TABLE OF CONTENTS
Page
DECLARATION
APPROVAL ii
DEDICATION iii
ACKNOWLEDGEMENT iv
LIST OF ACRYNOMS v
TABLE OF CONTENTS vi
LIST OF TABLES x
ABSTRACT xi
CFIAPTER ONE 12
INTRODUCTION 12
1.0 Introduction 12
Background of the study 12
1 .1 .1 Historical perspective 12
1 .1.2 Theoretical perspective 14
1 .1.3 Conceptual perspective 16
1.1 .4 Contextual perspective 18
1.2 Statement of the problem 21
1.3 Scope of the study 22
1.4 Objectives of the study 22
1 .4.1 General objective 22
1.4.2 Specific objectives of the study 22
1.5 Research questions 22
1.6 Significance of the study 23
1.7 Theoretical or conceptual framework showing Fiscal decentralization and service delivery.
24
CHAPTER TWO 26
LITERATURE REVIEW 26
vi
2.0 Introduction .26
2.1 Theoretical framework 26
2.l.lThe Tiebout model 26
2.1.2 The fourth dimension of Model 27
2.2 Definition of the concept decentralization 29
2.2.1 Health Service Delivery before Decentralization 30
2.3. Service delivery to the community 31
2.3.1 Challenges of health service 33
2.4 Transparency 35
2.5 Improved financial implementation of Fiscal decentralization in provision of the health
services 37
CHAPTER THREE 42
METHODOLOGY 42
3.0 Introduction 42
3.1 Research design 42
3.2 study population 42
3.3 Sample size 42
3.3.2 Sampling techniques 43
3.4 Data collection methods/instruments 44
3.6.2 Interview Method 44
3.6.3 Documentary Review Method 44
3.5 Data collection procedure 45
3.6 Data processing and analysis 45
3.6.1 Editing 45
3.6.2 Tabulation 45
3.6.3 Reliability and validity of quality of data 45
3.6.4 Piloting 46
3,6.5 Editing 46
3.7 Data Analysis 46
3.8 Ethical consideration 47
VII
3.9 Limitation of the st~~dy.47
CHAPTER FOUR 48
PRESENTATION, INTERPRETATION AND DISCUSSION OF FINDINGS 48
4.1 Introduction 48
4.2 list of respondents 48
4.2.1 Respondents’ Background Information 48
4.2.1.1 Gender of respondents 49
4.2.2 Position of the respondent 49
4.2.3 Duration of service 50
4.3 To establish whether there is service delivery to the local community 51
4.3.1 Findings on whether health services are affordable 51.
4.3.2 Findings on whether health services are accessible 51
4.4 To find out whether transparency improves performance in KCCA health centre in
Namuwongo, Makindye division 52
4.4.1 Findings on whether people participation in decision making can improve effective service
delivery 52
4.4.2 Findings on whether the health workers are committed to the delivery of health services..53
4.5 To establish whether there is improved financial implementation of Fiscal decentralization in
provision of health services 53
4.5.1 Findings on whether there is supervision in the audit financial reports to ensure effective
health service delivery 54
4.5.2 Findings on whether there is availability of resources in order to improve effective health
service delivery 55
4.5.3 Health Service Delivery 56
CHAPTER FIVE 59
FINDINGS, CONCLUSION AND RECOMMENDATIONS 59
5.0 Introduction 59
5.2 Summary 59
5.2 Conclusion 60
VIII
5.3 Recommendations .62
5.4 Areas recommended for further research 64
REFERENCES 65
APPENDICES 68
Appendix i: Questionnaires 68
Appendix ii: Map Showing Narnuwongo, Kampala 71
Appendix iii: Proposed Budget 72
Appendix iv: Time Frame 73
Appendix v: Table for Determining Sample Size from a Given Population 74
Note: “N” is population size 74
ABSTRACT The study examined fiscal decentralization and health service delivery in Namuwongo, Makindye division, it was guided by the following objectives to establish whether there is service delivery to the local community, to find out whether transparency improves performance in KCCA health centre in Namuwongo, Makindye division, and lastly To establish whether there is improved financial implementation of Fiscal decentralization in provision of health services. The study adopted a cross sectional study design and case study design. The study population was 45 respondents chosen from the leadership structure of KCCA health center and directly mandated to manage Health service in Namuwongo Makindye Division. Due to limited time and resources, a sample size of (40 respondents) was selected from the study population of (45) respondents using (Krejcie & Morgan, 1970) Findings reveal that the level of health service delivery by the health workers to local community as far as health service delivery is concerned though .The presence of this accountability has enabled the local community from getting the feedback concerning the mobilization, allocation and utilization of resources by their health centre. Therefore, the decentralization policy has promoted accountability which improved accessibility and satisfaction of the patients thus led to health service delivery at the health centre.More still, absence of transparency has limited to enhance people’s freedom to choose the services they want to be administered. Therefore, the policy has failed promoted people participation and awareness which has led to poor health service delivery in the division. The findings reveal that the absence of this parameter financial implementation has limited the local community from accessing information that can be used in making decisions as regards their needs and problems and coming up with solutions. Therefore, the policy has resulted into poor financial implementation since there is no the practice of which the policy is supposed to achieve. The study Concluded that the fiscal decentralization policy has led to increased utilization of the health facilities .the perception that the policy was good because it empowered the local community in terms of creating sense of ownership in the stakeholders, that has facilitated the sustainability 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. The researcher made the following recommendations Despite the negative finding still leading low efficiency of the Uganda’s local government in channeling public funds to health care and hence to the better services ,as revealed by the this study. The following steps have suggested to enable KCCA health centre improve on her fiscal decentralization system to ensure health service delivery. KCCA health centre in Namuwongo, Makindye division must ensure that they hold continuous trainings on educating the locals on what exactly is the meaning of Fiscal 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 misallocation of the funds. Donor involvement in the availability of the conditional grants for health , roads and education and closer monitoring by the central government ,donors and the non-governmental organization.
