ADMINISTRATIVE DECENTRALIZATION AND PERFORMANCE OF BUYINJA SUB

HOSPITAL IN NAMAYINGO DISTRICT, UGANDA

CONSTANCE MUKYALA

17/MPA/00/KLA/KWD/0016

A DISSERTATION SUBMITTED TO THE SCHOOL OF MANAGEMENT SCIENCE IN

PARTIAL FULFILMENT OF THE AWARD OF A MASTERS DEGREE IN

PUBLIC ADMINISTRATION OF UGANDA

MANAGEMENT INSTITUTE

FEBRUARY, 2023
 DECLARATION

I, Constance Mukyala Reg. NO17/MPA/00/KLA/KWD/0016, declare that this dissertation

entitled “Administrative Decentralization and Performance of Buyinja Sub Hospital: the Case

Namayingo District, Uganda” is my own original work and it has not been presented and will not

be presented to any other institution for any academic award. Where other people’s work has been

used, this has been duly acknowledged.

Sign ……………………………………. Date………………………………..

CONSTANCE MUKYALA

17/MPA/00/KLA/KWD/0016

i
 APPROVAL

This is to certify that this dissertation by Constance Mukyala Reg

NO17/MPA/00/KLA/KWD/0016 entitled, “Administrative Decentralization and Performance of

Buyinja Sub Hospital, Uganda: the case of Namayingo District, Uganda has been submitted for

examination with our approval as Institute supervisors.

Sign ……………………………………. Date………………………………..

SUPERVISOR

DR. MICHAEL KIWANUKA

Sign ……………………………………. Date………………………………..

SUPERVISOR

DR. KENNETH ALFRED KIIZA

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 DEDICATION

This dissertation is dedicated to my family members most especially my dear husband, my children

and my parents for their financial support and moral encouragement.

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 ACKNOWLEDGEMENT

I am deeply indebted to my research supervisors Dr. Michael Kiwanuka and Dr. Kenneth Alfred

Kiiza for their patience with my inadequacies as they guided me through the research process.

Without your parental and professional input, this research would have been difficult to elevate to

its current level.

I acknowledge with gratitude the contributions and co-operation made by the respondents from

Namayingo District for their willingness to provide the necessary information when I visited their

college during the research process. Without their cooperation, this study would have been

impossible to accomplish.

I also thank my colleagues at Uganda Management Institute, Womayi Samson for the great work

done and those who read through the questionnaires and perfected the draft report.

I deeply treasure the contributions of all the above persons and ask God Almighty to richly bless

them.

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 TABLE OF CONTENTS

DECLARATION.................................................................................................................................i

APPROVAL.......................................................................................................................................ii

DEDICATION..................................................................................................................................iii

ACKNOWLEDGEMENT...............................................................................................................iv

TABLE OF CONTENTS..................................................................................................................v

LIST OF TABLES.............................................................................................................................x

LIST OF FIGURES..........................................................................................................................xi

LIST OF ACRONYMS/ ABBREVIATIONS...............................................................................xii

ABSTRACT....................................................................................................................................xiii

CHAPTER ONE................................................................................................................................1

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

1.1 Introduction....................................................................................................................................1

1.2 Background of the study................................................................................................................1

1.2.1 Historical Background................................................................................................................1

1.2.2 Theoretical Background..............................................................................................................4

1.2.3 Conceptual Background..............................................................................................................5

1.2.4 Contextual Background..............................................................................................................6

1.3 Statement of the Problem...............................................................................................................8

1.4 Purpose of the study.......................................................................................................................8

1.5 Objectives of the study..................................................................................................................8

1.6 Research questions.........................................................................................................................9

1.7 Research hypothesis.......................................................................................................................9

1.8 Conceptual Framework..................................................................................................................9

1.9 Significance of the study.............................................................................................................10

1.10 Justification of the study............................................................................................................11

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1.11Study Scope................................................................................................................................11

1.11.1 Geographical Scope................................................................................................................11

1.11.2 Content scope..........................................................................................................................12

1.11.3 Time scope..............................................................................................................................12

1.12 Operational definitions of key terms.........................................................................................12

CHAPTER TWO.............................................................................................................................14

LITERATURE REVIEW...............................................................................................................14

2.1 Introduction..................................................................................................................................14

2.2 Theoretical Review......................................................................................................................14

2.3 Related Literature Review...........................................................................................................16

2.3.1 Deconcentration and Organizational Performance...................................................................16

2.3.1.1 Decision Making Authority and Organizational Performance..............................................16

2.3.1.2 Financial Management Authority and Organizational Performance.....................................18

2.3.1.3 Administrative Authority and Organizational Performance..................................................19

2.4. Delegation and Organizational Performance.............................................................................20

2.4. 1 Creation of Agencies and Organizational Performance..........................................................22

2.4.2. Transfer of responsibility and Organizational Performance....................................................23

2.4. 3 Accountability and Organizational Performance.....................................................................24

2.5. Devolution and Organizational Performance............................................................................25

2.5.1 Budgeting and Planning and its effects on Organizational Performance.................................27

2.5.2 Revenue generation and Organizational Performance.............................................................29

2.5.3 Degree of autonomy assigned and performance of organization.............................................31

2.5.4 Distribution of Responsibility and Organizational Performance..............................................32

2.6 Summary of the Literature Review..............................................................................................33

CHAPTER THREE.........................................................................................................................35

RESEARCH METHODOLOGY...................................................................................................35
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3.1 Introduction..................................................................................................................................35

3.2 Research design...........................................................................................................................35

3.3 Study population..........................................................................................................................36

3.4 Sample Size Selection and Determination...................................................................................37

3.5 Sampling Techniques...................................................................................................................37

3.5.1. Probability Sampling...............................................................................................................37

3.5.2.1 Purposive sampling................................................................................................................38

3.6. Data Collection Methods............................................................................................................39

3.6.1 Questionnaire Survey................................................................................................................39

3.6.2. Interview Method.....................................................................................................................39

3.7 Data Collection Instruments........................................................................................................39

3.7.1 Questionnaire............................................................................................................................40

3.7.2 Interview Guide........................................................................................................................40

3.8 Quality control.............................................................................................................................41

3.8.1 Validity of data collection tools...............................................................................................41

3.8.2 Reliability of data acquisition equipment................................................................................42

3.9 Measure of Variable....................................................................................................................43

3.10 Data Collection Procedure.........................................................................................................43

3.11 Data analysis..............................................................................................................................44

3.11.1 Quantitative data analysis.......................................................................................................44

3.11.2 Qualitative data analysis.........................................................................................................45

3.12 Ethical Considerations...............................................................................................................45

CHAPTER FOUR...........................................................................................................................36

DATA PRESENTATION, ANALYSIS AND INTERPRETATION..........................................36

4.1 Introduction..................................................................................................................................36

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4.2 Response Rate..............................................................................................................................36

4.3 Findings on background information of the respondent..............................................................36

4.3.1 Sex characteristics of the Respondents.....................................................................................37

4.3.2 Age of the Respondents............................................................................................................37

4.3.3 Respondents by Highest Level of Education............................................................................38

4.3.4 Marital Status............................................................................................................................39

4.3.5 Position in Organization...........................................................................................................40

4.3.6 Work Experience.....................................................................................................................41

4.4 Empirical results on administrative decentralization on the performance of Buyinja Sub

Hospital in Namayingo District Local Government.........................................................................41

4.4.1 Performance of Buyinja Sub Hospital in Namayingo District Local Government.................42

4.4.2 De-concentration and performance...........................................................................................44

4.4.3 Delegation and Performance....................................................................................................49

4.4.4. Devolution and performance...................................................................................................52

4.5 Multiple Regression Analysis Summaries...................................................................................56

CHAPTER FIVE.............................................................................................................................59

SUMMARY, DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS.......................59

5.1 Introduction..................................................................................................................................59

5.2. Summary of Major Findings.......................................................................................................59

5.2.1: De-concentration and Performance.........................................................................................59

5.2.2: Delegation and Performance...................................................................................................59

5.2.3: Devolution and performance...................................................................................................60

5.3. Discussion of Findings...............................................................................................................60

5.3.1: De-concentration and Performance.........................................................................................60

5.3.2: Delegation and Performance...................................................................................................61

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5.3.3: Devolution and performance..................................................................................................63

5.4 Conclusions..................................................................................................................................64

5.4.1 De-concentration and Performance..........................................................................................65

5.4.2 Delegation and Performance....................................................................................................65

5.5 Recommendations........................................................................................................................66

5.5.1 De-concentration and Performance..........................................................................................66

5.5.2 Delegation and Performance....................................................................................................66

5.5.3 Devolution and performance....................................................................................................67

5.6. Areas for future Research...........................................................................................................67

REFERENCES................................................................................................................................69

APPENDICES.....................................................................................................................................i

APPENDIX I: TABLE FOR DETERMINING SAMPLE SIZE...................................................i

APPENDIX III: RESEARCH QUESTIONAIRE FOR THE HEALTH WORKERS,

ADMINISTRATIVE OFFICERS / CADRES, PATIENTS OR CARE TAKERS AND

LOCAL LEADERS, CSO/ NGO REPRESENTATIVES.............................................................ii

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 LIST OF TABLES

Table 3.1: Sampling Procedure..........................................................................................................37

Table 3.2: Results of content validity for research tools...................................................................41

Table 3.3: Reliability test results of research instruments.................................................................42

Table 4.4: Response Rat....................................................................................................................36

Table 4.5: Marital Status....................................................................................................................39

Table 4.6: Position in Organization...................................................................................................40

Table 4.7: Performance of Buyinja Sub Hospital in Namayingo District Local Government.........42

Table 4.8: Descriptive Statistics on de-concentration and performance...........................................44

Table 4.9: Pearson Correlation Matrix for de-concentration and performance of Buyinja Sub

Hospital in Namayingo District Local Government.........................................................................48

Table 4.10: Descriptive Statistics on Delegation and Performance..................................................49

Table 4.11: Pearson Correlation Matrix for Delegation and performance of Buyinja Sub Hospital in

Namayingo District Local Government............................................................................................52

Table 4.12: Descriptive Statistics on devolution and performance...................................................53

Table 4.13: Pearson Correlation Matrix for Devolution and performance of Buyinja Sub Hospital

in Namayingo District Local Government........................................................................................56

Table 4.14: Multiple Regression Analysis Summaries for administrative decentralization and

performance.......................................................................................................................................57

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 LIST OF FIGURES

Figure 4.2: Sex of the Respondents...................................................................................................37

Figure 4.3: Age of the respondents....................................................................................................38

Figure 4.4: Highest Level of Education.............................................................................................39

Figure 4.5: Work Experience............................................................................................................41

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 LIST OF ACRONYMS/ ABBREVIATIONS

DHAR: District Health Annual Report

DLG: District Local Government

H/C: Health Centre

IMR: Infant Mortality Rate

IMM: Maternal Mortality Rate

NRM: National Resistance Movement

UBOS: Uganda Bureau of Statistics

UPE: Universal Primary Education

PNFP: Public Not For Private

PFP: Private for Profit

UDHS: Uganda Demographic Households Survey

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 ABSTRACT

The review focused in administrative decentralization and performance of Buyinja Sub Hospital in

Namayingo district, Uganda. The study was guided by three research objectives namely; to

establish the effect of de-concentration on performance of Buyinja HC IV, to examine the effect of

delegation on Performance of Buyinja HC IV and to establish the effect of devolution on

performance of Buyinja HC IV. The study adopted a cross sectional survey design where both

quantitative and qualitative approaches were used. In this study, out of the 88 questionnaires

administered, 68 were returned correctly filled representing 77%. Out of the 10 respondents that

were targeted for interviews, only 7 were actually interviewed implying a response rate of 70%.

The study findings revealed that there was a positive significant relationship between de-

concentration and performance of Buyinja Sub Hospital in Namayingo District Local Government.

The findings established that Delegation had a positive significant relationship with performance of

Buyinja Sub Hospital in Namayingo District Local Government. The findings established that

devolution had a positive significant relationship with performance of Buyinja Sub Hospital in

Namayingo District Local Government. It was recommended that there is need for the government

to increase its budget that is meant for Local Governments, the current budget need to be adjusted

if we are to have policies like decentralization to be implemented; the government needs to

prioritize the budget for Health because these are great determinants for the performance and

existence of the policies. Decentralization policy to large extent has been hindered by the limited

Finance; there should be separation of power between the central government and the local

government. This will help in making independent decisions hence ensuring accountability; the

central government needs to devise a means to rein in the tendency of local governments to spend

more on recurrent, rather than development, elements of the budget. The government should ensure

xiii
that there is empowerment of decentralization project committees at both parish and village levels

so that there is efficient monitory of implementation of decentralization policy.

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 CHAPTER ONE

INTRODUCTION

1.1 Introduction

For decades now decentralization has been at the Centre of public policy reform globally – a

process driven by both economic and political factors. The reforms have involved long run

structural transformation mainly economic and enhanced accountability but empirical evidence

suggests mixed results (World Bank, 2018).

The study will examine how administrative decentralization affects the performance of Buyinja

Sub Hospital (Health Center IV) in Namayingo district, Uganda. Administrative Decentralization

is the independent variable (IV), while Performance is a dependent variable (DV). This chapter

will cover; research background, problem description, research objectives, Purpose of the study,

research questions, research hypotheses, Conceptual frameworks, Significance of the study,

Justification of the study, Scope of study, Geographical Scope, Content Scope, Time Scope and

operational definition of terms

1.2 Background of the study

The back of the study is presented under the historical, theoretical, conceptual, and contextual

perspectives.

1.2.1 Historical Background

Globally, decentralization has been at the center of sudden rise of economic development in

many developing countries such as Nepal and Chile (Balunywa, 2014). The worldwide

governance is towards decentralization Rosen Baum (2013), for instance, the US has 50 state

governments and appropriately 85,000 local governments both National and devolved

governments which are independent with taxing authority and in many cases a quite high degree

of autonomy with the geographical sphere in which they function. In countries such as

Netherlands, local governments have been increasingly accepted as full partners in the process of

plan formulation and not as a mere agent of plan execution, (Allen, 1990). The formulation of

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National budget within the framework of the development plan is a priority to the Korea

Government, Tacoi (2009); argues that states would have increased involvement in the

development of the economy and the society if the formulation of plans and supervision of their

implementation was integrated.

