Decentralisation in its present form was introduced in Uganda in the 1990s. Uganda has a devolved form of government where local governments have extensive political and administrative powers. The health sector has been markedly influenced by this decentralisation and in the National Health Policy (1999) and the Health Sector Strategic Plan (2000) the sector has sought to decentralise health services even further by creating lower level management structures at a sub-district, or county level. At the same time, the health sector undertook a number of other reforms to improve the delivery of primary health care services in the districts. This paper investigates each of these reforms in turn, noting where progress has been made and where challenges still remain. Particular attention is paid to the impact of the reforms on efficiency, equity and community participation in the health sector. The paper concludes that the Ugandan health sector has performed quite well against a number of these objectives, but that performance is varied across and within districts. In particular, remote areas suffer from a number of drawbacks where for example, staff are unwilling to be stationed in hard-to-reach unattractive locations. Thus, in preparation for the new Health Sector Strategic Plan for the period 2004/05-2008/09, a number of challenges still need to be addressed in order to further improve the decentralised delivery of health services in the country.
In: Tashobya, C.; Ssengooba, F.; Oliveira-Cruz, V. (eds), Health systems reforms in Uganda: processes and outputs, London: Health Systems Development Programme, LSHTM, chp 6, pp 97-108, ISBN: 0 902657 77 1, 2006.