• Goal 4: decentralisation and sustainability

Goal 4: decentralisation and sustainability

This paper from Partnerships for Health Reform reports on a study to examine the impact of health sector decentralisation in Uganda on maternal and child health (MCH) services. The main hypothesis of the study was that MCH, a priority health need of the most vulnerable groups - women and children, who form the majority population - should benefit from the interrelated changes associated with decentralisation. Specifically, MCH services should improve as a result of increased financial resources and greater priority setting at a local level. The study tested this hypothesis by focusing on two of the first districts to be decentralised - Rakai and Mukono.

The study found that user fees are relatively high for MCH services, and local revenue has not increased significantly because people are reluctant or unable to pay them. Those revenues that are raised go to the district level for reallocation elsewhere. The result has been a negative impact on the utilisation of MCH services. Although more political and administrative powers have been granted to the districts, in reality, local facilities still have little decision-making and implementation authority because their need for health care financing forces them to turn to international donors and vertical programmes. [adapted from author]

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