Factors influencing the relationship between local government and the private not-for profit health providers in Kabarole District

Abstract

Introduction: In Uganda, with the National PPPH policy in place, state engagement with PNFPs has seen the most progress to date. As a result, PNFPs have been increasingly become a critical part of national health systems. However, despite these efforts, key governance challenges have resulted in slow and protracted policy implementation at district level. This study aimed to delve down to the district level and explore the factors influencing governance of the relationship between local government and the FB-PNFPs. Methods: This study applied a case study design in order to gain in-depth understanding of the nature of the relationships existing and the factors influencing governance of these relationships at the district level. The study was carried out in Kabarole district with data collected through key informant interviews and document reviews. Thematic content analysis was used to analyze the emerging themes. Results: Overall, most of the demonstrable aspects regarding operationalization of the PPPH policy are witnessed in Kabarole district. The governance arrangements including the absence of binding MOUs, lack of awareness and understanding of the PPPH policy, absence of the PPPH district desk office, minimal influence and participation in dialogues held at national level related overall strategic direction of district PNFP facilities and the contextual factors which include staff attrition, delays in disbursement of subsidies and under-resourced oversight and regulatory bodies continue to influence the relationships, hampering their ability to achieve the full realization of the PPPH goals Conclusion: It is well evident that the PPPH policy has provided the necessary legal and policy framework to enable these relationships. However, there still remains some work to be done to strengthen the PPPH policy implementation at the district level by tightening the governance arrangements, addressing the contextual factors with the relevant strategies for its full operationalization and institutionalization.