The challenges of decentralized health services in Uganda: a case study of Tororo District

Abstract

The study was conducted due to the problem of increased incidences of deaths that had continued to occur caused by failure to access health services. Therefore there was need to find out what decentralization has done in the realm of health service provision, the problems hindering the policy from performing better and hence look for solutions. The research was conducted in Tororo County in Tororo District, within selected Sub-counties. The researcher aimed at establishing the challenges of decentralized health services in Uganda, basing on; equitable access to health services, community involvement in the delivery of decentralized health services and challenges affecting the effective delivery of decentralized health services. The researcher used a case study research design to establish the challenges of decentralized health services in Uganda, using selected Sub-counties in Tororo County located in Tororo District. The sample size consisted of 100 beneficiaries, and 9 key informants who implement policies. The researcher used simple and systematic random sampling as well as the non-probability-sampling techniques to select participants in the study. Data was collected through documentary analysis, administration of a questionnaire and interviews. Qualitative data about the major and specific objectives of the study was analyzed by categorizing responses into themes. These were used to supplement quantitative data and information collected through interviews. Analysis was done using percentages. It was concluded that decentralization undermines equity by exacerbating differences in income levels between local areas. There are socio-economic differences in the health outcomes with the IMR at 60.2 deaths per 1,000 live births for the highest socio-economic quintile compared to 105.7 deaths per 1,000 live births for the lowest socio-economic lowest quintile with an inter-quintile ratio of 1.76. Similarly, the under 5-mortality rate for the lowest quintile is twice as high as that for the highest quintile. The TFR for the highest quintile is 4.1 births per woman while that for the lowest quintile is 8.5 births per woman. On average the richest 20% receive more than twice the financial benefit than the poorest 20% of the population from overall government health spending. An examination on the community involvement in the delivery of health care revealed that to some extent communities are involved in the delivery of decentralized health care through representation at every facility level. However, though the channels existed, they were often ineffective due to lack of capacity, inadequate flow of information and the limited usefulness of health committees. It was further revealed that the effective delivery of health services is being hindered by insufficient health budgets due to deteriorating economic conditions, combined with burgeoning health problems such as the global HIV-AIDS pandemic which have led to shortage of drugs and medical supplies, inadequate or non payment of health workers salaries, poor quality of care, and inequitable healthcare. In light of the above, various recommendations were made to: The Ministry of health, the Decentralization Secretariat in the Ministry of Local Government, the political and administrative leaders at the District, to sufficiently fund the health sector, and sensitize the “Wanainchi” and political leaders about the policy of decentralization.