In Africa, decentralization has had long genealogy of practice. However, it became more

pronounced in the 1980s and 1990s when it featured as one of the World Bank’s structural

criteria (Muriisa, 2009). Decentralization programs in Africa followed the recommendations of

the World Bank for developing countries to devolve political and administrative powers to local

and autonomous levels. This followed the need to transform the structure of governance with the

view that decentralization increases the overall efficiency and responsiveness of the public

sector in providing services, an outcome that enhances economic development and contributes

to a reduction in regional disparities (Amusa and Mabugu (2016). Meanwhile in Sub-Saharan

Africa governments have been undertaking various structural reforms, both politically and

socio-economically since 1980s. According to Francis and James (2003) decentralization has

been praised as one of the most far-reaching local government reform programs in the

developing world. Mitchinson (2003) views it as one of the most radical devolution initiatives of

any country at this time. In Ethiopia, decentralization particularly administrative

decentralization was pronounced in the 1990s focusing on the policy which tremendously

moved power, authority and resources to the Local Government (Berfat, 2018).

In 1992, Uganda adopted a decentralization policy that sought to establish a system of

governance under pined by strong local governments. Subsequently constitutional and legal

reforms established districts and Sub counties as key pillars of local government through which

effective service delivery and local governance was to be attained. Although decentralization has

been perused over the last two decades, there is wide spread consensus that the performance of

local government is less than desirable. The revenue base of local governments has diminished

substantially, rendering the local government heavily dependent on central government

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disbursements, mainly through conditional grants. The quality of service delivery is less

desirable in key services like health care, water and sanitation and yet there is no evidence of the

citizen as the primary beneficiary of decentralization demanding for accountability and better

performance from both the elected leaders and technocrats (Lillian Muyomba, 2010).

Organizational Performance during the 1950s, researchers such as Georgopoulos and

Tannenbaum (1957) contended that the possibility of performance managed both hierarchical

strategies and purposes, developed into six principle sub categories. Etzioni cited that during the

1960s regular assessments of organizations led to the achievement or non-accomplishment of

laid out targets and objectives. The assets which an organization expected to achieve its targets

and goals were not considered in Etzioni's proposition. Later scholars like Chandler (1970) and

Thompson (1967) expressed that a definitive proportion of authoritative performance is long

haul endurance and extension. As such, it has its essential objective of continuous advancement

of hierarchical performance. During the 1980s, Robbins (1987) considered performance as the

degree to which an organization, as a social framework, could think about its means and closure.

During the first decade of the 21st Century, the definition of organizational performance focused

mainly on the capability and ability of an organization to efficiently utilize the available

resources to achieve accomplishments consistent with the set objectives of the organization, as

well as considering the relevance of its uses (Fatemeh Azizi Rostam (2020). The performance of

an organization is believed to cover broader areas including the connection between performance

and organizational goal (effectiveness), organizational resources (efficiency), and satisfaction of

the stake holders (relevancy) Rivai and Mulyadi (2012) stated that anyone in a managerial

position is expected to achieve organizational goals, while organizational performance is abstract

and complex. The managers mobilize the talents, abilities, and efforts of several other people

within their authority Banerjee (2019). Organizational performance is one of the factors that

improve effectiveness; therefore, a tool is needed to determine its quality. According to Mulyadi

(2015) performance appraisal is a periodic determination of the operational effectiveness of an

3
organization, part of the organization, and its employees based on predetermined targets,

standards, and criteria. Organizations are basically run by humans; therefore, performance

appraisal is actually an assessment of human behavior in carrying out roles.

1.2.2 Theoretical Background

This study was guided by the Principal-Agent Theory (PAT) proposed by Stephen Ross-(1973).

The theory postulates a contractual relationship which exists between the two parties; the

Principal and Agent. In this relationship, the Agent is accountable to the principal because the

principal gives the agent the authority to perform some tasks on his behalf (Principal). Through

incentives and rules, principals encourage agents to reach their goals. Likewise, applying PAT to

decentralization change makes sense of the compromises between various entertainers and the

potential changes that might be achieved notwithstanding the new obligations of the entertainers

associated with decentralization (Masanyiwa, Niehof and Termeer, (2013). Hiskey (2010)

recognizes that PAT provides a framework for effectively designing, implementing and

evaluating decentralization reforms. He cites three important characteristics that influence

decentralization that this theory may question. That is, client and agent motivations and skills

within the community, the socio-political environment of the region that shapes the "stadium"

and behavior, the flow of information, and the efficiency of selecting effective agents to

influence the effectiveness of client decision-making and direct involvement Hiskey (2010). This

study utilizes PAT to investigate the connection between administrative decentralization and

performance of Buyinja Sub Hospital (for this situation the Ministry of Health, MOH) have

contracted with neighborhood health organization units (Namayingo District Health Department,

Health Centers IV, III, II) to give health administrations to individuals in the Namayingo region.

In such a relationship, the Ministry transfers power, authority and connections to Namayingo

area health room and general health community IV, III, II.

PAT has different goals for agents (Namayingo District Health Department, Health Centers IV,

III, and II) and regional conditions rather than principals (MOH) Brinkerhoff and Bossert (2013).

4
The agent can take advantage to make decisions that deviate from or have been modified from

the MOH guidelines. Therefore, their performance can be judged by how much they deviate

from MOH to make decisions within the narrow decision-making space managed and monitored

by the department through the role of supervisor in the relationship (Mio, et al. 2020). The theory

also pays particular attention to the obligations and responsibilities of MOH (Principal) and

Buyinja Sub Hospital in a decentralized environment and asks if they can fulfill their required

obligations. The theory relates to the study through the principal (MOH) providing incentives to

the agent (Buyinja Sub Hospital), which results into an alignment of the objectives between the

principal and agent, and the relationship is bound by a contract which calls for transparency and

accountability of all the actions of the agent to the principal

1.2.3 Conceptual Background

This Section Centres on conceptualizing and operationalizing the key concepts including;

Administrative decentralization and performance of Local Government. Administrative

decentralization is the exchange of liability regarding the preparation, supporting and the

executives of specific public capacities from the focal government and its organizations to

handle units of government offices, subordinate units or levels of government, semi-

autonomous public specialists or companies, or area wide, provincial or useful specialists World

Bank (2001).

Administrative decentralization is planned to reallocate authority, obligation and monetary assets

for offering public types of assistance among various degrees of government. Taking on from the

World Bank's definition, this study views administrative decentralization as the formation of

semi-autonomous and independent authoritative and lower health units and moving genuine

power from the Ministry of Health to those semi-autonomous health units. This has decentralized

health administrations from MOH to province health offices, area level health places IV, Sub-

locale level health habitats III, and local area level health communities II. This overview

estimates administrative decentralization in terms of deconcentration, delegation and devolution.

5
Deconcentration is the shift of force from the Ministry of Health to decentralized workplaces

with a similar regulatory construction (District Health Department to Health Center IV, Health

Center III, and Health Center II). Designation alludes to the exchange of liability and authority

from the focal government (Ministry of Health) to semi-independent managerial units like the

Regional Health Bureau, Health Center IV, Health Center III, and Health Center II.

Decentralization shifts liability and authority from the Ministry of Health to the detachment of

authoritative constructions that are still inside the extent of the presidential branch.

Performance is related to the extent to which the results achieved by the organization are

measured against the set goals (Ministry of Local Government, 2013). According to Heizer and

Render (2014), Performance refers to the responsiveness and willingness of governments to

quickly deliver services that accurately meet the expectations of their citizens. The extent to

which Buyinja HCIV is able to provide medical services to the residents of the district is

considered the organization's performance in the study. Performance was measured in terms of

healthcare professional responsiveness, accessibility, timeliness, customer satisfaction, staff

involvement, and Buyinja Sub Hospital capabilities to deliver health services. Performance is

defined as effective and efficient medical care that satisfies the expectations of Namayingo DLG

people.

1.2.4 Contextual Background

Namayingo region was created by Act of parliament from Bugiri locale in 2010 having been part

of Bugiri administration since 1997 when Bugiri was cut off from Iganga district. Administrative

decentralization advanced the presentation of the neighborhood government and was attempting

to disperse managerial specialists to appropriate liability and assets to offer public types of

assistance among various degrees of state-run administrations. Semi-autonomous and autonomic

nervous management and subordinate unit creation increased the participation of citizenship,

decision-making, appropriate planning, service delivery, efficiency and validity of buildings and

6
legitimacy coral (2017). However, in various health units of Namayingo district, Buyinja Health

Center IV inclusive their performance has been contrary Kigonya (2018).

Administration-dispersed administration related to Namayingo district is a remarkable health

unit, payment of salary, capacity building, budget approval, work plan implementation, regional

resource mobilization, recruitment, transfer, promote, reward and sanction of workers. In

addition, all planning and budget authority is based on the District Council. Namayingo local

government is obligated to be more obliged to the Supreme Committee, Chief Administrative

Officer heads the Technical Planning Committee, and each committee has to meet the fixed

function. In Namayingo district, health service is decentralized at various levels in alignment

with health center IV (Buyinja Sub Hospital) located in Namayingo Town Council, servicing the

entire district since the district has no hospital. Mutumba, Sigulu, Buswale, Banda have fully

established, functional Health Center IIIs, while the Sub Counties of Bukana, Buhemba, Lolwe

and Buyinja one of the existing health Centre IIs have been upgraded to health Centre III to

reduce on health stress and work load at Buyinja Sub Hospital and general distance by the

public. These health centers significantly improved accessibility of medical services to

communities. These health centers have health Unit management committees that play a superior

role. Similar to Uganda's other districts, medical services in Namayingo district have been

decentralized by the village's health team. Buyinja Sub Hospital’s medical service status remains

poor and wanting despite government efforts to distribute authority to district sub- managers to

plan, budget, mobilize, prioritize and manage local revenues. This definitely indicates poor

performance in DGL’s health center. 2018/2019 Namayingo District Health Annual Performance

Report, indicates that health facilities are performing poorly despite the premise that

decentralization would improve service performance evident in fact that although malaria testing

rate has improved steadily from 40 % in 2019 to 60% in 2020 (Namayingo District Annual

Performance Report 2019/2020), it is still below the national target of 100%. There is a reduction

in the number of mothers attending the antenatal services in both FY 2015/16 and FY 2017/18.

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1.3 Statement of the Problem

In Namayingo district, health administration has been decentralized at various levels of health

Centre IV, III and II both government, private and NGO under PNFP and PFP totaling to 34

Health Centres. These health Centres target to serve a total population of 215,443 as per the

National Housing and population Census Report (2014) under taken by UBOs. This was hoped

would enhance the performance of health services by reducing the work load, distance,

redistributing administrative authority, responsibility and financial resources for providing health

services at all levels. In spite of the above, the state of health service delivery in Namayingo

DLG remains worrying. For instance, the District Health Annual Report (2016 / 2017)

indicates a high disease burden with malaria at 40%, 5.6% HIV/AIDS prevalence rate,

365/100,000 Maternal Mortality Rate (MMR) rate, 50/1000 Infant Mortality rate (IMR), 35%

Teenage Pregnancy, 20% contraceptive prevalence compared to 35% national standard, 7.8

fertility rate compared to 6.5 national by UDHS (2016). Similarly, the DHAR (2018/2019)

indicates the uneven distribution of health facilities subjecting 60% of the households to 5km

distance to the nearest health facility while 40 % move over 5km. The situation is worsened by

lack of prerequisite health personnel were specialist –patient proportionate is 1:5401, Clinical

Official – patient proportion 1:1023, Nurse- patient ratio 1:986, Mid Wife – pregnant women

ratio 1:245, Latrine coverage 66% and staffing level of 57.6% which is beneath the public norm

of 75% (NDHAR, 2018/ 2019). The preceding situation propelled the researcher to investigate

the impact of administrative decentralization on performance of health focuses in Uganda

involving Buyinja Sub Hospital in Namayingo District as the contextual analysis.

1.4 Purpose of the study

The purpose of the study is to examine the effect of administrative decentralization on the

performance of Buyinja Sub Hospital in Namayingo District Local Government.

1.5 Objectives of the study

Specifically, the objectives of the study are:

8
i. To establish the effect of de-concentration on performance of Buyinja HC IV

ii. To examine the effect of delegation on Performance of Buyinja HC IV

iii. To assess the effect of devolution of power on performance of Buyinja HC IV

1.6 Research questions

Research questions for the Study are as below:

i. What is the effect of de-concentration on performance of Buyinja HC IV?

ii. How does delegation affect performance of Buyinja HC IV?

iii. What is the effect of devolution of power on performance of Buyinja HC IV?

1.7 Research hypothesis

Following the research questions, the hypotheses below give tentative answers which was

upheld or rejected depending on the findings of the study.

i. De-concentration has a significant positive effect on the performance of Buyinja Sub-

Hospital in Namayingo.

ii. Delegation has a significant positive effect on the performance of Buyinja Sub-Hospital in

Namayingo.

iii. Devolution of power has a significant positive effect on the performance of Buyinja Sub-

Hospital in Namayingo.

1.8 Conceptual Framework

The conceptual framework shows the diagrammatical representation of the relationship between

Administrative Decentralization and Performance of Buyinja Sub Hospital in Namayingo

District Local Government.

