Fiscal Decentralization and Health Service Delivery in Itojo Sub-County, Ntungamo District, Uganda

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Kabale University


The study examined the relationship between fiscal decentralization and health service delivery in Itojo sub-county. It was guided by the objective which were; to find out the extent to which citizens’ participation in planning and budgeting influence health services delivery in Itojo sub-county in Ntungamo District, to analyse how monitoring and evaluation of health care services affect health service delivery in Itojo sub-county in Ntungamo District and to identify the factors that constrain fiscal decentralization and health service delivery in Itojo sub county. The study used a case study design which and incorporated both qualitative and quantitative approaches. The sample for this study was 136 respondents and these were selected by use of purposive sampling. The study used questionnaires, interview guide and documentary review in gathering data for the study. Data analysis was done using SPSS which were used to generate frequency and percentages. From the findings, it was revealed that all decisions regarding health care services delivery are fully decentralized for effective delivery; decentralized planning has improved equitable health service delivery. Furthermore, it was revealed that monitoring is a key aspect of resource utilization for health service delivery. Further findings also revealed that feedback on the performance of the health sector is disseminated to technical staff at the local government level and this enhances health service delivery. It was pointed out that one of the most daunting challenges facing fiscal decentralization of health services in Uganda derives from the concerns relating to accountability, transparency, auditing and institutional corruption within both central and sub-national governments. From the findings corruption causes delays in implementation of health programmes thus ineffective healthcare service delivery. It was thus concluded that citizens’ participation in planning and budgeting influences health service delivery. The findings indicated that monitoring and evaluation greatly affect health service delivery. This implied that an increase in monitoring and evaluation of health services has positively influence on health service delivery. The study thus recommended that there is need for an effective and harmonized decentralized planning and budgeting processes at all levels in Uganda. There should be an effective budget committee in place in each of the districts to over-see resource mobilization and allocation of finance. Routine monitoring, supervision and evaluation of performance should be encouraged so that errors and misappropriations are reduced or eliminated in order to enhance effective health service delivery.



Fiscal Decentralization, Health Service Delivery