Fiscal Decentralization and Health Service Delivery in Namuwongo, Makindye Division.

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.