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
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.