The role of decentralisation in promoting health service delivery in arua hill division, arua city, Uganda
| dc.contributor.author | Fortunate Maketa | |
| dc.date.accessioned | 2026-05-26T07:04:34Z | |
| dc.date.available | 2026-05-26T07:04:34Z | |
| dc.date.issued | 2026-05-26 | |
| dc.description | Undergraduate | |
| dc.description.abstract | This study examined the role of decentralisation in promoting health service delivery in Arua Hill Division, Arua City, Uganda, covering the period 2020–2025. Guided by three specific objectives assessing the effects of political, administrative, and fiscal decentralisation on health service delivery the study adopted a qualitative case study research design and relied exclusively on secondary documentary sources, including national health sector performance reports, Auditor General reports, local government performance assessments, policy instruments, and peer-reviewed academic literature. Findings revealed that, while Uganda's decentralisation framework formally transferred governance responsibilities to division-level structures, all three dimensions of decentralisation fell short of generating meaningful improvements in health service delivery. Political decentralisation established formal institutional structures elected councils and citizen participation mechanisms but these did not produce functional downward accountability; no documented corrective responses to a 54% health worker vacancy rate and persistent medicine stockouts were found. Administrative decentralisation devolved management responsibility without a corresponding transfer of authority: division-level structures functioned as administrative relays rather than empowered management units, with staffing, drug procurement, and facility oversight remaining centrally controlled. Fiscal decentralisation operated as a fiscal management arrangement rather than a fiscal empowerment arrangement, with per capita health expenditure of approximately US$23 falling far below the WHO benchmark of US$86, transfer predictability constrained by the Treasury Single Account system, and grant conditionality limiting local expenditure discretion. The study concludes that decentralisation in Arua Hill Division achieved institutional form without institutional function across all three dimensions. It recommends strengthening political accountability mechanisms, expanding administrative decision space for health workforce and procurement management, revising the health conditional grant formula to reflect demographic pressures from refugee-hosting populations, and increasing the national health budget allocation toward the 15% Abuja Declaration target. The findings contribute to the limited scholarship on decentralised health governance in Uganda's West Nile sub-region and carry policy relevance for similar contexts across different countries. | |
| dc.identifier.uri | https://hdl.handle.net/20.500.12311/3303 | |
| dc.language.iso | en | |
| dc.publisher | Uganda Christian University | |
| dc.title | The role of decentralisation in promoting health service delivery in arua hill division, arua city, Uganda | |
| dc.type | Dissertation |