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INDEPENDENT VARIABLE DEPENDENT VARIABLE

Administrative decentralization Performance

Deconcentration 1. Responsiveness of health workers

1. Decision-making authority
2. Financial management authority 2. Accessibility

3. Administrative authority 3. Timeliness

4. Customer satisfaction
Delegation
1. Creation of agencies 5. Employee participation

2. Transfer of responsibility 6. Functionality

3. Accountability

Devolution
1. Budgeting & Planning
2. Revenue generation
3. Degree of autonomy assigned
4. Distribution of responsibility

Source: Adapted and modified from Kilonzo et al, (2017) and World Bank, (2001)

Figure 1: The conceptual framework showing the relationship between the effect of

Administrative decentralization (independent Variable) and performance (Dependent Variable).

1.9 Significance of the study

The study is likely to benefit Buyinja Sub Hospital and other health institutions of the

government whose interests lie in improving health services, outlining concerns of pitfalls in the

adoption of feasible devolution, deconcentration, and delegation policies.

In addition, the findings may guide policymakers and advocates at national and periphery levels

to determine appropriate policy for improving the performance of Health Centres and services.

Similarly, the findings may provide the basis for further research in the area of administrative

decentralization and the performance of Health Centres focusing on other dimensions of

10
performance not investigated in this study. These study findings will contribute to the existing

stock of knowledge in areas of administrative decentralization and performance of Health

Centre.

1.10 Justification of the study

Globally countries have been striving to adopt decentralization in health service delivery to

improve the performance of health centers. Uganda adopted a similar approach of decentralized

health service delivery to match the sustainable development expectations but little has been

investigated in respect to how administrative decentralization as a strategy has improved on

Health Centre performance. There is scanty evidence in the literature from scholarly work

considering that most scholars concentrate on fiscal and political decentralization at the expense

of administrative decentralization. Therefore, the study will fill the knowledge gap through

examination of the effect of administrative decentralization on the Performance of Buyinja Sub

Hospital in Namayingo District, Uganda.

1.11 Study Scope

The study scope presented in this section is limited in terms of geographical, content and time

perspective.

1.11.1 Geographical Scope

The study was carried out in Buyinja Sub Hospital in Namayingo District Local Government

located in South Eastern Uganda. Buyinja Sub Hospital is located in Bukooli South

Constituency, Namayingo Town Council, Namayingo ward, Namayingo cell. The district

headquarters are located approximately 95kms (59 mi), by road, Southeast of Jinja, the largest

city in Busoga Sub-region. This location lies approximately 38 kilometers (24 miles), by road,

south of Bugiri, the nearest large town and the coordinates of the district are: 00 17N, 33 51E.

Namayingo district is boarded by Bugiri district in the North West, Busia district in North East,

the Republic of Kenya to the East and South East, the Republic of Tanzania to the South and

Mayuge district to the West and Southwest.

11
1.11.2 Content scope

The study will focus on the effect of administrative decentralization and performance of Buyinja-

Sub Hospital. Under administrative decentralization, specifically, the study will focus on how

de-concentration, delegation and devolution of power affect the performance of Buyinja Sub-

Hospital in Namayingo. These was linked to performance to see whether one of them affect the

other.

1.11.3 Time scope

The study will focus on a period of three years from 2016 to 2019. This period is chosen because

of the poor performance of health services in Namayingo district, Buyinja Sub Hospital (NHAR,

2016 / 2017).

1.12 Operational definitions of key terms

Committee: Is an assortment of people that is subordinate to a deliberative get together.

Generally, the get together sends matters into a board of trustees as a method for investigating

them more completely than would be conceivable assuming the actual gathering were thinking

about them. Panel can be characterized as a little gathering decided to address a bigger

association and either decide or gather data for it.

Deconcentration; is a term used to depict the interaction by which a focal association moves a

portion of its liabilities to bring down level units inside its purview however stays responsible.

Delegation; is the task of power to someone else (regularly from a chief to a subordinate) to do

explicit exercises. It is the method involved with moving of power and obligation regarding

specific capacities, assignments or choices from the supervisor to the subordinate.

Devolution is the legal designation of abilities from the focal administration of a sovereign state

to oversee at a sub national level, like a provincial or neighborhood level. It is the moving of

force or obligation from a primary association to bring down level or from a focal government to

a nearby government.

12
Health Center; is one of an organization of facilities staffed by a gathering of general specialists

and medical caretakers giving medical services administrations to individuals in a specific

region. It is a reason, claimed by a nearby power, giving medical care to the neighborhood local

area and normally lodging a gathering practice.

Performance; is the manner by which well or seriously you follow through with something or

how well or severely something functions. Performance is also the measure of output against the

set target.

Service delivery; is the delivery of public administrations at the nearby level and is an

unmistakable area of public arrangement. It is likewise an instrument through which public good

is carried nearer to the population to enhance its government assistance. Neighborhood state run

administrations can be more intelligent of nearby requirements and interests and a great driver of

advancement in government rehearses.

13
 CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction

The chapter covers a review of existing literatures on the topic. It includes a review of the theory

used for the study, literature review, and summary of the literature review. The literature was

obtained from textbooks, articles published in journals and on the World Wide Web.

2.2 Theoretical Review

The Principal Agency Theory (also referred to as Agency Theory), is one of the dominant

theoretical perspectives for analyzing and descending public governance reforms. The Principal

Agency Theory was proposed by Stephen Ross (1973). He based his theory on contract

compensation between the land lord and tenants. The theory proposes a principal with specific

objectives and the agents are required to implement the activities to achieve those objectives.

The core of the principal- agency theory is the ‘agency relationship’ which depends on power

positions and information flows between the principal and agent, the question which arise is how

principals can manage the interests of the agents so that both the principal and the agent can

align their objectives (Niehof and Termeer, 2012).

In choosing and controlling the agent, the principal has to solve basic tasks: First, the principal

has to select the best agents and provide incentives for them to perform; and second, the

principal has to monitor the behavior of their agents to ensure that they are performing as agreed

(Ayee, 2005). A problem arises when the parties’ goals conflicts or when it is difficult or

expensive for the principal to verify what the agent is actually doing. In this case information

asymmetry introduces an issue of adverse selection and a moral hazard problem Simiyu et al

(2014). The problem of agency is particularly salient on the demand- side of the public service

delivery chain (Kamara, 2012). Analyzing administrative decentralization using Principal agency

theory perspective helps to explain the tradeoffs between the different actors and the changes

that decentralization may bring about given the new responsibilities of the actors involved

14
(Hiskey, 2010). Mewes (2011), links the agency theory to top –down and bottom –up models. In

the first, Local Governments are agents, exercising responsibilities on behalf of the central

government (principal). Local government Administrators responsible for executing functions

and responsibilities are agents of local political leaders and service users. Kayode (2013) further

argues that in a democratic polity, the ultimate principals are the citizens who are the consumers

of health services.

Relating the theory to the study, the Ministry of Health (clients) expresses that it has designated a

large number of its capacities, including the activity of health focuses to locale level managerial

units and town health groups (specialists). The management of medical facilities is delegated to

the hospital committee and medical center management committee, which are responsible for the

overall management of each medical center or Health facility. The district health officer manages

the provision of health services and performance of health facilities (Kirunga Tashobya, 2018),

and the district service commission is responsible for labor Planning and performance

management of health care workers. The principal (MoH) has contracts with agents (District

Health officers).

The Principal Agent theory has been condemned for its essential spotlight on the upward

connection between the Principal and the Agent, making it hard to examine numerous Principals,

particularly on the off chance that they are of various managerial levels (Francis Patrick Omia,

2013). Kayode (2013) argue that the Agency–theory is one sided because it negatively

characterizes an agent’s behavior as self–seeking and ignores agent loyalty, pride and

professionalism in aligning with the principal’s goal. Some scholars like Kamara (2012), argues

that PAT, omits the opportunistic behavior of the principals. Masanyiwa (2012) citing Batley

(2004) criticized the agency – theory for focusing on the vertical relationship between the Centre

and the periphery in a one dimensional way, which makes it difficult to analyze the multiple

principals and the agents, especially if they are at different administrative levels. Hiskey (2010)

sums it up that analyzing decentralization reforms from the Principal Agent perspective helps to

15
explain the tradeoffs between different actors and the changes that decentralization may bring,

given the new responsibilities of the actors involved (Masanyiwa, Niehof and Termeer, 2013).

2.3 Related Literature Review

This section presents the thematic literature review according to the research objectives.

2.3.1 Deconcentration and Organizational Performance

While governments in many parts of the world embarked on deconcentration with the hope to

bring service delivery closer to the grassroots, empirical findings in several countries show

contradictory findings. In Columbia, Faust Harbers (2012) concluded that deconcentration has

had a positive effect on organizational performance. They found that deconcentration enables

prominent redistribution and resource allocation proportions that aid central authorities to level

inequalities in access to health services while incorporating needs based decisions.

Findings by other scholars indicate that decentralization in Africa is progressing but unevenly in

terms of regional spread and in terms of the aspects of decentralization that are installed (Jorge

Martinez-Vazquez(2011). A comparable report by Namukuve (2019), which looked to lay out a

connection between decentralization of organization and the arrangement of administrations by

nearby legislatures in Namutumba region of Uganda, prompted the improvement of more

prominent regulatory limit of neighborhood states by designation of power. The central

government sector minimizes or has no impact on the performance of health Centres by

expanding its ability to undertake functions that normally do not work well. The study concluded

that delegation of medical services did not result in more participation by the general public and

accountability of the service provider to the community.

2.3.1.1 Decision Making Authority and Organizational Performance

Decision making Authority on major matters of local significance is decentralized to local

governance (Section 9(1) of LGA cap 243). In a decentralized context, the decision making

authority is transferred from National to Sub National Level Kwamie (2015), urges that the

district Health management teams and district level actors make decisions on which health areas

16
and interventions to prioritize, contextualize, adapt and implement policies at national level and

scale up to district and lower administrative units. The process of transferring decision making

powers from the central government to inter mediate governments varies from country to country

while there is solid theoretical justification for decentralizing services; the process requires

strong decision making commitment in order to succeed World Bank (2007).

Similar studies by World Bank (2007) also indicate that decentralized decision making authority

aids to efficient, better reflect on local priorities, and encourage participation. Vroom and Yetton

(1974), suggest that decision making is one of the most primary responsibilities of management

based on individual’s differences because every person has different thinking and information

processing style that makes a difference among the decisions made. Organizations operate under

the influence of internal and external factors, which decision makers must recognize their

influence and role in the decision making process in order to improve its performance Durai

(2015).

Study findings by Shaked and Schechter (2019) suggest that organizational managers must

understand that there are more than one way of actions in any given situation which may affect

the performance of the organization. Similar studies by Irawato (2015), reported positive

findings that organizations which allow their employees to involve in decision making process,

produced more results as a result of motivation and commitment to work. The study conducted

by Golooba and Mutebi (2005), on ethnographic research on participation in the health sector in

Uganda, indicated a lack of participatory political culture and citizen engagement. While Poteete

and Ribot (2011) found that decentralization in Botswana and Senegal empowered some local

actors and weakened others in an often involving process of decision making. Similarly,

Hendrickson (2017), indicated that district Health Management Team in Uganda perceived a

lack of decision space, because politicians have the power in the districts and are the final

decision makes regarding the district budget and work plan. He argues that while on paper health

systems are decentralized, but in reality, the national –level (MOH), has substantial influence on

17
district- level health system decision- making like in Malawi, Ghana and to less extend in

Uganda.

2.3.1.2 Financial Management Authority and Organizational Performance

Ribot (2002), financial resources are a critical part of decentralization process. Without which,

local authorities find it difficult to operate and may not be able to implement the decision of the

organization. Olsen (2007), argues that financial management authority rearranges roles,

responsibilities among the different levels of government within the intent of transferring some

of the financial decision making authority from the central government to Sub national

government, focusing on four areas; expenditure assignment, revenue assignment, inter

government transfers and sub-national borrowing. Financial Management Authority necessitates

reporting comprehensively on what Local Government have achieved with their expenditure

(Olsen, 2007). Studies by Madeira (2012), indicated that if the necessary fiscal resources to

manage the new administrative responsibilities are not granted to the local government, their

performance will suffer from scarcity of investment. This is supported by Ribot (2002) who

states that fiscal resources must be sufficient to cover, the cost of decentralized responsibilities.

In Columbia, Faust and Harbers (2012) concluded that deconcentration has had a positive effect

on performance. They found that deconcentration enables prominent redistribution and resource

allocation proportions that aid central authorities to level inequalities in access to health services

while incorporating needs based decisions. Mango (2012), argues that financial management

involves processes of planning, organizing, controlling and coordinating the organization’s

financial resources to achieve set objectives. He asserts that financial management to an

organization is like maintaining a vehicle and if neglected, the organization eventually breaks

down and fails to reach its intended destination/ goal. In such circumstance, he notes that

financial management is not prioritized and usually characterized by poor planning and

budgeting.

18
Ajonibad (2014) stated that financial control in a large organization is often the responsibility of

various people including, the audit committee, management committee, and financial controller.

However, he argues that it is not the case with smaller organization where control is the

responsibility of a single manager (Bett and Memba, 2018). McCrindell (2015) concluded that

the purpose of any financial management and control frame work is to facilitate and set boundary

lines for planning, use and accounting for resources which impacts on the profitability and

performance of an organization. The researcher is in agreement with the scholars because in the

local government setting the CAO is the accounting officer supported by Audit, Financial

controller and well established system of ensuring proper and effective financial management.

Although, sometimes these control measures are defaulted.

2.3.1.3 Administrative Authority and Organizational Performance

Administrative Authorities are public officials, bodies, commissions or institutions which are

concerned with implementation of government policies and enforcement of duly, enacted laws

(Biyinzika Allan, 2017). Administrative authority is invested in president, ministers, permanent

secretaries, public officers employed in the public service, local government and administrative

units, constitutional commissions, constitutional officers, public corporations, administrative

tribunals and police force. As per Uganda Constitution of 1995, Article 98, establishes the office

of the president and specifies that the president shall be the head of state, head of government

and commander in chief of UPDF.

Globally, different studies and scholars have contradictory findings on administrative authority.

