FISCAL DECENTRALIZATION AND HEALTH SERVICE DELIVERY IN LYANTONDE DISTRICT, UGANDA BY NUWAHEREZA SETH 1153-06404-02557 A RESEARCH DISSERTATION SUBMITTED TO THE COLLEGE OF HUMANITIES AND SOCIAL SCIENCES IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF A BACHELOR’S DEGREE OF PUBLIC AI)MINISTRAT1ON OF KAMPALA INTERNATIONAL UNIVERSITY OCTOBER, 2018 DECLARATION I, NUWAHEREZA SETI-I declare that this research dissertation on the “Fiscal Decentj’aljzatjon and Health Service Delivery in Lyantonde District, Uganda” is my original work and to the hcst of my knowledge, has not been submitted for an~ award at any academic institution. Student: NUWAHEREZA SETH Reg. No: 1153-06404-02557 Signed: Date: .~ APPROVAL This is to confirm that this research dissertation on ~Fiscal Decentralization and Health Service Delivery in Lyantonde District, Uganda” is under my supervision and is now ready for submission to the College of 1-lumanities and Social Sciences of Kampala International University. Signaturc Date SUPERVISOR: Ms. Tusiime Rhobinah K III DEDICATION I would like to dedicate this piece of work to my dear parents for their endless support both financially and morally during my academic career without forgetting my brothers and sisters For their contributions. May the Almighty God bless you all. iv ACKNOWLEDGEMENT I thank the Almighty God for strength and good health which has enabled me to come this way and achieve the long dream of accomplishment of the degree. I acknowledge my supervisor br her great support critical and professional support and guidance throughout my whole research. TABLE OF CONTENTS DECLARATION APPROVAL DEDICATION iv ACKNOWLEDGEMENT TABLE OF CONTENTS LISTOFTABLES LIST OF ACRONYMS ABSTRACT Chapter One Introduction I I. Background of the Study I .2 Statement of the problem I .3 General Objective 1.4 Objectives of the Study 3 1.5 Research questions 3 1.6 Scope of the Study 3 1 .6. I Geographical Scope I .6.2 Content Scope 4 1.6.3 T~ime Scope 4 I .7 Significance of the Study 4 I .8 Conceptual Framework S Chapter Two 7 Literature Review 7 2.0 Introduction 7 2.1 Theoretical Review 7 2.2 Contributions of Fiscal Decentralization in Lyantonde District. Uganda 8 2.3 Effect of Fiscal Decentralization on I-lealth Service Delivery in Lyantonde District, Uganda v~ 2.4 Relationship between Fiscal Decentralization and Health Service Delivery in Lyantonde District, Uganda 12 2.5 Empirical studies 5 Chapter Three I 7 Methodology 17 3.0. Introduction 17 3. I Research Design I 7 3.2 Population 7 3.3 Sample 18 3.4 Sampling procedures 18 3.5 Sources of data 19 3.5.1 Primary Data 3.5.2 Secondary Data to 3.6 Data Collection Instruments 9 3.7 Data analysis 3.8 Ethical Considerations Chapter Four 2 I Data Presentation, Interpretation and Analysis 2 I 4. 0 Introduction 2 I 4. I Description of respondents’ background information 2 I 4. I . I Respondents by Gender 2 I 4. I .2 Respondents by Level of Education 22 4. 1 .3 Respondents by Age 23 4.2 Findings on contributions of Fiscal Decentralization in Lyantonde District 23 4.2. 1 Fiscal decentralization can improve the efficiency of public service delivery through preference matching and allocative efficiency 23 4.3 Findings on effect of fiscal decentralization on health service delivery in Lvantonde Districi 27 4.4Findings on relationship between fiscal decentralization and health service delivery in Lyantonde District, Uganda Chapter Five 36 Findings, Conclusions and Recommendations vU 5.1 Summary of findings and discussions .~6 5.1 .1 Contributions of Fiscal Decentralization in Lyantonde District .~6 5.1.2 Effect of fiscal decentralization on health service delivery in Lyantonde District. Uganda 38 5.1.3 Relationship between fiscal decentralization and health service delivery in Lyantonde District, Uganda 5.2 Conclusion 41 5.2.1 Contributions of Fiscal Decentralization in Lyantonde District, Uganda 41 5.2.2 Effect of fiscal decentralization on health service delivery in Lyantonde District, Uganda 42 5.2.3 Relationship between fiscal decentralization and health service delivery in Lyantonde District, Uganda 43 5.3 Recommendations 43 5.4 Suggestions for further research 44 REFERENCES APPENDICES 47 Appendix I: Questionnaire $7 VIII LIST OF TABLES Table 4. 1 : Gender of respondents . 21 Table 4. 2: Level of Education 22 Table 4. 3: Age of respondents 23 Table 4. 4: Fiscal decentralization can improve the efficiency of public service delivery through preference matching and allocative efficiency 24 Table 4. 5: Fiscal decentralization can also ameliorate efficiencies by fostering stronger accountability 25 Table 4. 6: Decentralization gives voters more electoral control over the authorities 26 Table 4. 7: Fiscal decentralization can worsen public service delivery if scale economy is important 27 Table 4. 