The relationship between financial decentralization and quality of maternal health services
Emmyline Twinamatsiko, Benard Nuwatuhaire, Anthony Mpairwe and Deusdedit Byabasheija
Department of Public Administration and Management of Kampala International University, Uganda.
This study aimed at investigating Decentralisation policy implementation and quality of maternal health services in Kihiihi Town Council and Nyanga Sub county-Kanungu District. It was guided by three objectives namely. The objectives were; to determine the relationship between Political decentralization and the quality of maternal health services in Kihiihi town council and Nyanga Sub County – Kanungu district, to find out the relationship between financial decentralization and quality of maternal health services in Kihiihi town council and Nyanga Sub County – Kanungu district and to assess the relationship between administrative decentralization and quality of maternal health services in Kihiihi town council and Nyanga Sub County -Kanungu district. The study adopted descriptive cross-sectional research and correlational designs on a sample of 235 respondents. Data was collected using a questionnaire and an interview guide. Quantitative data were analyzed using frequencies, percentages mean, correlation and regression. Qualitative data were analyzed using thematic analysis. Inferential analysis results indicated that financial decentralisation had a strong positive significant relationship with quality of maternal health services. Therefore, it was concluded that financial decentralisation as components of decentralization policy implementation is essential for quality of maternal health services.
Keywords: financial decentralization, maternal health services, women.
Decentralization policy refers to the process through which control over planning, decision- making, and administrative power is transferred from the central government to its administrative divisions, local governments, and field organizations . Between the formation of a policy (such as the enactment of legislation, the issuance of an executive order, or the promulgation of a regulatory rule) and the effects of the policy on the people it touches, policy implementation is a stage of policy making. However, the definition of decentralization policy implementation used in this study was based on how different academics conceptualized Fiscal/ financial, Administrative, and Political decentralization [2-3]. Fiscal/ Financial decentralization is the transfer of funds, revenue-generating power and authority over expenditure to local government and private organisations. Fiscal decentralisation considers financial accountability to be an essential component of decentralization. If subnational governments are to carry out decentralized functions effectively, they must have adequate revenues, either locally generated or transferred from national governments, as well as the authority to make expenditure decisions . Pre-conception and family planning services, prenatal care, and postnatal care are examples of common maternal health services . Decentralisation policies in maternal health service delivery are intended to assist improve women’s maternal health by facilitating access in terms of transportation, distance between users and health facilities, and enhancing the quality of maternal health services . The degree to which health services for people and groups enhance the likelihood of desired health outcomes and are compatible with current professional knowledge is referred to as service quality.
The study found that financial decentralization has a substantial (p=0.000<0.05) impact on the quality of maternal health care in Kanungu district, and there is a strong positive association (r=0.77) between financial decentralization and the quality of maternal health services. As a result of financial decentralization, maternal health quality improves, because if the Central government provides enough funds to the district for the provision of maternal health programs, funds at the district are allocated according to the needs of health center III, and proper accountability at all levels for maternal health funds at the district. This was confirmed by district authorities who were interviewed. In relation to the above, another district official confirmed that, in this area, there’s still low quality of maternal health services because people largely spend most of their incomes and time in seeking quality services in private facilities. Nevertheless, there is improvement, those who manage to go to government facilities; a few are able to access the service”.
The study’s findings concur with Naidoo’s  analysis of the Health Sector Decentralization in Sub-Saharan Africa, which found that nations with excellent financial decentralization policies had better resource mobilization for the provision of maternal health services. The significant financial gains districts experienced following decentralization provide proof of this. The results show that decentralized health systems in sub-Saharan Africa depend on funding from the central government to manage activities in the provision of health services in their areas of jurisdiction, which is in line with Gasto and Anna’s  analysis of participation in health planning in a decentralized system. The money is often released afterward and in around four payments during the fiscal year. The financing mechanism in Uganda is known only as the quota system. This, in Frumence’s opinion, makes it more difficult to carry out sound health policies and provide quality medical care. According to Anna-Karin Hurtig, Gasto et al. , central funding in a decentralized system is not the best way to guarantee the effective and efficient operation of local authorities due to obstacles like limited funding disbursement, delays in funding release, and a lack of funding from other sources, among others. These obstacles all highlight the need for the introduction of informal coping strategies to deal with the situation.
Financial decentralization significantly affects the quality of maternal health services which implies that when local governments are in charge of the financial resources, it can improve the quality of maternal health services
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CITE AS: Emmyline Twinamatsiko, Benard Nuwatuhaire, Anthony Mpairwe and Deusdedit Byabasheija (2023). The relationship between financial decentralization and quality of maternal health services. INOSR ARTS AND HUMANITIES 9(2):10-16. https://doi.org/10.59298/INOSRAH/2023/2.2.4000