FISCAL DECENTRALIZATION AND QUALITY OF PRIMARY HEALTH CARE SERVICES IN UGANDA LOCAL GOVERNMENTS: A CASE STUDY OF KIGARAMA SUB-COUNTY, BUSHENYI DISTRICT

Abstract

The purpose of the study was to asses the effect of fiscal decentralization on the quality of PHC services delivered in Kigarama sub-county for the period 2003-2008. The study design used was cross sectional, correlational case study. The study used a questionnaire, interviews, observation and documentary review to collect data.. Validity was tested using face, content and construct validity. Reliability test was done using Cronbach’s alpha test-retest method and it yielded 0.89. A sample of 108 PHC clients was selected to participate in the study. The response rate was 89.8%. Pearson product-moment correlation coefficient was used to assess the relationship between the variables, and regression analysis was used to measure the magnitude of the relationship. Decentralized planning reflected a coefficient of .204 (significant at 0.05,2 tailed), decentralized execution had .243 (significant at 0.05 level, 2 tailed), conditional grants had .262 (significant at 0.01 level, 2 tailed), unconditional grants had .309 (significant at 0.01 level, 2 tailed) and government policies had .437 (significant at 0.01 level, 2 tailed). Decentralized monitoring reflected no significant relationship with a coefficient of -.024 (significant at .814 level, 2 tailed). These results imply that there is a significant relationship between fiscal decentralization and quality of PHC services. Basing on the findings, the study concluded that the small budget does allow implementation of locally generated priorities and this limits the participation of the stake holders at the grass root. Conditions attached to the funding from the centre is does not cater for the priorities generated from the beneficiary community. The study recommended that budget allocation for drugs should be increased to ensure the availability of drugs at the health centre all the time. Conditions attached to the PHC conditional grants should be adjusted to allow flexibility for funding of locally generated priorities. Cost sharing should be reinstated at client-affordable rates to enable the health centre obtain funding to fill the existing gaps for a quality service.