8: Fiscal decentralisation helps to improve the quality of decisions/decision-making at the top level management in relation to health service delivery 28 Table 4. 9: Fiscal decentralized system delivery facilitates diversification of activities 29 Table 4. 10: Decentralized health service delivery makes decision-making quicker and better.. 30 Table 4. II :Decentralizing health service delivery provides opportunity to learn by doing Table 4. 12: Health status of the people of urban and rural communities in Uganda is poor Table 4. 13: Attention to the state in which the national (public) health system components exist in the local jurisdictions Table 4. 14: Some of the private health care providers operate without registration Table 4. 15: Health care services are inadequate both quantitatively and qualitatively ix LIST OF ACRONYMS CBR Crude Birth Rates CDR Crude Death Rate GDP Gross Domestic Product MoH Ministry of Health NGO Non-Governmental Organization TBA5 Traditional Birth Attendants TFR Total Fertility Rate WB World Bank x ABSTRACT The study sought to examine Fiscal Decentralization and Health Service Delivery in Lyantonde District, Uganda. The study objectives were; to establish the contributions of Fiscal Decentralization in Lyantonde District, Uganda, to examine the effect of fiscal decentralization on health service delivery in Lyantonde District, Uganda and to determine the relationship between fiscal decentralization and health service delivery in Lyantonde District. Uganda. This study was used descriptive research design. The purpose of employ this method was to describe the nature of a situation, as it exists at the time of the study and to explore the causes of particular phenomena. The descriptive approach was also quick and more practical. The population of Lyantonde District was 18000 people (Uganda Demographic Survey. 2016). The research population of 130 as a target population representing district development officers. community leaders, peasants and District health officials. The study used Sloven’s formula to determine the sample size of the actual respondents and the sample size is 98 respondents. 1 he researcher used varieties of sampling which included: Purposive and random sampling. Data \\flS collected from primary and secondary sources using questionnaires and interviews. After collecting data. the researcher organized well-answered questionnaire. data was edited and sorted for the next stage. The data was presented in tabular form. pie charts and bar graphs \\ iii frequencies and percentages. It was found out that fiscal decentralization can improve the efficiency of public service delivery through preference matching and allocative efficiency where by 20 (20.4%) respondents strongly disagreed. The results presented in the table above show that Fiscal decentralization can improve the efficiency of public service delivery throu~h preference matching and allocative efficiency where by 21 (2 1.4%) respondents disagreed. The study concludes that fiscal decentralization can improve the efficiency of public service delivery through preference matching and allocative efficiency. Local governments possess better access to local preferences and. consequently. have an informational advantage over the central government in deciding which provision of goods and services would best satisfy citizens’ needs. There needs to he more discussion and agreement on the degree of balanced distribution of fiscal resources among different regions. The study recommends that the revenue—sharing formula should be transparent. Furthermore, there is need to create some incentives for the development of own-source revenue at the regional and local level. xi Chapter One Introduction 1.1 Background of the Study In the last quarter of the 9~ Century. countries the world over have attempted to implement decentralization by transferring responsibilities of the state to lower tiers of government. Significantly, most of these lower government administrative units have been established to provide for administrative, fiscal and political aspects under decentralization strategy (World Bank Policy Research Paper, May 2015). In Africa, the issue of decentralization has been hotly debated in Nigeria for the past decade. Following the collapse of the military dictatorship in I 991 . few Somalis open lv advocate for the return to a centralized authoritarian state that monopolizes power in Mogadishu. For many Nigerians, some form of decentralization is necessary (Akin, Hutchinson & Strump[ 2001). In Uganda, rural development structures gradually moved from local authorities to more legitimate and representative structures after 1995 constitution, and resulted in a rural development law at the end of