Ribot(2002), observed that increased administrative efficiency is the overriding impetus for

governments to decentralize. Madeira (2012) concurs with Ribot (2002) that decentralization

reforms are commonly justified by the belief that Local governments are more accountable and

responsive to the needs of their local communities. For effective administrative decentralization

to meaning fully contribute to improvement in the quality of health Centre performance, Winker

& Gershberg (2003), emphasizes that national and or regional ministries of health should be

19
restructured to provide new functions to sub national governments and Sub – health districts.

Namukasa (2007) observed that in the context of Uganda, many support structures with defined

roles have been put in place to support the implementation of administrative decentralization.

For instance, the National Health Strategic plan is responsible for capacity building of LGs to

effectively and efficiently perform. The District Service Commission under Section 55(1) of

LGA is mandated to recruit personnel in the district to handle responsibilities including, DHO

and all health workers deployed both at health Sub District and lower Health Centres at sub

county and parish level. However, CAO, under the LGA is the responsible officer, mandated to

implement the district Council Resolution and approved Work plan.

In her study Namukasa (2007) argues that decentralization in Uganda expanded the overall size

of bureaucracy to include local councils. However, she asserts that this administrative expansion

does not necessary imply an increase in efficiency. There is evidence that bureaucratic delays

and inadequacies have been curtailed by decentralization but corruption seems to have

multiplied. Madeira (2012) on the other hand argues that local governments lack the necessary

administrative competencies to provide services efficiently. Scholars like Scott & Orav (2017),

conclude that increased integration leads to better coordination and health care. Universal and

subsidized access to health care and medical supplies are significantly related to improved

performance of organization (Guard, 2011). The researcher agrees with scholars like Namukasa

(2007), who asserts that expansion of administrative authority does not imply efficiency and

effectiveness in the performance of organization.

2.4. Delegation and Organizational Performance

Governments in many parts of the world have embraced delegations and transferred

responsibility for decision-making and management of public missions to lower levels of

government. Such governments imagined that this would lead to better performance. Despite this

premise, research has shown mixed results about the impact of such reforms on performance. For

example, the study by (Mushemeza, 2019), Decentralization of Uganda: Integration Trends,

20
Outcomes, Challenges, and Proposals, suggests that delegation improves local and state

bureaucracy, promote training of local civil servants, and succession. He pointed out that

learning promotes new responsibilities, with minimal impact on performance of organization at

lower levels. Mushemeza asserts that in most cases delegation takes place without the transfer of

funds. Due to lack of funds, lower units cannot operate effectively. Investigations also found that

delegation reduced the autonomy of lower-level local government agencies and increased their

reliance on subsequent local tax transfers or local government debt for the provision of public

social services.

Meanwhile Maria (2010) in her studies on Decentralization and performance of Local authorities

concluded that delegation improves the performance of aid allocation which results in higher

organizational overall performance. Maria (2010) argues that delegated degrees of presidency

have their raison within the provision of products and offerings whose intake is restricted to their

very own jurisdictions. Maria (2010) suggests that delegation increases financial welfare and

therefore, the higher organizational overall performance for the reason that sub national

administrative unit are closer to the people. In support, Bai (2014) observed that delegation

contributes to greater green offerings. It helps right allocation of duties and new obligations

amongst devices to equip their attitudes and judgments to satisfy preferred goals. In

contradiction, Darwish (2018) determined that delegation negatively impacts on performance.

He determined that maximum people in nearby administrative devices with stand permitting

autonomy and delegation of authority which impacts their potential to perform and the Poor

performance is attributed to the problem of more than one accountability. Ostrom & Schroeder

(2018), determined that delegation promotes responsibility and decreases corruption within the

governments. They argue that sub national governments are closer to the people and take into

consideration a greater privy to sub national governments` movements of the crucial authorities

(Namukuve, 2019). The researcher observes that delegation under decentralization should be

21
followed with transfer of resources for effective performance of the delegated organization and

in this context central government to local government.

2.4. 1 Creation of Agencies and Organizational Performance

In many countries, ‘‘agency is used as a generic term for all kind of public organizations and

include, ‘‘central agencies’’ headed by ministers and Executive agencies ‘‘headed by public

officials’’. Thynne (2004), agencies are ‘‘executive bodies, as well as those statutory bodies

which are not incorporated and do not have representatives that rightly distance them from

ministerial oversight and direction. An agency is a relationship between a principal and an agent

in which the principal confers his or her rights on the agent to act on principal’s behalf. Such a

relationship is based on an agency contract. The rights and duties of the agent and principal are

in accordance with the express or implied terms of the contract. An agency relationship is one in

which one or more persons (the principals) engage another person (the agent), to perform some

service on their behalf which involves delegating some decision making authority to the agent

Hill and Jones (1992). Agency is created when a person delegates his authority to another

person, that is appoints them to do some specific job or a number of them in specified areas of

work. Establishment of the principal –Agent relationship confers rights and duties upon the

parties. The creation of agency is based on agency theory which is a set of proportion in

governing a modern organization typically characterized by large number of stakeholders or

owners who allow separate individuals to control and direct the use of their collective capital for

future gains. These individuals may not own capital but have professional skills to manage the

organization. Formally, the main task of creating agencies is usually for policy implementation

such as service delivery, regulation or exercising different kind of public authority (Pollitt, 2004;

and Thiel, 2012).

There is little literature on creation of agencies but a few study findings indicate that though

agencies are deliberately created to implement and not make policy, the bureaucratic networks

impact on their performance in different ways (Gains, 2003). The author has demonstrated that

22
agencies may have a strong influence on the definition of operational goals and may not even

determine the several policy agenda, depending on the type of resource exchange involved.

(Niklasson & Pierre, 2012) suggests that administrative reform may have profound effect on the

roles of agencies in making policies which affect the performance of organization. The creation

of agencies inevitably lead to more complex relationship which more often involve multiple

principals and stake holders (Verschuere and Vancoppenolle, 2012). The researcher agrees with

the study findings by relating the MOH and health Centres, which have been established to offer

health related services to the public on behalf of the ministry. But the MOH issues policies and

guidelines to health Centres to follow while performing the delegated functions and

responsibilities.

2.4.2. Transfer of responsibility and Organizational Performance

Governments in many parts of the world have embraced delegations and transferred

responsibility for decision-making and management of public missions to lower levels of

government. Such a government imagined that this would lead to better performance. Despite

this premise, research has shown mixed results about the impact of such reforms on

performance. In relation, the study by Mushemeza (2019), on Decentralization of Uganda:

Integration Trends, Outcomes, Challenges, and Proposals; indicates that delegation improve

local and state bureaucracy, promote training of local civil servants, and succession. He

pointed out that learning promotes new responsibilities, with minimal impact on organizational

performance at lower levels.

Mushemeza (2019) urged that in most cases delegation takes place without the transfer of funds.

Therefore, due to lack of funds, lower units cannot operate effectively. Similar studies also

indicate that delegation reduces the autonomy of lower-level local government agencies and

increases their reliance on subsequent local tax transfers from central government or local

government debt for the provision of public social services. Other studies on Human Resources

for Health (2019) conducted in Uganda, Tanzania and Ghana on 44 health workers and 21

23
Administrators indicated that, transfers of responsibility initiated by health workers were mostly

based on family conditions and preferences to move away from rural areas, while transfer of

responsibility initiated by administrators were based on service requirement, productivity and

performance. The study also revealed that management of transfers were not guided by clear and

explicitly procedures and depended on the discretion of decision makers and the health workers

were not involved which had a negative effect on performance of health care systems. The study

suggested that to improve performance in health care system, there is need to foster incentives to

attract and retain health workers in rural areas.

2.4. 3 Accountability and Organizational Performance

Merriam Webster dictionary defines accountability as; ‘‘subject of having to report, explain or

justify, answerable, responsible or liable to an act’’. Accountability is seen as the quality or state

of being accountable that an obligation or willingness to accept responsibility or to account for

one’s actions. It is the guiding principle that defines how employees make commitments to one

another, how they measure and report their wrong and how much ownership they take

responsibility. Accountability by general consensus, involves both answerability- responsibility

of duty bearers provide information and justify about their actions and enforceability- the

responsibility claims Goetz and Jenkins (2005). In principle what is called accountability only

reflects the weaker category, answerability. Goetz and Jenkins (2005), emphasizes on the

importance of distinction between de jure accountability and defector accountability.

Accountability may either enhance or hinder performance Ossege (2012).

In their view of accountability researcher Lerner and Tetlock (1999) concluded that

‘‘accountability is a logically complex construct that interacts with the characteristics of the

decision maker and properties of the task environment to produce an array of effects- only some

of which are beneficial’’. Although the relationship may not be as clear as we want it to be, it is

not any less important to reconsider the effect of accountability on organizational performance,

the so called ‘‘pursuit of accountability’’ Dubnick and Yang (2011). Accountability involves

24
accounting mechanism, which comprises of institutional structures or arrangements that hold

bureaucratic accountable for their roles in the policy making process (Hong, 2016). This

mechanism is manifested in adverse context, such as in the relationship between the public and

its officials, elected or otherwise Brinkerhoff and Wetterberg (2016), or private contractors

Romzek (2014).

Winker and Gershberg (2003) efficiency and effectiveness of local governments are likely to

improve under decentralization when local governments / health Centres are held accountable for

their results and actions. May (2007) agrees that accountability is necessary for the performance

of an organization. He quotes Avcion and Heintzman (2000) who articulates that accountability

concerns the control of abuse of public authority by ensuring that resources are properly used.

Kluuers (2003), also agrees with the author, by arguing that accountability is the basis of the

west minister system of government because the electorate has the right to be informed about the

actions and expenditures of the executive and legislative arm of government. The World Bank

asserts that accountability is a prerequisite for improved Local Government and that information

is key to accountability. Further, suggests that in circumstances where accountability standards

are low especially, under administrative decentralization, the stakeholders can engage the civil

society, media to articulate their views to local government. The researcher agrees with the

different scholars and authors because accountability does not occur in the vacuum but society

were there must be relationships and in this relationship the actor must be held accountable.

2.5. Devolution and Organizational Performance

Scholars have broadly made observation in respect to the connection between devolution and

organizational performance. For instance Dedan (2016) observed that decentralization decidedly

affected the organizational performance. By devolving functions, responsibilities and authority

from central authorities to subordinate administrative units, it streamlines and integrates services

that were previously autonomous at the top-level executives .This devolution improved

efficiency and performance of sub national governments. Similar results were found in the study

25
"Decentralization and Providing Local Services in Uganda" by Bashaasha ( 2011), Found that

decentralization creates a supportive environment that enables senior government officials to

oversee and develop effective policies, while at the same time providing services that enable

ownership and participation. The results indicated that decentralization promoted oversight of

subordinate administrative units, thus increasing accountability and improving performance.

Clashing outcomes have been found in the Philippines, Kenya and Ghana with respect to the

effect of decentralization.

In their study in Kenya, Mwatsuma (2014) concluded that decentralization had a negative impact

on corporate performance. They found that decentralization program created excessive anxiety

and conflict among staff, which significantly hindered the provision of medical services, created

public health risks and banned investment in the sector. Unfortunately, both central and

peripheral leadership and stakeholders have shown little interest over compromised service

delivery. Bashaasha (2011) argues that Decentralization underestimates claims to improve health

services because health indicators are stagnant or worse. The authors attribute the poor

performance in local governments due to lack of public participation and accountability by state

actors. Similarly, a study in the Philippines where decentralization has taken place over the last

25 years, Liwanag and Wyss (2018) concluded that decentralization has minimal impact on the

performance of healthcare services in the Philippines. They argue that in most cases elected local

civil servants (politicians), who may not have experience, managing health systems, make health

decisions rather than local health authorities (doctors), who have the legal authority on the

matter. This was cited by study participants as an impediment to medical delivery. Patrick (2013)

mentions devolution of responsibility to the sub national level, where lower-level managers

weigh health services themselves and their priorities to enhance and expand their livelihood

profiling capabilities. However, in a study by Muchomba and Karanja (2015), examining the

influence of devolution of government service delivery on provision of Health care. The study

revealed that devolved procurement process, availability of infrastructure, resources allocation

26
and availability of health personnel as well as policy and regulatory frame work had a significant

influence on the performance of the Sub- Hospitals and overall health sector.

Similarly, Savage and Lumbasi (2016) found that due to devolution of health services, there has

been increase in health facilities (units) and infrastructure, increase in health personnel as while

as improved performance. Devolution of health care has positive effect through increasing local

ownership and accountability, improving health Centre infrastructure and responsiveness to local

needs and strengthening integration of services at the local level. However, Barret (2007), argues

that if devolved systems are not properly designed and implemented it leads to transition of

central government bureaucracies, inefficient utilization of resources and lack of accountability

into an Organization. Other scholars such as Kimenyi (2002), argue that devolution could

undermine national unity and could inflate ethnic, religious, cultural diversities and greater

marginalization thus affecting the performance of organization.

2.5.1 Budgeting and Planning and its effects on Organizational Performance

Budgeting has proved to be one of the accounting practices in achieving accounting because it

embodies the annual plans of the organization, contributes to the accounting relationship and

ensure complementarity. Budgeting is a cornerstone of management control processes in nearly

all organizations Hansen (2003) and is traditionally described as a common accounting tool that

organizations use for implementing strategies Ostergen and Stensaker (2011). Budgeting gives

targets and plans financial values, making the progress easily measureable and transform the

strategic ideas into understandable operative action Hanninen (2013).

The budgeting process implies setting strategic goals and objectives, developing fore castes of

revenues, cash flows and expenditure. In a decentralized system, budgeting is thought to

increase budget accuracy by placing responsibilities for budgeting in the hands of those who are

best able to forecast expenditure requirements. Districts and Urban Councils in Uganda are

responsible for a wide range of public services and the LGA (1997) provides them with the

financial flame work and autonomy for their provision. However, evidence suggests that

27
although they are have the power over the budgets and revenue collection, local governments are

generally unable to access adequate financial resources for all their needs hence subjecting their

dependency on central government conditional grants. Local government discretionary spending

comes from locally generated revenues and unconditional grants.

