driven action.