n Journal of Public Administration - The challenges of decentralised health services in Uganda




The Government of Uganda has decentralised health services since 1993. Despite the positive achievements as a result of this reform process compared to the period during centralisation, the indicators are not impressive. Several challenges still remain. These challenges include: the nature of the health care strategy; access and utilisation of health facilities; funding; ineffective integration of top-down or vertical donor programmes into decentralised systems; weak management; inadequate planning; lack of personnel; un-coordinated distribution of power between different levels of government; poor accountability; and, the health sector reforms overriding the essential differences between private and public sector management. The article, therefore, concludes that these challenges, if not addressed by policy-makers and implementers alike, will easily derail the decentralised health sector reform in the long term. The actors can only achieve the ultimate desired decentralised health objectives if they view the relationship between decentralisation and other elements of health system reform in a holistic manner.


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