Livingston & Charlton (2001) suggests that “reforms in local taxation are necessary but not

sufficient condition for the successful achievement of the objectives of devolution. They argue

that, local revenue base is incapable of financing the budget and the range of activities devolved

to local councils under decentralization. Livingston and Charlton (2001) contend that shortage of

funds to cover recurrent expenditure in both rural and urban areas, has resulted into poor

performance of organization. Studies on budgeting conclude that budgeting stands at cross roads

because every organization has unique requirements for their financial planning and other study

findings on budgeting are contradictory due to organization environment, inevitable influences

of national and organizational culture (Dewaal, 2011). On the other hand, planning, is one of the

management functions which is the process of setting goals and objectives in an organization and

determining how to achieve such goals and objectives Alaka (2011). Schendel and Hoffer

(1997), asserts that it is an anticipatory decision making process for effective performance.

Henri Fanyol (2016) Planning is deciding the best alternative to perform different managerial

operations for achieving predetermined goals. Planning is an intellectual decision – making

process in which creative thinking and imagination are essential Haynes and Massie (2018).

Planning involves the determination of objectives and selecting the best course of action to

achieve defined objectives effectively and efficiently. Planning is normally where the discretion

of the organization is made through multiplicity of activities comprising the making of goals. As

such, the planning function of management symbolizes numerous points of decision making

Schroeder (2015). Under devolution, Article 90 of the Constitution of Uganda 1995 requires the

district council to prepare a comprehensive and integrated development plan incorporating plans

of lower local governments for submission to National Planning Authority (NPA). In

28
consideration of the principles of decentralization and devolution of functions, powers and

services enshrined in the National consultation, planning shall be decentralized at all levels of

local government to ensure good governance and democratic participation by all the people. The

process of planning shall be participatory, compressive and inclusive in terms of representation

and content (Section 37&38 of LGA, 1997) which stipulates that the process of planning shall be

a mix top – down and bottom- up approach.

Scholars such as Ansof (1970), Mcllquham-Schmidt (2010), Arasa and K’Obonyo (2012) in

their studies agree that Budgeting and planning has been identified by modern managers to

possess very strong relationship with organizational performance. Similar studies by

Aldehayyata and Twassi (2011) indicate a strong positive relationship between budgeting and

planning and performance of organization in the Jordaniun small industrial publicly quoted

firms. The study findings show empirical evidence about the involvement of top and line

management in planning, use of strategy tools and techniques. In the study conducted by

Njoronge (2018), it was found that strategic planning is the foundation that improves

organization processes and ultimately reduces the internal costs of the organization. The study

also indicates that strategic planning in event planning firms is an important instrument for

forecasting and planning which enables the organization to meet customer’s needs and changes

which may crop up while performing its duties. The researcher concurs with the different

scholars and authors on the study finding on budgeting and planning because organizations to

perform and survive, it calls for effective budgeting and planning.

2.5.2 Revenue generation and Organizational Performance

The common wealth local government forum reinforces revenue generation by suggesting that

‘‘Fiscal decentralization has lagged behind political and administrative decentralization’’.

Revenue generation is a major source of income to states or local government in general, even

though it is said to be dwindling due to weak controls in the systems of revenue generation and

29
worker’s attitude. Notion and Kaplan (2012), suggests that finance focus is not enough to

effectively handle the diverse types of revenue to be collected. Revenue is income collected and

received by local government, the sum of payment received by a local government from

individuals’ residents, organizations and transfers by the National government for financing

service delivery and devolved functions. The locally raised revenues expected to be received

from within the jurisdiction of local government (Cardno, E., M., USA. Ltd, 2016). Revenue

generation are means used to mobilize local revenues that effectively use the scarce resources-

people power and money in a manner that reduces the cost of compliance while maximizing the

revenue collected (LGFC, 2003). Uganda decentralization system empowers local government to

access revenue for effective financing of local needs of the community Article 191(1)2 of the

Constitution of Uganda (1995) and Section 80 of (LGA, 1997). The local government execute

their functions using resources transferred from the Centre, mobilized locally, and directly

received from donors. In Ethiopia to execute the functions are specified in regional Constitution,

local government require the boosting of their internally generated revenues (Felix Onen Eteng,

2018). Resource transfer from the central government to local government comes in form of

conditional and unconditional grant or equalization grant. To fulfill its obligation to finance its

budget and plans, LGs exercise their powers to raise revenue locally from the cities,

municipalities, town councils and rural areas. In rural areas, LG revenue is mobilized by and

collected by sub county officials, who retain 65%, 35% to higher LG and remit 30% to village

and parish (MoLG, 2008). However, increased political freedom and power at the local level

have affected the revenue base of LG, inefficiency and corruption in the tax administration has

made LGs to resort to privatization of revenue collection of certain categories of revenue.

However, surveys indicate that the procedure of awarding tax collection contracts are ridden

with the very short comings that privatization was intended to circumvent, leading to poor

revenue generation performance (Bahaiigwa, 2004). The existing literature on revenue

generation under decentralization specifically local government indicate that local governments

30
across all decentralized states like Ethiopia, Ghana and Uganda are mandated by their local

existing laws to mobilize, levy and collect taxes on all approved viable revenue sources to meet

their financial obligation. However, this is not possible as LGs have failed to realize local

revenues and thus depend mostly on central government conditional grants to finance their

budgets.

2.5.3 Degree of autonomy assigned and performance of organization

There is a good deal of confusion and misinterpretation as the term ‘autonomy’ connotes, despite

its regular usage, yet the real understanding of the term leaves much to be desired. The numerous

Scholars and government functionaries who used the term assumed that their audience

understands the concept. Furthermore, government reforms that are intended to preserve or

extend local government autonomy ends up short of their objectives because the full meaning of

the term ‘autonomy’ has not been fully explained (Adegeno,2005). Autonomy implies the extent

of decision making authority wielded by a given position, person or organization. In a

decentralized organization, autonomy is one in which power is dispersed among many

individuals (Mintzberg, 1989). Degree of autonomy assigned under decentralization is broadly

understood as local autonomy concerned with the question of responsibilities, resources and

discretion conferred on the local authorities. It presumes that local government must possess the

power to take decisions independently of external control within the limit laid down by the law

and must mobilize efficient resources to meet their responsibilities.

Scholarly studies have indicated contradictory findings on the degree of autonomy under

decentralization; Studies by Bashaasha and Najjingo (2011) on Decentralization and Providing

Local Services in Uganda, concluded that decentralization creates a supportive environment that

enables senior government officials to oversee and develop effective policies, while providing

services that enhance ownership and participation. Similar studies in Philippines, Kenya and

Ghana with respect to the effect of decentralization on an association's presentation had

contradictory findings .In Kenya Mwatsuma Mwamuye (2014) concluded that decentralization

31
had a negative impact on corporate performance. They found that decentralization program

created excessive anxiety and conflict among staff, which significantly hindered the provision of

medical services, created public health risks and banned investment in the sector. Scholars like

Bashaasha (2011), argued that Decentralization underestimates claims to improve health services

because health indicators are stagnant or worse and not independent of the central government

influence. The authors attribute the poor performance of medical services to lack of public

participation, national level influence on decision making and accountability to the service

provider community. This indicates that decentralization has a negative impact on Uganda's

medical services and general performance of local government. The researcher concurs with

scholars such as Bashaasha and Najjingo (2011), who argues that decentralization has created

autonomy in decision making, planning and budgeting at sub national units which has improved

performance of local governments.

32
2.5.4 Distribution of Responsibility and Organizational Performance

Governments in many parts of the world have embraced devolution and distribution of

responsibility for decision-making and management of public missions from national

government to sub national government with the intention to draw services closer to the people,

enhance participation, build capacity of local officials and eventually improve performance of

local governments. Despite this premise, research has shown mixed results about the

impact of such reforms on performance. The study by Mushemeza (2019), on Decentralization

of Uganda: Integration Trends, Outcomes, Challenges, and Proposals, indicates that

devolution improve local and state bureaucracy, promote training of local civil servants,

and succession. The author argues that learning promotes new responsibilities, with minimal

impact on performance of organization at lower levels. Mushemeza (2019) asserts that if

administrative decentralization takes place without the transfer of funds, the reform may

decrease the autonomy of sub national debts to perform. Similar studies also indicate that

devolution reduces the autonomy of lower-level local government agencies and increases their

dependence on transfers from central government or local government debt for the provision of

public social services.

Other studies on Human Resources for Health (2019) conducted in Uganda, Tanzania and Ghana

on 44 health workers and 21 Administrators indicated that, transfers of responsibility initiated by

health workers were mostly based on family conditions and preferences to move away from rural

areas, while transfer of responsibility initiated by administrators were based on service

requirement, productivity and performance. The study also revealed that management of

transfers were not guided by clear and explicit procedures but depended on the discretion of

decision makers and the health workers were not involved which had a negative effect on

performance of health care systems. The study suggested that to improve performance in health

care system, there is need to foster incentives to attract and retain health workers in rural areas,

build the technical capacity and assign well aligned roles and responsibilities

33
2.6 Summary of the Literature Review

The literature reviews from the different scholars indicate contradictory findings on the

relationship between the dimension of Administrative decentralization and organizational

performance. Faust and Harbers (2012); Mushemeza (2019) and Namukuve (2019), in their

studies agreed that administrative decentralization has positive influence on organizational

performance in terms of availability of infrastructure, resource allocation and personnel.

Scholars like Jin and Zou (2012); Poteete and Ribot (2011) on the contrary agree that

administrative decentralization has negative influence on organizational performance as they

argue that it creates anxiety and conflicts among staff which impacts on the provision of medical

services, creates health risks for the masses and limits investment in the sector. However, much

of the studies on decentralization focuses on other types of decentralization (political and fiscal),

less studies have been done on administrative decentralization in relation to performance of

health Centres and existing studies also tend to concentrate on local government rather than

health Centres. Thus, creating knowledge gap at national, regional, and global level which has

motivated the researcher to investigate the effect of administrative decentralization on the

performance of health Centres in Uganda, using Buyinja Sub – Hospital as a case study in

Namayingo District.

34
 CHAPTER THREE

RESEARCH METHODOLOGY

3.1 Introduction.

In particular the chapter includes research design, Study population, Sample Size Selection and

Determination, Sampling Techniques, Probability Sampling, Simple Random Sampling, Non –

Probability Sampling, Purposive sampling, Data Collection Methods, Questionnaire Survey,

Interview Method, Data Collection Instruments, Questionnaire, Interview Guide, Quality control,

Validity of data collection tools, Reliability of data acquisition equipment, Measure of Variable,

Data Collection Procedure, Data analysis, Quantitative data analysis, Qualitative data analysis

and Ethical Considerations

3.2 Research design.

This study adopted a Cross sectional study design to allow collection of data from many

respondents at a time (Creswell, 2013). A cross sectional design enabled this study to collect

35
information simultaneously from the different groups of respondents at one time. The study will

apply mixed research approaches of quantitative and qualitative methods during data collection

and analysis. Mixed research methods is a research methodology which incorporates multiple

methods to address research questions in an appropriate and principled manner Bryman (2012);

Creswell (2015); Creswell and Plano Clark (2011), it involves collecting, analyzing, interpreting

and reporting both qualitative and quantitative data. Mixed Research Methods integrates and

synergizes multiple data sources which assisted to study complex problems (Poth and Munce,

2020). Mixed Research Methods answers the same question which can produce greater certainty

and wider implication in the conclusion (Maxwell, 2016) and (Morgan, 2014). The study applied

convergent parallel mixed method, which is an efficient and popular approach to mixing research

Methods (Creswell & Plano Clark, 2018). The integration of both data helps a researcher gain a

complete understanding of the one provided by the quantitative or qualitative results alone. It is

an approach in which two data sets are combined to get a complete picture of the issue being

explored and to validate one set of findings with the other (Creswell & Plano Clark, 2018).

Using the quantitative method, the study collected data from a large number of participants; thus,

increasing the possibility to generalize the findings to a wider population. The qualitative

approach, on the other hand provided a deeper understanding of the issue being investigated,

honoring the voices of its participants. The quantitative results will then be triangulated with

Qualitative findings and vice versa. Triangulation, as a qualitative research strategy will involve

the use of multiple methods or data sources to develop a comprehensive understanding of a

research problem or to test validity through the convergence of information from different

sources (Carter et al., 2014).

In a quantitative method, the study collected data from many participants. Increase the

opportunity to generalize the survey results to a more extensive population. Meanwhile,

qualitative approaches have deeper understanding of the inspected issues to examine participants'

votes. Quantitative results are qualitative survey results and triangulation, and vice versa. As a

36
qualitative research strategy, triangulation involved the use of multiple methods or data sources

to develop a comprehensive understanding of research problems or to test the convergence of

information from various sources (Carter, 2014).

3.3 Study population

Study Population in this study refers to the total individuals, occasions, or areas connected with

the examination (Stoppler, 2019). The study population comprised of 88 drawn from population

categories including District Health office, Health Management Committee, Heads of

Department (HoDs), Health workers, Patients, Administrative Staff, Political leaders and CSOs.

The above respondents are selected for this study because they are knowledgeable, concerned

with service delivery and can provide an evaluation of the objectives under study.

3.4 Sample Size Selection and Determination

A sample is a collection of population elements (Madhuri, 2020). Sample is a sub group of the

target population that a researcher plans to study for generalizing about the target population

(Creswell, 2012). The sample size for this study was determined from Krejcie and Morgan,

tables - (1970).

Table 3.1: Sampling Procedure

The table shows the study population, Sample size and the Sampling technique.

Category Population Sample size Sampling technique

District Health office 4 4 Purposive sampling

Health Management Committee 2 2 Purposive sampling

Heads of Department(HoDs) 8 8 Purposive sampling

Health workers 20 19 Purposive sampling

Patients 15 14 Simple Random Sampling

Administrative Staff 20 19 Purposive sampling

Political Leader 15 14 Simple Random Sampling

Civil Society Organization(CSOs) 4 4 Simple Random Sampling

37
 Total 88 84

Source: Namayingo District Health Service survey (2020)

3.5 Sampling Techniques

In this study, both probability and non-probability sampling techniques was adopted.

