Decentralization and public health service delivery in Uganda: a case study of Bulambuli town council
This study examined the relationship between decentralization and public health service delivery in Uganda, taking Bulambuli Town Council as a case study. The objectives of the study were; To establish the relationship between political decentralization and public health service delivery, To determine the relationship between fiscal decentralization and public health service delivery, and To establish the relationship between administrative decentralization and public health service delivery. A case study research design was used and quantitative and qualitative approaches were employed where questionnaire, interview and observation methods were used. Self-administered questionnaires and Interview guide were employed as data collection tools on a sample size of 150 respondents that was determined from a target population of 240 using the formula for Yamane and Taro. Purposive and simple random sampling techniques were used in selecting respondents. In addition, observation method by use of observation checklist as a data collection tool was also used to supplement on questionnaire and interview methods. Pearson product moment correlation coefficient was used to test the hypotheses and the study findings revealed a significant relationship between the three decentralization dimensions and public health service delivery. It was therefore concluded that there is a positive significant relationship between political decentralization and public health service delivery, positive significant relationship between fiscal decentralization and public health service delivery and a positive significant relationship between administrative decentralization and public health service delivery in Bulambuli Town Council and the study recommended that there should be improvement in political decentralization, fiscal decentralization and administrative decentralization through embracing citizen participation in decision making by ensuring public hearings and consultation system and also involving them in the budget preparation process, finding out more revenue generating opportunities to widen the tax bases by encouraging entrepreneurial spirit and embracing the qualities of good governance like transparence, responsiveness, and rule of law, accountability, equity and inclusiveness and also appreciation of the whistle blowers in the management, regular monitoring and evaluation of the Town Council operations by the responsible Local Government officials and the Central Government should regularly demand for accountability from the Town Council on its performance to instill a sense of seriousness and proper allocation of the funds, proper utilization of the disbursed drugs and other health equipment of machines assigned to it to facilitate in health related operations. This study focused on decentralization in terms of (political, fiscal and administartive) and how the trio relate to public health service delivery, a further study may be carried out to examine the relationship between decentralization and public education service delivery in Bulambuli district, a similar study may be carried out in other Local Government Town Councils in the country especially in Eastern and Northern Uganda, more research may also be carried out to investigate the influence of locally generated funds on public health service delivery in the Local Governments of Uganda.