This paper reports a study which was undertaken between 1994 and 1997 with the overall aim of describing and accounting for the 'socioeconomic survival strategies' of health workers and their effects. It took place against a background of substantial health sector development in the country which has accompanied its economic recovery. Among other developments, decentralisation of administrative authority across all sectors in the country has had major implications for the health sector. The World Bank's series of Health Projects together with other aid programmes such as the EC's health service rehabilitation project in the South West of Uganda have had a substantial impact on the quality of the physical infrastructure for health service delivery. Supply of drugs and other essential supplies has been improved through Danish aid and within the decentralisation framework. The study was first discussed in 1990 alongside proposals which were put to the Ugandan parliament to introduce user charges on a national basis. The acceptance by parliament of the user charge proposals and their subsequent introduction was widely believed imminent at that time but in the event, they were suspended and a national programme never approved. Nevertheless, decentralisation policy and the development of health unit management committees (HUMCs), intended as preparation for the policy, prompted widespread local adoption of user charges using different levels and structures from district to district and even from health unit to health unit.
In: Ferrinho P, Van Lerberghe W (eds.), Providing health care under adverse circumstances: Health personnel performance & individual coping strategies. Belgium: ITGPress, pp 135-155.