The challenges of providing malaria curative services in a new district: the case of Amolatar District in Northern Uganda

Abstract

This research aimed at identifying the main challenges that were faced in delivering health services in Amolatar , as a case study of new districts. Being a self funded study, the research focused on one sector of health service delivery, namely malaria curative service as the indicator for assessing the service delivery. Both the view points of the service providers and recipients of the services were assessed. Key aspects that were studied included: identifying the managerial, institutional, Technical capacity, community and other contextual challenges that were faced by the new district during the formative and transition stages. Both primary and secondary data were collected using mainly interview of Local Government(LG) staff and members of the communities they serve. The findings revealed that the district leadership had the commitment to give priority to the mitigation of incidences of malaria in the district. However the transition from a county to a district status presented major challenge of trying to meet the enhanced expectations of the communities. Key institutional, management, technical and community needs should have been addressed prior to creation of the new district in order to reach an acceptable level of service delivery to the communities. Future new district could pay due attention to proper planning, growth and nurturing of formal and informal institutions and community involvement in planning and implementation of social programs. It is also important to prepare the consumer communities to absorb the services. Creating new districts based on political pressure merely serve to quench the communities’ sentiments rather than address the real needs of the people. Using the malaria curative service in Amolatar district as a case of the services to the communities, this study found that two years down the road , the creation of a new district has led to marginal reduction in the prevalence of malaria. Moreover unlike in other districts, input by the private sector and CSOs in Amolatar district was found to be minimal, hence the bulk of the burden of providing malaria curative services was found to be resting upon the LG. Hence although Decentralization is a good development strategy, its institutionalization requires time, commitment and a consistent flow of resources. This study noted that notwithstanding the popularity of creating new districts, when implemented without proper planning and preparation it constrains delivery of social services particularly in the “off-spring” districts, due to various factors such as: lack of formal institutional capacity to provide the required services to the communities, leadership gaps in the new district, low quality of health services, lack of capacity to provide and regulate quality Services , shortage of qualified staff, and communities’ lack of awareness on their roles in accessing services from the health facilities.