The Role of Community Participation in Improving Social Services to Rural Communities in Uganda: The Case of Decentralized Health Services in Butambala Health Sub-District - Mpigi District

ABSTRACT The study mainly set out to analyze the role of community participation 111 improving social services to rural communities in Uganda. The researcher based the study on the fact that, most deaths in the community are due to conditions that could otherwise be preventable . This would be reduced through meaningful community participation and the belief was that decentralizution would offer an environment for such participation. It was mainly a field survey of a sample county /Health sub-district in Mpigi District. The main objectives of the study were to identify the effects of the management structures on community participation, to assess the quality of service delivered under a decentralized frame work, and to establish the impact of community participation on health service delivery. A number of research instruments were used in the study ranging from questionnaires, interviews, observation and review of related literature. The Sampling techniques used were: simple random sampling and the stratilied random sampling lo ensure that all the population Sub groups were fully and objectively involved in the study. The quality of health services was measured against their accessibility, affordability, availability lo the porulation and the level of community awareness of the service. The major findings of the study are that, though decentralization offered the opportunities for community participation, the community is still not fully involved. This is partly clue to community ignorance pl us the domination of lower level Health Management structures by District level representatives. The study also revealed that the quality of health services delivered is much higher in preventive and rromotive services compared lo the curative services largely due to the level of accessibility to these services These challenges demand restructuring and strengthening the lower level health management structures, to ensure that there is capacity and capability to respond to health and social needs. Thus, attentiot1 should be drawn to processes that involve community participation but with special attention to vulnerable groups especially the rural poor, women and children.

TABLE OF CONTENTS

DECLARATION ................................................................................................................ !

APPROVAL ....................................................................................................................... !

DEDICATION .................................................................................................................. II

ACKNOWLEDGEMENTS ........................................................................................... III

TABLE OF CONTENTS ............................................................................................... IV

LIST OF TABLES ....................................................................................................... VIII

LIST OF GRAPHS ......................................................................................................... IX

LIST OF CHARTS .......................................................................................................... X

LIST OF ABBREVIATIONS: ....................................................................................... XI

ABSTRACT ................................................................................................................... XII

CHAPTER ONE ............................................................................................................... I

INTRODUCTION ............................................................................................................. 1

1.0 Introduction ................................................................................................................. I

I.I Background to the study ...................................................................................... 2

1.2 Statement of the problem ........................................................................................... 5

1.3 Purpose of the study/ general objectives ................................................................... 6

I..J Specific objectives ....................................................................................................... 6

1.5 Scope of the study: ...................................................................................................... 6

1.5.2 Subject scope ................................................................................... : ................ 7

1.5.3 Geographical Scope ......................................................................................... 7

1.6 Significance of the study ............................................................................................. 7

1.7 Hypothesis of the study ............................................................................................... 8

1.8 The Conceptual Frame Work ........ : ........................................................................... 8

CHAPTER TVO ............................................................................................................ 10

LITERATURE REVIEW .............................................................................................. 10

2.1 Introduction ............................................................................................................... 10

IV

2.2 Uganda's Decentralization Policy, the local Government Structure and Health

Service Delivery ............................................................................................................... 10

2.2.1 The Local Government Act 1997: ................................................................... 11

2.2.2 The HSD System in Uganda: ........................................................................... 11

2.2.3 The Role of the Health Sub-District (HSD) ..................................................... 14

2.3 The Concept of Primary Health Care (PHC) and Community Participation in a

Decentralized Frame Work ............................................................................................ 16

2.3. I PHC as a Development Strategy and as A Service ......................................... 19

2.3.2 Integration of Health Programmes under a Decentralized Framework: .......... 22

CHAPTER Tf!REE ........................................................................................................ 29

RESEARCH METHODOLOGY .................................................................................. 29

3.0 Introduction ............................................................................................................... 29

3.1 Research Design ........................................................................................................ 29

3.3 Methods of Data Collection ...................................................................................... 30

3.4 Sampling Procedure .................................................................................................. 32

3.5 Determination of Sample Size ................................................................................ 33

3.6 Data Processing, Analysis and Presentation .......................................................... 34

Data was analyzed manually, with the help of computer programme; micro soft

excel. The data is presented in tables, graphs and pie-charts .................................... 34

3. 7 Ethical Considerations ............................................................................................. 34

3.8 Dissemination of findings ......................................................................................... 35

3.9 Project management ................................................................................................. 35

3. 9.1 Limitations of the Study .................................................................................. 36

CHAPTER FOUR ........................................................................................................... 37

FINDINGS, DATA PRESENTATION ~ND INTERPRETATION .......................... 37

4. 0 Introduction .............................................................................................................. 37

4.l The Effect of Management Structures on Community Participation .................. 37

V

4.1.l Level of Community Awareness about Established Management Structures in

the HSD ..................................................................................................................... 37

4.1.2. Composition of the Management Structures ................................................... 40

4.1.3. HUMC Meetings as an Avenue for Interaction with the Community ............ 42

4.1.4 Involvement of the VilJage Health Management Committee (VHC), in the

Development of Health Plans ................................................................................... 44

4.1.5. Involvement of Health Staff in the Health Planning Process ......................... 45

4.1.6. Involving Stakeholders in the Planning Process ............................................ 46

4.1.7. Problems Encountered as a Result of the Planning Process Involving Different

Stakeholders .............................................................................................................. 4 7

4.2 Quality of Services Offered ...................................................................................... 49

4.2.l. Preventive Services ......................................................................................... 51

4.2.1. l Health Education ........................................................................................... 51

4.2. l .2 Immunization ............................................................................................... 53

4.2.l .3 Antenatal Care ............................................................................................. 55

4.2.2 Curative Services .................................................................................................. 56

4.2.3 Promotive Services ..................................................................... : .......................... 60

4.2.3. l. Family Planning Services ............................................................................ 61

4.2.3.2 Promotion of Good Nutrition ....................................................................... 62

4.2.3.3 Promotion and Provision of Condom use to Prevent STI/H!V/AIDS ......... 64

4.3 Community Involvement .......................................................................................... 65

CHAPTER FIVE ............................................................................................................ 69

SUMMARY, RECOMMENDATIONS AND CONCLUSION ................................. 69

5.0 Introduction ............................................................................................................... 69

5.1 Summary of Findings ............................................................................................... 69

5.2 Recommendations ..................................................................................................... 70

5.3 Building Structures that Promote Democratic Participation ............................... 70

5.3. I Restructuring the Composition of Lower level Management Structures ......... 71

5.3.2 Community Meetings ....................................................................................... 72

5.4 Improvement of the Quality of I-~ealth Services: ................................................... 73

5.4. I Diversification of the Community Out-reach Programmes: ............................ 73

5.4.2 Payment for Health Care Services: .................................................................. 73

5.5 Enhancing Community Participation .................................................................. 74

5.5. l Continued Awareness Creation and Orientations: ........................................... 74

5.5.2 Harmonization and Integration ....................................................................... 75