Community participation in the implementation of decentralised health service systems: a case study of the health sector in Lugusulu Sub-County, Sembabule District

Abstract

Investigating the role of community participation in implementation of decentralized health systems raises the question of whether stakeholder community members have been given consideration in the implementation process of decentralized health systems. It is in light of this, that the study sought to assess the involvement of the community in planning for decentralized health service systems, to examine the community’s role in monitoring and evaluation of decentralized health service delivery systems and to evaluate the challenges involved in enhancing community participation in the implementation of decentralized health service systems. The study was carried out in Lugusuulu Sub County, Sembabule district. It was conducted in selected areas of five parishes of the Sub-county. The study was carried out using semi-structured interviews of key informants with tape recorders and interview schedule as data collection tools to get a broad and deep understanding of the subject matter being studied. Semi structured questionnaires were used too because the method was cheap and it did not require research assistants. FGD’s too were used because they produce rich information relevant to the topic under study. Data was analyzed using SSPS. From the findings of the study, these conclusions were derived; the community members did not directly participate in planning for health service delivery. They are always left out in major issues that concern their health and some times represented through the Local Government officials and LC executives. This however, had affected service delivery as it had limited the community members’ enthusiasm in participating in the sustainability of health service facilities. It was further concluded that community members participate in the health monitoring system though at most levels their views were not respected. A number of challenges which included negative attitudes, inadequate resources, poverty, gender inferiority, illiteracy, lack of participatory skills were established to be the challenges that inhibit community participation in the delivery of health services. Unless they are managed, community participation will just remain in theory. The study yielded a number of recommendations which include; the government to decentralize certain powers like decision making and functions in order to increase local control; functional adult literacy should be considered in combating illiteracy in rural areas; need to empower community members in order to enhance their participation in the implementation of heath service delivery system in all its parameters; the Sub county’s need to involve community members in the process of monitoring in order to enhance sustainability of health facilities.