Decentralization and Development in Contemporary Uganda

Green, Elliott

doi:10.4324/9781351259521-6

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…The political decision taken in 2005 to begin dividing districts into smaller sized units (‘district splitting’) created complications. By the end of our study period, the number of districts doubled ( Green 2008 ).…”

Section: Methodsmentioning

confidence: 99%

Did PEPFAR investments result in health system strengthening? A retrospective longitudinal study measuring non-HIV health service utilization at the district level

Luboga

Stover

Lim

et al. 2016

Health Policy Plan.

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Objectives PEPFAR’s initial rapid scale-up approach was largely a vertical effort focused fairly exclusively on AIDS. The purpose of our research was to identify spill-over health system effects, if any, of investments intended to stem the HIV epidemic over a 6-year period with evidence from Uganda. The test of whether there were health system expansions (aside from direct HIV programming) was evidence of increases in utilization of non-HIV services—such as outpatient visits, in-facility births or immunizations—that could be associated with varying levels of PEPFAR investments at the district level.Methods Uganda’s Health Management Information System article-based records were available from mid-2005 onwards. We visited all 112 District Health offices to collect routine monthly reports (which contain data aggregated from monthly facility reports) and annual reports (which contain data aggregated from annual facility reports). Counts of individuals on anti-retroviral therapy (ART) at year-end served as our primary predictor variable. We grouped district-months into tertiles of high, medium or low PEPFAR investment based on their total reported number of patients on ART at the end of the year. We generated incidence-rate ratios, interpreted as the relative rate of the outcome measure in relation to the lowest investment PEPFAR tertile, holding constant control variables in the model.Results We found PEPFAR investment overall was associated with small declines in service volumes in several key areas of non-HIV care (outpatient care for young children, TB tests and in-facility deliveries), after adjusting for sanitation, elementary education and HIV prevalence. For example, districts with medium and high ART investment had 11% fewer outpatient visits for children aged 4 and younger compared with low investment districts, incidence rate ratio (IRR) of 0.89 for high investment compared with low (95% CI, 0.85–0.94) and IRR of 0.93 for medium compared with low (0.90–0.96). Similarly, 22% fewer TB sputum tests were performed in high investment districts compared with low investment, [IRR 0.78 (0.72–0.85)] and 13% fewer in medium compared with low, [IRR 0.88 (0.83–0.94)]. Districts with medium and high ART investment had 5% fewer in-facility deliveries compared with low investment districts [IRR 0.95 for high compared with low, (91–1.00) and 0.96 for medium compared with low (0.93–0.99)]. Although not statistically significant, the rate of maternal deaths in high investment district-months was 13% lower than observed in low investment districts.Conclusions This study sought to understand whether PEPFAR, as a vertical programme, may have had a spill-over effect on the health system generally, as measured by utilization. Our conclusion is that it did not, at least not in Uganda.

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Section: Methodsmentioning

confidence: 99%

Did PEPFAR investments result in health system strengthening? A retrospective longitudinal study measuring non-HIV health service utilization at the district level

Luboga

Stover

Lim

et al. 2016

Health Policy Plan.

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“…However, the definition of decentralization policy implementation used in this study was based on how different academics conceptualized Fiscal/ financial, Administrative, and Political decentralization [2][3]. Fiscal/ Financial decentralization is the transfer of funds, revenue-generating power and authority over expenditure to local government and private organisations.…”

Section: Introductionmentioning

confidence: 99%

The relationship between financial decentralization and quality of maternal health services

Twinamatsiko,

Nuwatuhaire,

Mpairwe

et al. 2023

INOSR AH

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This study aimed at investigating Decentralisation policy implementation and quality of maternal health services in Kihiihi Town Council and Nyanga Sub county-Kanungu District. It was guided by three objectives namely. The objectives were; to determine the relationship between Political decentralization and the quality of maternal health services in Kihiihi town council and Nyanga Sub County - Kanungu district, to find out the relationship between financial decentralization and quality of maternal health services in Kihiihi town council and Nyanga Sub County - Kanungu district and to assess the relationship between administrative decentralization and quality of maternal health services in Kihiihi town council and Nyanga Sub County -Kanungu district. The study adopted descriptive crosssectional research and correlational designs on a sample of 235 respondents. Data was collected using a questionnaire and an interview guide. Quantitative data were analyzed using frequencies, percentages mean, correlation and regression. Qualitative data were analyzed using thematic analysis. Inferential analysis results indicated that financial decentralisation had a strong positive significant relationship with quality of maternal health services. Therefore, it was concluded that financial decentralisation as components of decentralization policy implementation is essential for quality of maternal health services. Keywords: financial decentralization, maternal health services, women.

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“…Territorial division at the subnational level is an undertheorized phenomenon, partly due to its rare occurrence in developed countries. Whereas comparative analysis of territorial division is scant, case studies showing country‐specific models of territorial division are emerging (see Green, ; Malesky, ). The Indonesian model of territorial division is a recent addition to the literature.…”

Section: Introductionmentioning

confidence: 99%

A Veto Players Analysis of Subnational Territorial Reform in Indonesia

Tumanut

2016

Asian Politics and Policy

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Indonesia has been prolific in creating local governments since 1999. This article reexamines provincial division in Indonesia and proposes a Veto players (VP) Theory of territorial reform, a function of the interplay of a number of VPs, their cohesion, and congruence of VP preferences. Using comparative analysis and process tracing of successful and failed cases through key informant interviews and secondary materials, Indonesia is found to have large but decisive VPs, where the direction of reform is contingent on the preferences of local players through territorial leveraging or opportunism. They are political elites who are supported by social movements whose preferences run parallel with the former. Despite a large absolute number of VPs, territorial reform was achieved due to smaller effective number of VPs (via established executive-legislative relations), due to mirroring and manipulation of preferences through side payments and other strategic behaviors (lobbying and social mobilization), and through reciprocity norms of patronage and personal linkages.

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Decentralization and Development in Contemporary Uganda

Cited by 4 publications

References 13 publications

Did PEPFAR investments result in health system strengthening? A retrospective longitudinal study measuring non-HIV health service utilization at the district level

Did PEPFAR investments result in health system strengthening? A retrospective longitudinal study measuring non-HIV health service utilization at the district level

The relationship between financial decentralization and quality of maternal health services

A Veto Players Analysis of Subnational Territorial Reform in Indonesia

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