Understanding the impact of decentralization on the quality of primary health care in Pallisa District in Uganda : a study of users' and providers' experiences and perspectives
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Abstract
This is a study of the experiences and perspectives of the users and
providers of primary health care. The study analyses the users and the
providers' experiences and perspectives with regards to the decentralization
policy and its impact on the quality of primary health care delivery in the
rural district of Pallisa in Uganda since its implementation in 1990s-2005.
This is mainly a qualitative study in which both users and providers were
interviewed although quantitative data was applied to add meaning where
necessary.
The study has shown that decentralization in Uganda is a new form and
means of service delivery. The planners aim at getting every segment of the
population to participate in all aspects of service delivery. There is evidence
to show that the policy has had a positive impact on the structure of the
health sector as a whole. However, the systematic processes of cost
containment measures has resulted in the general economic hardship in the
operationalization of the decentralization policy in Uganda and has resulted
in varied experiences and the way decentralization is viewed in Pallisa. The
study noted that hardships have resulted from increasing responsibilities
given to lower level of government amidst declining state support in terms
of funding and manpower development. The study notes that the apparent
changes brought by the overall restructuring of health services have
resulted in the 'commercialization of social relations which has changed the
way people live and view public goods which also contributes to hardships in
service utilization.
This study shows that although health service delivery and its quality in
rural Pallisa is an old problem, there are feelings among the users and
providers that these problems have worsened in the recent past
transforming health care consumers and providers into a new category of
social actors who have taken different approaches to survive a midst poverty,
exclusion and the declining state support system.
Although this study does not recommend a return to a centralization system
of service delivery in the health sector, it does however, find implementation
problems which will have to be addressed if the intended benefits are to be
realized