Drivers, processes and coping mechanisms of institutional restructuring in Uganda : a case study of the 2018 Ministry of Health restructuring

Abstract

Various internal and external factors drive decisions to undertake restructuring in ministries, organizations, or agencies. The purpose of this study was to determine the drivers, processes, and coping mechanisms for the institutional 2018 restructuring of the Ministry of Health in Uganda. This was a qualitative case study design that involved an in-depth probe and application of subjectively interpreted data among 18 respondents that included top managers, Middle managers, and lower ranking officers from the Ministry of public service, Ministry of Health and Health Service commission. Data was collected using both the in-depth interview guide and key informant interview guide and was analyzed using thematic content analysis. Findings indicate that the drivers for the 2018 MoH institutional restructuring were to improve service delivery, reduce the workload, define clear roles and responsibilities, and upgrade the organizational profile. Further, it was intended to properly position divisions, create new directorates to address critical public health issues at a high level, and to create more visibility to attract more resources. The processes included MoH communicating the need for restructuring to MoPS that did a needs assessment and realigned the structure, which was shared with MoH top and senior top management for their input. The realigned structure was presented to the cabinet for approval and later shared with MoPS, MoH, and HSC for recruitment of staff and implementation. However, findings reveal an underlying challenge with the way employees were engaged and prepared for the changes with some expressing extreme discontent with the way they were treated. The study concludes that the drivers mentioned by the study respondents were valid and justified. The re-alignment of departments, divisions, and units within the Ministry of Health was long overdue because most divisions and units were suffocated within existing old departments in the old structure. Besides, the study further concludes that the restructuring in the Ministry of Health to large extent has yielded benefits to the health sector because some divisions that were hitherto obscured within the old departments got visibility. The study recommends that government should always take time to prepare adequately for the restructuring of ministries or departments, the 2018 exercise was hurried, that’s why members were not reached out during consultations. Furthermore, the laid-off staff should always be counseled and prepared well for life after being a government employee. Department of Human resources should prepare workshops and counseling sessions with the proposed members some months before they are laid off