Governing health care in Uganda: explaining the mixed record on delivering rural maternal health services

Governing health care in Uganda: explaining the mixed record on delivering rural maternal health services

Uganda’s ruling party, the National Resistance Movement (NRM), came to power with a ‘Ten-Point Plan’. This outlined clear and specific ideas about what was needed to improve service delivery, and the role the public would play in achieving this objective and wider ambitions. Government made some important advances in the health sector, particularly in terms of reducing the level of HIV-AIDS prevalence and improving the accessibility of primary health care centres for rural citizens.

In recent years, however, the imperative of maintaining power seems to have distracted politicians at national and local levels from building a more effective health service that can deliver high-quality provision. This problem is particularly evident in terms of providing for maternal and child health, with Uganda recording slower rates of progress than some of its counterparts towards keypolicygoals, such as the MDG 5 target to reduce the maternal mortality ratio (MMR) by
three-quarters by 2015.
 
Key findings:
  • the quality of public health care in Uganda, including the delivery of maternal health services, is highly uneven; this is closely shaped by politics at the global, national and local level
  • the channelling of vast amounts of money into the health sector through internationally funded projects has created several power centres and bred rivalries. This has left the Ministry of Health highly factionalised and less capable of delivering on its remit
  • for much of the past decade, the health sector has been governed for political ends rather than geared towards higher levels of performance
  • capacity for supervision, inspection and enforcement of standards by central government is lacking; accountability at district level is therefore dependent on local monitoring and evaluation systems that are often too weak to
    improve levels of performance
  • local politics also closely shapes service delivery at district level: the quality and motivations of local leaders and their capacity to collaborate have a significant influence on the quality of service delivery
  • the highest levels of performance are driven by developmental coalitions with the capacity and commitment to devise and enforce innovative approaches to governing the sector
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