Digitizing Trust:
How Machines Are Giving Citizens Power to Be Heard
Written by: Catherine Nalwanga
At Kitebi Health Centre III in Uganda’s capital Kampala , an innovative digital device placed at the entrance is quietly transforming the way health services are delivered.
The Sema feedback machine, is a digital tool designed to strengthen accountability and improve service delivery in public institutions and allows patients to instantly rate their experiences and give feedback on how the service was provided, has greatly replaced the traditional suggestion box that the patient couldn’t even notice.
The feedback machine was created by a team of innovators from the Sema Organisation, a non-profit social enterprise founded in 2018 with the mission of improving public service in Uganda with roots in the Netherlands.
The organisation provides public institutions with actionable insights to strengthen accountability, enhance transparency, and address service gaps thus empowering citizens’ voices to shape more effective and responsive institutions.
With the machine, patients can rate services instantly, confidentially, and without fear of being seen by others. Once feedback is shared, it is analysed, allowing the public institutions to review complaints, identify problems, and take action to improve services.
For many years, patients at Kitebi always complained about long waiting hours, particularly in the laboratory, how they used to sit for long hours without being attended to.
“I used to come here and there was always a long line. I could wait for hours before I received the services,” Lydia Hanyere, a patient at Kitebi, whom we managed to talk to explained.
However, their complaints were always ignored because they could not reach the people in charge.
When the Organisation introduced the feedback machine at Kitebi Health Centre, those complaints could now be easily heard and solutions drafted and this greatly improved service delivery at Kitebi. Each month, feedback is compiled by Sema Foundation into a report that is shared with the health centre management.
“After getting the feedback report, we analyse it as the facility, looking at our strengths and weaknesses. Thereafter, we focus on improving the weaknesses mentioned in feedback,” explained Dr. Gelevas Rwecungura, the senior clinical officer at the facility.
Unlike the suggestion box, which patients often ignored or struggled to locate, the Sema machine is accessible at every entrance. It also provides confidentiality and ease of use. Patients give their feedback in privacy, often through emojis and simple language prompts that anyone can understand.
Hanyere managed to provide her feedback using the Sema machine and said she found it very fast and private.
“With the suggestion box, everyone is going to see you writing and also your information could land in various hands, but with the machine, you give your opinion alone and it’s confidential,” Henyere says
“I used the machine to pass on my complaint to the management so that other patients are not affected by the same issue,” she explained.
Hanyere says that she feels that providing feedback using the Sema machine really makes a big difference because the feedback is being used to improve service delivery.
Dr. Rwecungura says the system has greatly helped them track weaknesses in service delivery and design quick solutions, which has really brought about a big transformation in service delivery at the health centre.
“When patients raised concerns about delays that were happening mostly at the laboratory, we responded by deploying laboratory personnel directly in departments that attract high numbers of clients, such as the HIV clinic and antenatal care. This reduced waiting times significantly,” he explains.
He says with Sema, the patient is free to express themselves and also many could miss the suggestion box, unlike Sema that is staged at all entrances and patients could access it very fast and give in their feedback.
Uganda’s health system is built in levels, from village health volunteers up to national referral hospitals. The lower levels have Health Centre Units (VHTs), then Health Centre II and III, which handle common illness and maternal care, and lastly Health Centre IVs and district hospitals, which are meant to handle emergencies and referrals.
However, across all these health centres, patients face different challenges like long waiting hours, limited drugs, poor customer care, overcrowding, and high costs. Patients face these hardships but complaints rarely reach the management because suggestion boxes are ignored and inaccessible, and many fear retaliation. As a result, such problems go unsolved and patients suffer in silence.
The wider work of the feedback machine goes beyond Kitebi Health Centre, over 50 devices are in operation across Uganda for example Public offices in Jinja, Mbarara , Gulu and more.According to Bonana Esther, a trainee at Sema, the organisation conducts nationwide surveys in public offices like in education, where parents often complain about overcrowded classrooms and understaffed schools, in police services, where delays in reporting or mishandling cases are widespread, at the National Identification Authority (NIRA), where citizens queue for days to process IDs.
“We usually stand at the exit of these stations so that we get each and every person’s feedback on the service provided. We use the KoboCollect tool to capture feedback, which is then shared with the respective institutions so that they improve their service delivery to the citizens where necessary,” she explains.
She says there are various ways people record their feedback, and that is the QR code that they scan and get the form on their smartphones, and also the USSD code, which are all familiar and easier to use by the people.
This feedback machine has created a practical way for citizens to influence how public services are delivered. Instead of complaints being buried in neglected suggestion boxes, they are now documented, analysed, and acted upon.
Dr. Sarah Zalwango , Acting Director of Public Health and Environment in KCCA explains that beyond the suggestion boxes and talking wall with toll-free numbers as mechanisms for collecting feedback from the citizens, they also work with Sema as an independent partner.
“Their feedback machines at facility entrances give us real-time information from the citizens, helping us respond faster and monitor performance
For Joanitah Success Nsasiirwe, the team leader at Sema, the innovation was born out of the need to create easier ways for citizens to be able to give feedback on the services they receive in public offices.
“We were trying to think of efficient ways of how the citizens could share feedback. That’s why the device uses emojis and everyday language,” she says.
She says the feedback machine is user-friendly to all people regardless of the educational level because it uses emojis that depict emotions. “You can easily see that this particular button is smiling or sad, therefore even someone who has not been to class can easily use it and give his/her feedback.”
Nsasiirwe also says that the machine has brought about remarkable changes in the public offices where it’s used. For example, DCIC Jinja was ranked three times in a row among immigration offices after acting on Sema Feedback.
Today, Kitebi Health Centre has become an example of how accountability tools can directly improve service delivery. Reports from Sema help the facility identify strengths, confront weaknesses, and implement targeted solutions.
Dr. Rwecungura credited the system for raising standards at the facility. “Since Sema was introduced, services have improved because feedback on weaknesses is received instantly and addressed promptly. It has helped us understand exactly how we are performing and where we need to improve.”
When people are listened to, services get better. The Sema machine has changed complaints into real solutions, making public office workers more responsive and citizens more confident. It is proof that accountability works best when everyone has a voice.
The Sema system is not without challenges. Joanitah admits that the process is difficult sometimes, many people are not used to openly giving feedback, so Sema first has to always first build a culture of participation. “Also some institutions, especially police, are sensitive about being monitored and we have to first engage them in capacity building to help them understand the value of community feedback to allow deployment of the machines.” she explains.
Even when feedback is collected, Joanitah says the recommendations from the community members have budget implications for public institutions which are already underfunded, making implementation slow.
Citizens without smartphones are sometimes left out, especially those who might want to give feedback via the QR code system. Still, the machine has become an important accountability tool for both citizens and health workers.
In a survey done by Twaweza, 39% of young citizens point to health services as their top concerns, however, without the feedback mechanism, their thoughts or concerns go unnoticed and the services they receive from the health sector can not be improved without their feedback.
Dr. sarah Zalwango, the Acting Director Public Health and Environment at Kampala Capital City Authority KCCA says city-run health facilities have been maintained although they still face certain challenges the work load which result from low recruitment of health workers so the drug allocations can never be enough.
She says they have adopted the Sema feedback machine as a way of collecting feedback from the citizens , Besides the suggestion box , the talking walls which includes toll free numbers that one can call and rate the services, we also have an independent assessment with our partner Sema, who provide citizen feedback reports and real-time response from the machines placed on all exits.
