Priority Service Provision under Decentralization: A Case Study of Maternal and Child Health Care in Uganda. Small Applied Research No. 10

摘要

In 1993, Uganda began decentralization of its health care sector to the district and subdistrict levels. Its objectives were to increase local revenue for health service provision, in part through user fees; involve the consumers in the management of their health care services; and integrate all providers, including non-governmental organizations, missions, and non-traditional providers, into the care delivery system. The increased revenues and consumer participation was expected to improve quality and increase utilization of services. With a focus on maternal and child health (MCH) services, this study used statistical data and interviews with local health administrators and physicians to assess how the reform policies have been implemented and how they have impacted MCH service provision and utilization. It found that user fees are relatively high for MCH services; increased local revenue has failed to materialize because people are reluctant or unable to pay user fees, and those revenues that are raised go to the district level for reallocation elsewhere; and local facilities in reality still have little decision-making and implementation authority because their need for health care financing forces them to turn to international donors and vertical programs.