3.5.1. Probability Sampling

Creswell; Creswell (2018), Probability Sampling is a sampling technique in which the researcher

chooses samples from a larger population using a method based on the theory. Shona McCombes

(2019) spelt out four types of probability sampling; Simple Random Sampling, Systematic

Sampling, Stratified sampling and Cluster sampling. The study used Simple Random Sampling.

3.5.1.1. Simple Random Sampling

This is a randomly selected Sub set of a population ( Thomas, 2020).The study will apply Simple

Random Sampling Technique during data collection on five categories of respondents, health

workers, Patients , administrative staff , CSO and Political Leaders. The technique was used

because it removes all hints of bias, since every individual has an equal chance to participate.

The technique allows generalization of findings to the entire population; it is simple and

minimizes bias though it is complex, time consuming and costly. The technique is pronounced

for reducing the potential of human bias in the selection of cases to be included in the study.

3.5.2. Non –Probability Sampling

The individuals are selected based on non–random criteria and not every individual has a chance

of being included (McCombes, 2019). The techniques include; Convenience sampling, Purposive

sampling and Snow ball sampling. The study used purposive sampling.

3.5.2.1 Purposive sampling

A purposive sample refers to a non-probability sample that is selected basing on the

characteristics of the study population and the study objectives (Crossman, 2020). The technique

was used because it enables the researcher to sequence a lot of information out of the data

collected. It helps in collection of data out of a small population of interest, make generalization

38
and arrive at valuable research conclusion, though the process of data collection is prone to

research bias, costly and an ineffective method to a large population. The technique aims at

explaining how the collected data is expected to provide valuable information given the

inferential goal of the study. The participants was identified and selected basing on their

proficiency and understanding of the study subject (Cress well and Clark, 2011).The respondents

will include; District Health Office, Health Management Committee, Heads of Department

(HoDs).

3.6. Data Collection Methods

This was the process of preparing and collecting data in order to obtain information, to make

decisions about important issues, and to pass information on to other (Kothari, 2008). Data was

collected from primary and secondary sources for both the qualitative and quantitative data using

Questionnaire Survey Method and Interview Method.

3.6.1 Questionnaire Survey

This is a technique for gathering statistical information about the attributes, attitudes, or actions

of a population by a structured set of questions (Preston, 2009). This involved questions about

the topic of study with a list of possible alternatives from which respondents can select the

answer that best describes the situation as evidenced in research questions and hypothesis. This

method enabled large amounts of information to be collected from Health workers, Patients,

administrative staff, political leaders and CSOs in a short period of time and in a relatively cost-

effective way.

3.6.2. Interview Method

An interview is a purposeful exchange of ideas, the answering of questions and communication

between two or more persons (Cunningham, 2021). An interview is typically a face to face

conversation between a researcher and a participant involving transfer of information to the

39
interviewer (Creswell, 2012).Interviews was used to collect qualitative data by probing for

information from the respondents with the aid of an interview guide (Hellevik, 2019).

3.7 Data Collection Instruments

These are tests, questionnaires, inventories, interviews, schedules or guides, rating scale and

survey plans or any other forms which are used to collect information on substantially identified

items from 10 or more respondent (Creswell, 2019). These instruments were used to collect both

qualitative and quantitative studies as deemed suitable for the study (Stake, 2011).

3.7.1 Questionnaire

Questionnaire is a procedure in quantitative research which is administered to a small group of

people (called the sample) to identify trends in attitudes, opinions, behavior or characteristics of

a large group of people (called the population), (Creswell, 2012). Questionnaire is a research

instrument consisting of a series of questions for the purpose of gathering information from

respondents (McLeod, 2018). A self-administered questionnaire was used to collect data from 70

respondents in the category of 19 Health worker, 14 Patients, 19 Administrative staff, 14

Political Leaders and 4CSOs. Self-Administered Questionnaire offers fast, efficient and in

expensive means of gathering large amounts of information from sizeable samples and addresses

a large number of issues in a standardized way (Sauders and Kulchitsky, 2021). The

questionnaire will contain close ended questions where the researcher provided a response list

on a 5Likert scale of 5-1 in terms of 5- Strongly Agree (SA), 4- Agree (A), 3-Not sure (NS), 2-

Dis Agree (D) and 1- Strongly Disagree (SD) to produce quantitative data. It is chosen because it

is unambiguous and allows calculating the average index score for those agreeing or disagreeing

with each individual statement hence indicating the greater or lesser degree of prejudice reflected

in a particular response (Jebb and Tay, 2019).

3.7.2 Interview Guide

According to Helevik (2019), an interview guide contains a list of open ended questions

regarding the area and topic to be covered by the study. An interview guide was developed in

40
line with the research objectives to guide the conversation between the interviewers seeking for

information from interviewee. The interview guide will aid the researcher to establish what to

ask about sequence to follow, how to pose questions, and how to pose follow-ups and was used

to collect data. Interview guide was applied to collect data from 14 respondents in the category

of 4 District Health Office, 2Health Management Committee, and 8 HoD. Yin (2011), states that

interview guide can help focus the conversation on the topic or issue being investigated and

provide the data needed to achieve a particular research goal. It is useful for collecting

information from key informants, as research provides deeper information (Sarantakos, 2011).

3.8 Quality control

Data quality in respect to ensuring validity and reliability is a requirement to fulfill when

designing a scientific investigation aimed at attaining qualitative results and conclusions

(Yamanaka and Novotny, 2016)

3.8 Quality control

Data quality control technology ensures that the data collected is valid and reliable. The

device is first tested for effectiveness and reliability.

3.8.1 Validity of data collection tools

Validity is the extent, to which the research tool measures what is being measured

(Gruber, 2011). Measuring validity guarantees the stability and quality of the acquired data

(Earl Babbie, 2011). The Content Validity Index (C.V.I.) is used to determine w h a t it was

intended to measure considering item considered for rating in a quantitative study. Quantitative

data: Validity is determined using the Content Validity Index (C.V.I.). C.V.I = Items

considered relevant by both judges divided by the total number of items in the questionnaire, as

shown below. According to Amin (2005) a questionnaire that scores above 50% is considered

valid.

CVI=No. of relevant items x100

Total No. of items in the question

41
Table 3.2: Results of content validity for research tools

Dimensions No of Items Relevant CVI

De-concentration 09 07 0.777

Delegation 09 08 0.888

Devolution 09 07 0.777

Performance 07 6 0.857

Source: Primary Data (2022)

Table 3.2 presents averages of 0.870 and (0.777, 0.888, 0.777 & 0.857 respectively) on all four

variables had a CVIs that were above 0.7, imply that the tool was validity since it was

appropriately answering / measuring the objectives and conceptualization of the study.

According to Mugenda & Mugenda (2003), the tool can be considered valid where the CVI

value is 0.7 and above as is the case for all the four variables provided above.

3.8.2 Reliability of data acquisition equipment

Reliability refers to the reliability or reliability of a measurement tool in that it consistently

measures what is being measured (Stake, 2011). Tool reliability was determined by piloting

questionnaires to ensure consistency and reliability. Ten (10) questionnaires were pretested to

ensure consistency of the responses. On the other hand, the researcher obtained Cronbach Alpha

coefficient values for each construct and variable from the field results to guide data cleaning

until the coefficients are over and above the 0.7 threshold upon which was concluded that the

results used were reliable. The reliability of instruments was established using Cronbach Alpha

Coefficient which tests internal reliability and the average reliability test result for research was

0.84 which is recommended as given below in 3.3.

Table 3.3: Reliability test results of research instruments.

Study variables Cronbach’s Alpha

De-concentration 0.745

42
 Delegation 0.986

Devolution 0.876

Performance 0.765

Average Cronbach Alpha coefficient for variables 0.843

3.9 Measure of Variable

Research variables are measured as follows: Administrative Decentralization includes

deconcentration (decision-making, financial management authority and administrative authority),

delegation (creation of agencies, Transfer of responsibility and accountability), and devolution

(budgeting and planning, revenue generation, autonomy and distribution of responsibility).

On the other hand, Performance the dependent variable was measured in terms of responsiveness

of health workers, accessibility, timeliness, customer satisfaction, employee participation and

functionality. That is, 5-Likert scales. 5- Strongly Agree, 4- Agree, 3 Not Sure, 2 -Disagree, 1 -

Strongly Disagree was used to measure the variables of the survey. This will ensure that each

point on the scale represents the respondent's attitudes, perceptions, values, and behaviors

towards a particular phenomenon (Sharaf, 2019).

3.10 Data Collection Procedure

Data Collection is the process of gathering and measuring information on variables of interest, in

an established systematic fashion that enables one to answer stated research questions, test

hypotheses and evaluate out comes (Syed Muhammad, 2016). The study collected data from

both primary and secondary sources. The primary data was collected using questionnaires and

interview guide from the respondents, quantitative in nature (Creswell, 2013). The secondary

data collection will involve, reviewing of published and unpublished reports like disseminations,

thesis, journals, articles, books and internet materials. The researcher will defend the proposal

before the proposal defense committee of Uganda Management Institute and once successfully

defended, the committee will recommend the researcher to proceed for data collection and write

a report. The institute will issue the researcher with a field introduction letter to Namayingo

43
DLG the area of study. The researcher will proceed with data collection using approved data

collection tools. During data collection exercise, the researcher will recruit one research assistant

to help with data collection he or she was trained on the tools to create better understanding of

the tools and to avoid collecting unnecessary information. Data collection will take one week and

the research assistant will submit each set of questionnaire completed for verification to ensure

that the questions are answered correctly. After data collection, all the questionnaires was

collected and assembled for analyzing, coding, interpreting and report writing. The draft report

was produced forwarded to the supervisors for commenting and the raised comments was

addressed and the report forwarded back to the supervisors and once the comments are cleared

by the supervisors, the final report was produced and submitted to the school of higher degrees

department waiting for viva. With the final comments raised during the viva, the researcher will

address the comments make the final report submit and wait for graduation.

3.11 Data analysis

Bernardita Calzon (2022), data Analysis is the process of collecting, modeling and analyzing

data to extract in sights that supports decision – making. Data was analyzed both quantitatively

and qualitatively.

3.11.1 Quantitative data analysis

Quantitative data is mainly collected from closed questions. The information is set, checked,

altered, and text handled to dispose of blunders and guarantee the exactness of the gathered

information to stay away from errors. Additional data is reduced to frequency and percentage as

a unit of measurement using SPSS, and descriptive statistics are used to describe the sample

population. Correlation analysis is applied to establish relationships between study variables.

Correlation coefficient is used to indicate the degree to which variables are interrelated. This

gives researchers a sense of direction, positive or negative. Pearson's correlation coefficient is

performed to establish a linear relationship between the dependent and independent variables

(Kothari, 2008). Schober & Schwarte (2018), correlation analysis is a statistical method used to

44
measure the strength of linear relationships between two variables and to calculate their

relationships. Researchers use Pearson's correlation coefficient (ρ) to measure how strongly the

movements of two different variables are related (Nickolas, 2021). Senthilnathan (2019) adds

that correlation is a bivariate analysis that measures the strength and direction of the relationship

between two variables. For the strength of the relationship, the value of the correlation

coefficient varies between +1 and 1. A value of + 1 indicates the complete relevance between the

two variables. As the value of the correlation coefficient approaches 0, the relationship between

the two variables weakens (Khalil, 2020).

3.11.2 Qualitative data analysis

Qualitative data analysis will involve both thematic and content analysis and was based on data

collected in relation to research questions. Content analysis was used to edit qualitative data and

re- organize it into meaningful shorter sentences. Thematic analysis was used to organize data

into themes and codes (Sekaran, 2003). After data collection, information of the same category

was assembled together and their similarity with the quantitative data was created and a report

written. The content analysis was performed manually and the answers were summarized in an

explanatory format to present the main findings of the survey.

3.12 Ethical Considerations

Ethical Consideration is a set of principles that guide the research designs and practice

(Bhandari, 2021). Creswell (2009) alludes to the need and importance to adhere to ethical

practice during the research process, right from topic identification, problem statement, writing

style, targeted respondents, research sites, potential readers, data collection methods and analysis

procedures to increase the validity of the results. Creswell (2009) further asserts that, ethical

questions in the current generation focused on personal disclosure, professionalism, professional

code of conduct, authenticity and credibility of the research report, the role of researchers in the

cross- cultural contexts, and issues of personal privacy through forms of internet data collection.

During the process of data collection, the researcher will put into consideration ethical issues by;

45
Obtaining Consent from the Accounting Officer (CAO), Namayingo DLG by presenting a field

introduction letter from Uganda Management Institute, explaining the purpose of the study, the

participants involved, after obtaining the consent of the Accounting Officer, a formal written

authority letter was issued, granting permission to proceed with data collection.

In respect to confidentiality, the researcher will build trust and honesty of the respondents by

assuring the respondent that information obtained was treated with confidentiality and not

disclosed in any form without the consent of the respondents and informed on the fact that

information obtained is purely for academic purposes. The respondent’s personal identifiable

information was anonymized by not including the provision for the respondent’s bio data on the

questionnaires during the process of data collection.

Voluntary participation; the research subjects are free to choose to participate without pressure or

coercion (Bhandari, 2021). The scholar explains that all the participants are free to with draw

from or leave the study at any point without feeling an obligation to continue and no need to

provide a reason for withdrawing from the study. The researcher will inform the respondent

about the procedure, purpose and seek consent for participating in the study. The respondents

who will consent to participate voluntarily in the study was enrolled and data collection will

start. Respondents was informed that they can withdraw from the study anytime they fill so and

that decision will not cause any harm/ disadvantage to them in anyway.

