Decentralization and Primary Health Care Service delivery in Local Governments in Uganda: A Case Study of Kabale Municipality

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Kabale University


The decentralization policy was introduced in 1993 with the objective of transferring financial and planning powers to local governments so that they could improve service delivery in the five national priority areas. The national priority areas included primary health care, extension of agriculture services, water and sanitation, primary education and feeder roads (Ugandan Local Government Act, 1997). Indeed, decentralization has enabled local governments to carry out their own planning and budgeting with a focus on their local priorities. Local governments have been able to finance some of these priorities using the locally-generated revenue. However, a problem of delivering poor quality primary health care services has remained outstanding. This study was conducted to assess the factors that may have hindered the implementation of financial, political and administrative decentralization and primary health care service delivery in Kabale Municipality so as to establish relevant remedies that have to be applied in improving decentralization and health service delivery in Kabale Municipality and Uganda at large. The study espoused a cross-sectional research design supported by both qualitative and quantitative approaches. A sample size of 112 respondents was used and respondents were selected using simple random and purposive sampling techniques. Data collection methods involved the use of questionnaires and interviews. Data analysis was done using the Statistical Package for Social Sciences Version 20 that helped to generate frequencies, percentages, mean and standard deviation. The study found that some the factors that hampered financial decentralization in Kabale Municipality were lack of enough revenue generation that would have improved provision of primary health care services. More so, it established that local revenue was highly misappropriated and diverted which affected the quality of primary health care service delivery. There was high rate of tax evasion by taxpayers resulting into low revenue to finance the health sector for improved quality primary health care services. Kabale Municipality had high rate of bureaucratic red tape, corruption and fraud by some administrators, delayed implementation of projects and programmes for primary health care services. There was also inadequate human resources in the health sector to deliver quality primary health care services. The study established that strengthening the fight against corruption and embezzlement of funds would impact greatly towards improved delivery of primary health care services. It was established that there was need for the Local Government to recruit adequate primary health care staff to provide quality health services. The study recommended that the Government should ensure that the budget allocation for drugs is increased to meet the demands of the clients and ensure their satisfaction and that of service providers. Since cases of corruption were found to hinder administrative decentralization and primary health care service delivery, there is need for the government and its anti-corruption agencies to strengthen measures to fight against corruption


A Dissertation submitted to the Directorate of Postgraduate training in Partial Fulfilment of the Requirements for the Award of a Master of Arts Degree in Public Administration and Management of Kabale University


Decentralization, Primary Health Care, Service delivery, Local Governments