Contents
DECLARATI( N
APPROVAL
DEDICATIOI\
ACKNOWLEE )GEMENT iv
ACRONYMS
TABLES OF ( ONTENTS
ABSTRACT ix
CHAPTER O~E 1
INTRODUCI ION 1
1.0 Introductio
1.1 Backgrounl of the study
1 .1.1 Historica perspective
1.1.2 Theoretic ii perspective 3
1.1 .3 Conceptu ii perspective 5
1.1.4 Contextual perspective 7
1.2 Problem st~ tement 10
1.3 The purpos of the study 11
1.4 The specific objective of the study 11
1.5 Research question 11
1.6 Significanc ~s of the study 11
1.7 The scope fthe study ii
1.7.1 Geograpl ical scope 12
1.7.2 Time scope 12
1.8 The corn eptual frame work of the study 12
CHAPTER TWO 14
LITERATUR ~ REVIEW 14
vi
2.0 Literature r~view 14
2.1 Theoretical review 14
2.1.lThe Tiebout model 14
2.1.2 The fourt:i dimension of Model 16
2.2 Related liteature 17
2.2.1 Fiscal dec entralization 17
2.2.2 Health Service Delivery before Decentralization 18
2.3 Fiscal deceutralizatjon and infrastructure 19
2.3.1 Fiscal dec entralization and availability of drugs 21
2.3.2 Fiscal dec entralization and human Resource 21
2.3.3 Fiscal dec entralization and accountability in health service delivery 27
2.3.4 Fiscal deentralization and effectiveness in health service delivery 28
CHAPTER TI tREE 30
METHODOLOGY 30
3.0 lntroductioi 30
3.1 Research &sign 30
3.2 Study popu’ation 30
3.3 Sample, Sive and Selection 30
3.4 Data collec ion methods 32
3.5 Data collec ion instruments 32
3.5.1 Questionuaires 32
3.5.2 Interview~ 32
3.5.3 Interview Guides 32
3.6 Validity anl reliability 33
3.6.1 Validity of the questionnaire 33
3.6.2 Reliabiliti of the questionnaires 33
3.7 Procedures of data collection 33
3.8Dataanaly~is 34
CHAPTER F( )UR 35
VI
PRESENTALON, INTERPRETATION AND DISCUSSION OF FINDINGS 35
4.0 Introduction 35
4.1 list of resp ndents 35
4.2 The contribution of fiscal decentralization on the health structure in Kasese Municipality. . 39
4.3 The contribution of fiscal decentralization on Human Resource in Kasese Municipality 41
4.4 The contribution of fiscal decentralization has on the availability of drugs in Kasese
Municipality 44
CHAPTER Fl VE 47
SUMMARY, CONCLUSION AND RECOMMENDATIONS 47
5.0 Introductio 47
5.1 Summary 47
5.1.1 The cont~ ibution of fiscal decentralization on the health structure in Kasese Municipality.47
5.2 Conclusion 52
5.2.1 The conti bution of fiscal decentralization on the health structure in Kasese Municipality.52
5.3 Recommen iations 55
5.3.1 The conti bution of fiscal decentralization on the health structure in Kasese Municipality.55
5.4 Areas recot ~imended for further research 57
References 58
Appendix 1: (uestionnaires 63
APPENDIX 2: INTERVIEW GUIDE FOR THE KEY INFORMANTS 67
ABSTRACT The purpose ol the study was to examine the effect of fiscal decentralization on the delivery of health services in Kasese district, Kasese Municipality. This study was based on the following objectives: To examine the contribution of fiscal decentralization on the health structure in Kasese Municinality. To analyze the contribution of fiscal decentralization on Human Resource in Kasese Mui icipality. To determine the contribution of fiscal decentralization has on the availability of Irugs in Kasese Municipality. The study employed qualitative and quantitative approach whici aimed at describing the phenomena nature and patterns of the study. The study population wa~ 150 consisting of municipal health officers, the chairpersons, LC III, the sub county chiefs, ~.D.O, the mayor, health workers, members of the community. The sample size was selected u sing the table by Krejecie and Morgan cited by Amin, (2005) thus our study population of 50 was summarized to the sample size of 120 respondents. Self administration questionnaires and interview guides were used as means of collecting data from the respondents wi ile conducting research. The researcher analyzed data through use of sampling and sapling te hniques. Data was collected with both the aid of structural and non structured questions. The study Concluded that The fiscal decentralization policy has led to increased utilization of tl~e health facilities .the perception that the policy was good because it empowered the local comi ~iunity in terms of creating sense of ownership in the stakeholders, that has facilitated the sistainability of the public institution .in spite the views expressed ,the policy has failed to deal with drug shortages, inefficient utilization of the resources ,morale among the staff, retraining of the staff and better remuneration in order match effective implementation of the policy. Inc eased corruption: In sub-national governments officials are more likely to be subject to the ressures coming from local elites or other interest groups. In addition, subnational office s have more discretion than national ones. Lastly, sub-national governments’ institutions are less developed and skilled than the ones at the central level. so they may be less capable to con rol abuses of power/resources by public employees and officials. The study Recommended that Despite the negative finding still leading low efficiency of the Uganda’s local governm~. ut in channeling public funds to health care and hence to the better services ,as revealed by th this study. The following steps have suggested to enable health centre improve on her fiscal decentralization system to ensure health service delivery. Kasese District, must ensure that th. y hold continuous trainings on educating the locals on what exactly is the meaning of Fi cal decentralization since many people conceptualized fiscal decentralization depending on their culture. Monthly transfer of the public funds for wage and non wage expenditure to the heath centre and regular publication in the main newspapers and radio to avoid misalloc~ tion ofthe funds.