46
 CHAPTER FOUR

DATA PRESENTATION, ANALYSIS AND INTERPRETATION

4.1 Introduction

This Chapter presents the findings, analysis and interpretations to the findings. The findings are

presented according to the objectives of the study. The study investigated the relationship

administrative decentralization on the performance of Buyinja Sub Hospital in Namayingo District

Local Government. The objectives of the study were to establish the effect of de-concentration on

performance of Buyinja HC IV, to examine the effect of delegation on Performance of Buyinja HC

IV and to establish the effect of devolution on performance of Buyinja HC IV.

4.2 Response Rate

Presentation of tabulated data according respondents’ response rate

Table 4.4: Response Rat

Instrument Target Actual Response Response rate

Questionnaire 88 68 77

Interview 10 5 50

Source Primary Data (2022)

Table 4.4 above presents the response rate from the study. The number of questionnaires distributed

was 88 and 68 were returned making a response rate of 77%. Face to face interviews were carried out

with the respondents; in total 5 key informants were interviewed. Edwin (2019) posits that a response

rate of more than 50 percent is suitable enough for a study as shown in Table 4.4 above.

4.3 Findings on background information of the respondent

The demographic characteristics (education level, sex, among others) for the 68 respondents were

examined, presented and used later in the report to make systematic conclusions.

36
4.3.1 Sex characteristics of the Respondents

The sex characteristics of respondents were investigated for this study, and findings are presented

below.

Figure 4.1: Sex of the Respondents

Female
26%

Male
74%

Source: Primary Data (2022)

Figure 4.2 above shows that the majority of the respondents were male 74% and females were 26%.

The study was representative of both sexes. The implication of this finding was that no matter the

disparity in percentage of males and females who attended the study, at least views of both males and

females were captured which is too vital in making a critical analysis of administrative

decentralization and the performance of Buyinja Sub Hospital in Namayingo District Local

Government. This made the study findings representative and, therefore enabled generalizations.

4.3.2 Age of the Respondents

The study looked at the distribution of the respondents by age using frequency distribution. The

results obtained on the item are presented in Figure 4.2 below.

37
 60

50

40

30
Percentage
20

10

0
18-30 31-50 51-60 Above 60

Source: Primary Data (2022)

Figure 4.2: Age of the respondents

The findings from the figure 4.3 above indicate that the majority of respondents were between 31-50

years implying 54%, 22% were between 18-30 years, those between 51-60years were 7% and those

that were above 60 years were 16%. This indicated that all categories of respondents in reference to

different age groups were represented in this study. This implies that all categories of respondents in

reference to different age groups were represented in this study.

4.3.3 Respondents by Highest Level of Education

By examining the highest educational qualifications of the study respondents, the researcher wished

to ascertain whether there were substantial differences in the responses as indicated in the figure

below.

38
 Certificate Masters
12% 7%

Diploma
19%

Degree
62%

Source: Primary Data (2022)

Figure 4.3: Highest Level of Education

The findings from Figure 4.4 above indicate that majority of the respondents were degree holders

making a total percentage of 63%, the respondents with diploma were 19%, those with certificate

were 12%, and those Master’s degree 7%. This implies that the respondents had good qualifications

and the right skills and knowledge to deliver. Besides, the respondents were able to understand, read,

interpret the questionnaire and gave relevant responses.

4.3.4 Marital Status

By examining the marital Status of the study respondents, the researcher wished to ascertain whether

there were substantial differences in the responses as indicated in the table below.

Table 4.5: Marital Status

Marital Status Frequency Percentage

Married 42 62

Single 10 15

Others 6 9

Total 68 100

Source: Primary Data (2022)

39
The findings in the Table 4.5 above reveal that majority of the respondents 62% were married, 15%

were single and 9% indicated others. This showed the married people were the most active

participants and parties in the local government. Married people participated more in than any other

categories this was attributed to the fact that people entrusted their votes with people who had

responsibility like families because they are mature enough to take constructive decisions regarding

health related issues as per this study.

4.3.5 Position in Organization

By examining the positions in organization of the study respondents, the researcher wished to

ascertain whether there were substantial differences in the responses as indicated in the table below.

Table 4.6: Position in Organization

Position in Organization Frequency Percentage

Administration 25 38

Health worker 20 29

District Health office 4 6

Health Unit Management 14 21

HoDs & units 5 7

Total 68 100

Source: Primary Data (2022)

The findings from the Table 4.6 indicate that majority of the respondents 38% were administrators,

29% were Health workers, 6% were District Health officers, 21%were Health Unit Management and

7% were HoDs & units. This indicates that the study focused more on the local officials and central

government civil servants as they are the ones most equipped with knowledge about administrative

decentralization on the performance of Buyinja Sub Hospital in Namayingo District Local

Government.

40
4.3.6 Work Experience

By examining the work experience of the study respondents, the researcher wished to ascertain

whether there were substantial differences in the responses as indicated in the figure below.

Above 5 years

between 2 – 5years
Percentage

Less than 2 years

0 10 20 30 40 50 60 70 80

Source: Primary Data (2022)

Figure 4.4: Work Experience

The findings from Figure 4.5 above indicate that majority of the respondents 68% had worked 2-5

years, 19% less than 2 years and 13% above 5 years. This meant that majority of the respondents had

a working experience of 5 years and above, thereby having enough knowledge to provide relevant

information on the relationship administrative decentralization on the performance of Buyinja Sub

Hospital in Namayingo District Local Government.

4.4 Empirical results on administrative decentralization on the performance of Buyinja Sub

Hospital in Namayingo District Local Government.

In this section, the empirical results for each of the specific research objectives is presented, analysed

and interpreted with an overall goal of demonstrating how de-concentration influences public health

information in Uganda.

41
4.4.1 Performance of Buyinja Sub Hospital in Namayingo District Local Government

The items on Health Professional Involvement were structured basing on the objective of the study.

Items were measured on a five-point Likert scale where code 1 = strongly Disagree, 2 = Disagree, 3 =

Not sure, 4 = Agree and 5 = strongly Agree. Six (6) Items which are statistically tabulated and

presented in the table below with the frequencies and percentages according to the responses

collected.

Table 4.7: Performance of Buyinja Sub Hospital in Namayingo District Local Government.

Item Responses Frequency Percent Mean Std D

Buyinja Health Centre Strongly Disagree 14 21% 3.73 0.864

provides appropriate health Disagree 05 7%

services to clients Not sure 00 00%

Agree 37 54%

Strongly Agree 12 18%

Buyinja Health Centre Strongly Disagree 08 12% 4.59 1.03

HUMC is functional and Disagree 00 00%

plays its oversight role. Not sure 00 00%

Agree 51 75%

Strongly Agree 09 13%

Resources are properly Strongly Disagree 06 09% 4.00 1.08

utilized by Buyinja Disagree 02 03%

Health Not sure 00 29%

Agree 48 71%

Strongly Agree 12 18%

The accessibility of our Strongly Disagree 05 07% 4.54 1.00

services are satisfactory to Disagree 00 20%

42
 our clients Not sure 00 10%

Agree 45 66%

Strongly Agree 18 26%

Most clients are happy Strongly Disagree 03 4% 4.70 0.02

about our timely services to Disagree 00 00%

them Not sure 00 00%

Agree 56 82%

Strongly Agree 09 13%

Buyinja Health Centre Strongly Disagree 06 09% 4.00 0.02

provides appropriate health Disagree 02 03%

services to clients Not sure 00 29%

Agree 48 71%

Strongly Agree 12 18%

Source: Primary Data (2022)

As to whether Buyinja Health Centre provides appropriate health services to clients, majority of the

respondents, 54% agreed 18% strongly agreed, 00% were not sure, 07% disagreed and 21% strongly

disagreed. The mean = 3.73 corresponding to agree indicated the majority of the respondents agreed

that Buyinja Health Centre provides appropriate health services to clients, and the standard deviation

of 1.08 showed the deviating responses from respondents.

Responses to the question as to whether Buyinja Health Centre HUMC is functional and plays its

oversight role, majority of the respondents, 75% agreed 13% strongly agreed, 00% were not sure,

00% disagreed and 12%strongly disagreed. The mean = 4.57 corresponding to agree indicated that

the majority of the respondents agreed that Buyinja Health Centre HUMC is functional and plays its

oversight role with the standard deviation of 1.12 indicating the deviation from the response.

43
As to whether Resources are properly utilized by Buyinja Health, the majority of the respondents,

71% agreed with the statement, 18% strongly agreed, 00% were not sure, 03% disagreed and 09%

strongly disagreed. The mean of 4.00 corresponding to agree indicated that the respondents agreed

that resources a r e properly utilized by Buyinja Health.

As to whether the accessibility of our services are satisfactory to our clients, the majority of the

respondents, 66% agreed, 26% strongly disagreed, 00% (00) were not sure, 00% (00) disagreed and

07% strongly disagreed. The mean = 3.80 corresponding to agree indicated the majority of the

respondents agreed that the accessibility of our services are satisfactory to our clients.

Responses to the question as to whether most clients are happy about our timely services to them,

majority of the respondents, 82% agreed 13% strongly agreed, 00% were not sure, 00% disagreed and

4%strongly disagreed. The mean = 4.70 corresponding to agree indicated that the majority of the

respondents agreed that Buyinja Health Centre HUMC is functional and plays its oversight role with

the standard deviation of 0.02 indicating the deviation from the response.

As to whether Buyinja Health Centre provides appropriate health services to clients, the majority of

the respondents, 71% agreed with the statement, 18% strongly agreed, 00% were not sure, 03%

disagreed and 09% strongly disagreed. The mean of 4.00 corresponding to agree indicated that the

respondents agreed that resources a r e properly utilized by Buyinja Health.

4.4.2 De-concentration and performance

The items on de-concentration were structured basing on the objective of the study. Items were

measured on a five-point Likert scale where code 1 = strongly Disagree, 2 = Disagree, 3 = Not sure, 4

= Agree and 5 = strongly Agree. Eight (8) Items which are statistically tabulated and presented in the

table below with the frequencies and percentages according to the responses collected.

Table 4.8: Descriptive Statistics on de-concentration and performance

Item Response Freq % Mean Std D

De-concentration has increased doctor- Strongly Disagree 09 13% 3.70 0.877
patient ratio in Buyinja HC IV Disagree 2 03%
Not sure 2 03%
44
 Agree 17 25%
Strongly Agree 38 56%
Buyinja HC IV involves local people in Strongly Disagree 01 01% 3.9 0.986
planning for health delivery Disagree 06 09%
Not sure 03 04%
Agree 37 54%
Strongly Agree 21 31%
Namayingo District mobilizes its own Strongly Disagree 02 03% 4.54 1.00
resources Disagree 03 04%
Not sure 8 12%
Agree 42 62%
Strongly Agree 13 19%
Buyinja HC IV calls for stakeholder Strongly Disagree 06 01% 4.54 0.984
meeting to present accountability Disagree 03 04%
Not sure 00 00%
Agree 50 74%
Strongly Agree 08 12%
Buyinja HC IV publishes the receipt of Strongly Disagree 09 13% 3.54 0.877
funds in open for public to view Disagree 6 9%
Not sure 0 00%
Agree 17 25%
Strongly Agree 36 52%
Buyinja HC IV reports health gains to Strongly Disagree 16 24% 4.54 1.00
stakeholders Disagree 03 04%
Not sure 06 09%
Agree 35 51%
Strongly Agree 08 12%
Buyinja HC IV publishes the expenditure Strongly Disagree 01 01% 3.60 0.984
of funds in open for public to view Disagree 06 09%
Not sure 03 04%
Agree 37 54%
Strongly Agree 21 31%
Buyinja Sub Hospital has powers to Strongly Disagree 00 00% 4.54 0.984
make its on Administrative decisions. Disagree 00 00%
Not sure 8 12%
Agree 45 66%
Strongly Agree 15 22%
Source Primary Data (2022)

As to whether De-concentration has increased doctor-patient ratio in Buyinja HC IV, the

respondent’s responses indicated that the majority of the respondents 56% strongly agreed, 25% (17)

agree, 03% (02) not sure, 03% (02) disagreed and 13% strongly disagreed with the statement. The

mean = 4.00 that corresponds to strongly agree indicated that the respondents agreed that De-
45
concentration has increased doctor-patient ratio in Buyinja HC IV. This was attributed that although

primary health care was introduced through decentralization, some important decisions and

responsibilities remained at the centre. For example, staffing decisions in health are made at the

district level but district funding comes largely from the central government in the form of

conditional grants with explicitly identified uses. The findings are supported by the key informant’s

views:

Deconcentration is implemented by the MOH through structures of Health IV

(Buyinja), Health3, H/C2 and Village Health Teams. This is implemented through;

Medical supplies by MOH through National Medical Stores to the district to H/C4,

H/C3, and H/C2 as the lowest level health Centre. Health Sub District has lower level

Health Centres under its jurisdiction (H/C3 and H/C2). These health Centres have

health workers who are responsible for health service delivery (KII/001/24/07/2022).

Responses to the question as to whether Buyinja HC IV involves local people in planning for health

delivery, the respondent’s responses indicated that the majority of the respondents 54% agreed with

the statement 31% strongly disagreed, 09% disagreed, 04% were not sure, 01% disagreed. The mean

= 3.9 corresponding to strongly agree indicated that Buyinja HC IV involves local people in planning

for health delivery.

With respect to whether Namayingo District mobilizes its own resources, the majority of the

respondents 62% agreed, 19% strongly agreed, 04% disagreed, 12% not sure, 03% strongly

disagreed. The mean = 3.800 which corresponded to strongly agree indicated the majority of the

respondents strongly agreed that Namayingo District mobilizes its own resources. The findings were

opined by interview results where one interviewee said;

Financially, all the three levels of health Centre 4, 3, 2, manage resources as

allocated by the MOH, by identifying local needs, priorities, plan, budget and

implement. But the planning, budgeting and implementation must be within the

46
 guidelines of the MOH concerning health service delivery at these three levels of

health Centres. (KII/001/24/07/2022).

