Political analysis of rapid change in Uganda’s health financing policy and consequences on service delivery for malaria control
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Date
2004
Journal Title
Journal ISSN
Volume Title
Publisher
The international journal of health planning and management
Abstract
The aim of this study was to assess the political and social dynamics resulting from the rapid
change in user-fee reforms in Uganda and the effects on service delivery for malaria control.
Using political mapping and political risk analysis techniques, the study analysed qualitative
and quantitative data obtained from secondary data sources and key actors in the policy arena.
The results have shown that the feasibility of user-fees in Uganda was undermined by the
absence of strong central government leadership and strategies to manage the politics of
the reforms. The resultant rapid change in policy adversely affected the recurrent expenditures
of health units that previously relied heavily on cost sharing, which led to a chronic
shortage of malaria drugs and undermined the ability of health facilities to hire and motivate
staff. The study results demonstrate that in order to contribute positively to healthcare delivery
goals for malaria control in endemic countries, user-fees require full ownership and strong
political leadership by the central government. Decentralization, when merely used as a strategy
to navigate the political risks associated with user-fees, is unlikely to succeed without a
centrally coordinated and managed process of policy formulation and acceptance involving
wider consultations and political management of interest groups.
Description
Keywords
Health care reform, User-fee, Decentralization, Malaria, Uganda
Citation
Kajula, P. W., Kintu, F., Barugahare, J., & Neema, S. (2004). Political analysis of rapid change in Uganda's health financing policy and consequences on service delivery for malaria control. The international journal of health planning and management, 19(S1), S133-S153. DOI: 10.1002/hpm.772