The Minister of Health, Stephen Malinga, has said decentralization of health services has failed. He wants the management of health care returned to the central government in order to stop the sector from falling apart.
Malinga said this on Friday last week at the close of a surgical camp at Kampala International University Teaching Hospital in Bushenyi. He blamed the poor recruitment policies, shortage of staff and equipment and brain drain in the health sector on decentralization, accusing districts of failing to manage their primary health care facilities.
Malinga noted that every year 200 doctors graduate from universities in Uganda, yet the 204 Grade Four health centers around the country are severely understaffed. He said this could be attributed to the poor pay package offered by the districts, forcing many doctors to seek better opportunities in neighboring countries and abroad.
The Minister argued that if health services were centralized, government would be in greater control of remunerations. He said this would guarantee that entry-level doctors receive no less than 400,000 shillings a month and senior consultants would be paid at least five million shillings for their expertise.
Uganda undertook the gradual decentralization of its social services under a World Bank-sponsored structural adjustment program in 1994.
Referral hospitals remain under the Ministry of Health, but district hospitals and health centers were decentralized in July 1998. Supervision of health services became the responsibility of the Chief Administrative Officer and the District Health Officer.
The decentralization of health services administration to district level was intended to improve the quality of health services and pharmaceutical supplies in the hospitals. It was hoped that this would increase in the level of utilization of health facilities.
A 2004 study of the impact of decentralization on health services in Uganda, which was published in the East African Medical Journal, found that eight years after decentralization, there was a general increase in patient attendance in hospitals and health centers. However drug availability was erratic and not always adequate.
According to the report, decentralization enable communities to feel more involved in the decisions made about the health services, but complaints about management of the sector were numerous. Interviewees were unhappy that decentralization failed to improve drug shortages and there was inefficient utilization of resources, and low morale among hospital staff. There were also many complaints about political leaders in the districts interfering in the sector.