Assessment of the Implementation of the Health Sub-District Concept in Arua District in Uganda.

Abstract

INTRODUCTION: The implementation of the HSD concept, a strategy under health sector reforms and decentralization had been associated with poor management and delivery of health services in HSDs in Arua District. This was in the context of the expected service delivery output. Sufficient, accurate and objective information about the implementation of the concept of HSD was lacking. METHODOLOGY: A Cross sectional study using qualitative methods of data collection was done in April 2001 to assess the implementation of the concept Data was analyzed using Epi-info computer package and also manually. RESULTS: The staffing requirements for HC IV and CHD of hospitals had been met only for only a few cadres of staff. The construction of both the theatre and the doctor’s house had been completed at only one of the hour HC iv. The HSDs had received from 57.4% to 67.5% of their 2000/01 annual budget. All the HSDs headquarters had carried out planning, outreach services and support supervision. At two of the HC IV, Minor operations and some obstetrics and gynecological procedures had been performed.The key informants reported that the HSD concept was poorly understood.

CONCLUSIONS: Although there was under staffing, inadequate infrastructure, financial constraints as well as limited sensitization about the HSD concept, the objectives of creating HSDs had been met to a consideration extent. There was need for more resources and sensitization about the HSD concept. RECOMMENDATIONS: Arua District Authorities should recruit the missing staff, review funding procedures, construct infrastructure and conduct sensitization workshops on HSD concept for health workers and local authorities.