Responses to the question as to whether Buyinja HC IV calls for stakeholder meeting to present

accountability, the majority of the respondents 73% agreed, 12% strongly agreed, 09% were not sure,

04% disagreed and 01% strongly agreed. The mean = 4.17 which corresponded to strongly agree

indicated the majority of the respondents strongly agreed that Buyinja HC IV calls for stakeholder

meeting to present accountability. The findings were opined by interview results where one

interviewee said;

Fostered stakeholder involvement in needs identification, planning processes, decision

making. Some respondents said that during the establishment of H/C2, the community

donated land freely. For example, Syanjonja, Mulombi and Buchumba H/C2s, the land

was donated by community members (KII/001/24/07/2022).

As to whether Buyinja HC IV publishes the receipt of funds in open for public to view, the

respondent’s responses indicated that the majority of the respondents 52% strongly agreed, 25%

agree, 00% not sure, 03% disagreed and 13% strongly disagreed with the statement. The mean = 4.00

that corresponds to strongly agree indicated that the respondents agreed that Buyinja HC IV publishes

the receipt of funds in open for public to view.

As to whether Buyinja HC IV reports health gains to stakeholders, the respondent’s responses

indicated that the majority of the respondents 51% strongly agreed, 12% agree, 03% not sure, 03%

disagreed and 24% strongly disagreed with the statement. The mean = 3.60 that corresponds to

strongly agree indicated that the respondents agreed that Buyinja HC IV reports health gains to

stakeholders.

Responses to the question as to whether Buyinja HC IV publishes the expenditure of funds in open

for public to view, the respondent’s responses indicated that the majority of the respondents 54%

agreed with the statement 31% strongly disagreed, 09% disagreed, 04% were not sure, 01%

47
disagreed. The mean = 3.9 corresponding to strongly agree indicated that Buyinja HC IV involves

local people in planning for health delivery. The findings are supported with key informant views:

Budget cuts as the initial resources of H/C4 are shared with newly created health

Centres. For instance during financial year 2020/2022, three health Centres of

Syanyonja, Bukana and Bukimbi were upgraded to health Centre 3 status.

(KII/001/26/07/2022).

As to whether Buyinja Sub Hospital has powers to make its on Administrative decisions, the

respondent’s responses indicated that the majority of the respondents 66% strongly agreed, 22%

agree, 12% not sure, 00% disagreed and 00% strongly disagreed with the statement. The mean = 4.00

that corresponds to strongly agree indicated that the respondents agreed that Buyinja Sub Hospital has

powers to make its on Administrative decisions. The findings are supported with key informant

views:

The health Centres make independent decision on behalf of the H/C in terms of

identifying HR gaps, needs, allocate resources, post, mentor, coach, staff but the

powers to recruit rests on District Service Commission and approval of work plan and

budgets is the responsibility of the district council (KII/001/26/07/2022).

Table 4.9: Pearson Correlation Matrix for de-concentration and performance of Buyinja Sub

Hospital in Namayingo District Local Government.

Pearson Correlation coefficients De-concentration Performance

De-concentration Pearson Correlation 1 .688**
Sig. (2-tailed) .000
N 68 68
Performance Pearson Correlation .688** 1
Sig. (2-tailed) .000
N 68 68
**. Correlation is significant at the 0.01 level (2-tailed). Source: Primary Data (2022)

The Pearson correlation results as presented in Table 4.9 indicate that the coefficient was. 688**, P-

value (P=0.000<0.05) and the significance level was 0.000. The result indicates that there is a
48
significant positive relationship between de-concentration and performance of Buyinja Sub Hospital

in Namayingo District Local Government. Therefore, the alternative hypothesis that was earlier

stated in chapter one is upheld. This implies that de-concentration in terms of decision-making

authority; financial management authority and administrative authority are all essential measures of

performance of Buyinja Sub Hospital in Namayingo District Local Government.

4.4.3 Delegation and Performance

The items on delegation information were structured basing on the objective of the study. Items were

measured on a five-point Likert scale where code 1 = strongly Disagree, 2 = Disagree, 3 = Not sure, 4

= Agree and 5 = strongly Agree. Six (6) Items which are statistically tabulated and presented in the

table below with the frequencies and percentages according to the responses collected.

Table 4.10: Descriptive Statistics on Delegation and Performance

Item Responses Frequency Percent Mean Std D

Delegation of authority is Strongly Disagree 01 01% 3.50 1.02
practiced in Buyinja HC IV Disagree 12 18%
Not sure 9 13%
Agree 28 41%
Strongly Agree 18 26%
Buyinja HC IV board is Strongly Disagree 01 1% 4.49 1.12
responsible for planning, Disagree 04 6%
Budgeting and oversight Not sure 05 7%
roles
Agree 44 65%
Strongly Agree 14 21%
The Health center Strongly Disagree 01 01% 3.48 0.958
leadership has full Disagree 06 08%
autonomy to formulate Not sure 9 13%
health center policies
Agree 34 50%
Strongly Agree 18 26%
Transfer of responsibilities Strongly Disagree 13 19% 2.14 1.02
in Buyinja HC IV has Disagree 27 40%
improved on the Not sure 07 10%
responsiveness of health
Agree 16 24%
workers
Strongly Agree 05 07%
Health Centres have Strongly Disagree 01 1% 4.80 1.12
increased and improved Disagree 04 6%
access to health care Not sure 00 00%
49
 services Agree 58 85%
Strongly Agree 07 10%
Delegation of authority in Strongly Disagree 02 3% 4.00 1.08
Buyinja HC IV has Disagree 04 6%
contributed to more Not sure 04 6%
efficient services
Agree 22 32%
Strongly Agree 36 53%
Source: Primary Data (2022)

Responses to the question as to whether Buyinja HC IV board is responsible for planning, Budgeting

and oversight roles, majority of the respondents, 65% agreed 21% strongly agreed, 7% were not sure,

6% disagreed and 01% strongly disagreed. The mean = 4.49 corresponding to agree indicated that the

majority of the respondents agreed that Buyinja SH board is responsible for hospital administration

with the standard deviation of 1.12 indicating the deviation from the response. The findings are

supported with key informant views:

The MOH has in some instances delegated partners to implement health related

services on its behalf in collaboration with Buyinja Health Centre. For example Star-

EC was delegated by MOH to handle laboratory, maternity and OPD infrastructure

development and when they were completed Star EC recruited one laboratory

technician and currently handed over the facility to Buyinja H/C4 management

(KII/001/24/07/2022).

As to whether the Health center leadership has full autonomy to formulate health center policies, the

majority of the respondents, 50% agreed with the statement, 26% strongly agreed, 13% were not sure,

08% disagreed and 01% strongly disagreed. The mean of 3.48 corresponding to agree indicated that

the respondents agreed Buyinja HC IV has procedures for stakeholders to demand accountability.

With respect to whether transfer of responsibilities in Buyinja HC IV has improved on the

responsiveness of health workers, the majority of the respondents, 40% disagreed, 19% strongly

disagreed, 10% were not sure, 20% disagreed and 6% strongly disagreed. The mean = 2.14

corresponding to disagree indicated the majority of the respondents disagreed that Buyinja HC IV

50
stakeholders enforce standards in the health facility. The findings are supported with key informant

views:

Enhanced stakeholder involvement in planning and budgeting process; However,

those respondents who said that deconcentration has negative influence on health care

systems in Buyinja Health centre 4, argued that clients are not aware of their rights,

have no bargaining power on the services offered to them and these services are

decided by health (KII/001/24/07/2022).

With respect to whether delegation of authority is practiced in Buyinja HC IV, the majority of the

respondents, 85% agreed with the statement, 10% strongly agreed, 00% were not sure, 01% disagreed

and 02% strongly disagreed. The mean = 4.80 corresponding to agree indicated the majority of the

respondents agreed that delegation of authority is practiced in Buyinja HC IV.

As to whether the Health Centres have increased and improved access to health care services, the

majority of the respondents, 41% agreed with the statement, 26% strongly agreed, 13% were not sure,

18% disagreed and 01% strongly disagreed. The mean = 3.50 corresponding to agree indicated the

majority of the respondents agreed that the Health Centres have increased and improved

With respect to whether Delegation of authority in Buyinja HC IV has contributed to more efficient

services, majority of the respondents, 32% agreed 53% strongly agreed, 06% were not sure, 03%

disagreed and 06% strongly disagreed. The mean = 4.00 corresponding to agree indicated the

majority of the respondents agreed that Delegation of authority in Buyinja HC IV has contributed to

more efficient services and the standard deviation of 1.08 showed the deviating responses from

respondents. The findings are supported with key informant views:

The MOH through the district Health Officer is mandated to coordinate the health

services in the district through Buyinja H/C4 in performance of services like

vaccination of the community against COVI.19, Measles and cholera. The delegation

is implemented from the MOH to DHO (H/C4), H/C3 to H/C2 (KII/001/25/07/2022).

51
Table 4.11: Pearson Correlation Matrix for Delegation and performance of Buyinja Sub

Hospital in Namayingo District Local Government.

Pearson Correlation coefficients

Delegation Performance
Delegation Pearson correlation 1 .769**
Sig.(2-tailed) .000
N 68 68
Performance Pearson correlation . 769** 1
Sig.(2-tailed) .000
N 68 68
*Correlation is significant at 0.01 level (2-tailed) Source: Primary Data (2022)

The Pearson correlation results as presented in table 4.11 indicate that the coefficient was .769**, P-

value (P=0.000<0.05) and the significance level was 0.000. The result indicates that there is a

significant positive relationship between Delegation and performance of Buyinja Sub Hospital in

Namayingo District Local Government. Therefore, the alternative hypothesis that was earlier stated

in chapter one is upheld. This implies that Delegation in terms of d Creation of agencies, transfer of

responsibility and accountability are all essential measures of performance of Buyinja Sub Hospital

in Namayingo District Local Government.

4.4.4. Devolution and performance

The items on devolution and performance were structured basing on the objective of the study. Items

were measured on a five-point Likert scale where code 1 = strongly Disagree, 2 = Disagree, 3 = Not

sure, 4 = Agree and 5 = strongly Agree. Seven (7) Items which are statistically tabulated and

presented in the table below with the frequencies and percentages according to the responses

collected.

Table 4.12: Descriptive Statistics on devolution and performance

Item Responses Frequency Percent Mean Std D

52
 Healthcare provision Strongly Disagree 05 07% 3.59 0.864
has improved since Disagree 10 15%
implementation of Not sure 05 07%
devolution
Agree 28 41%
Strongly Agree 20 29%
Devolution has led to an Strongly Disagree 03 04% 3.60 1.03
increase in the number Disagree 00 01%
healthcare workforce in Not sure 00 07%
Buyinja HC IV
Agree 15 22%
Strongly Agree 34 50%
Devolution has led to Strongly Disagree 04 06% 3.86 1.08
improvement and addition Disagree 08 12%
of Health Centre Not sure 00 04%
infrastructure
Agree 43 63%
Strongly Agree 13 19%
As a result of devolution, Strongly Disagree 05 07% 3.54 1.00
health care has been moved Disagree 10 15%
closer to the local citizens at Not sure 03 04%
the grassroots
Agree 30 44%
Strongly Agree 20 29%
Medical supplies and Strongly Disagree 18 26% 3.35 1.00
financial allocations to Disagree 05 7%
health sector has improved
Not sure 06 09%
with devolution
Agree 27 40%
Strongly Agree 12 18%
Budgeting and planning Strongly Disagree 08 12% 3.60 1.03
involves employee Disagree 10 15%
participation Not sure 04 06%
Agree 37 54%
Strongly Agree 09 13%
Devolution has made Strongly Disagree 06 09% 4.00 0.67
financing of the health Disagree 02 03%
center by the Central Not sure 00 00%
Government timely and
Agree 48 71%
sufficient
Strongly Agree 12 18%
Source Primary Data (2022)

With respect to whether Healthcare provision has improved since implementation of devolution,

41% agreed with the statement, 29% strongly agreed, 07% were not sure, 15% disagreed and 07%

strongly disagreed a mean of 3.59 which corresponded to agreed indicated the majority of the

53
respondents agreed that Healthcare provision has improved since implementation of devolution. The

findings are supported by key informant views:

Under devolution, health services in Buyinja Health Centre are implemented through

established structures of both administrative / Technical and Health Unit Management

Committee at Health Centre 4, H/C2 and H/C3 to Village Health Teams

(KII/001/24/07/2022).

As to whether Devolution has led to an increase in the number healthcare workforce in Buyinja HC

IV, 40% strongly agreed, 22% agreed, 07% not sure, 01% disagreed and 04% strongly disagreed. The

mean of 3.60 corresponding to agree indicated that Devolution has led to an increase in the number

healthcare workforce in Buyinja HC IV

With respect to whether devolution has led to improvement and addition of Health Centre

infrastructure, the majority of the respondents 63% agreed with the statement, 22% strongly agreed,

04% (03) were not sure, 12% (08) disagreed and 06% (10) strongly agreed. The mean = 3.86

corresponding to agree indicated that the majority of the respondents agreed that devolution has led

to improvement and addition of Health Centre infrastructure.

Whether as a result of devolution, health care has been moved closer to the local citizens at the

grassroots, the majority of the respondents, 44% agreed, 29% strongly agreed, 04% were not sure,

15% disagreed and 07% strongly disagreed. The mean = 3.54 corresponding to agree indicated that

the majority of the respondents agreed that as a result of devolution, health care has been moved

closer to the local citizens at the grassroots.

As to whether medical supplies and financial allocations to health sector has improved with

devolution, majority of the respondents, 27% agreed 18% strongly agreed, 09% were not sure, 07%

disagreed and 18% strongly disagreed. The mean = 3.35 Corresponding to agree indicated the

majority of the respondents agreed that medical supplies and financial allocations to health sector has

improved with devolution, and the standard deviation of 1.08 showed the deviating responses from

54
respondents.

Responses to the question as to whether Budgeting and planning involves employee participation,

54% agreed 13% strongly agreed, 06% were not sure, 15% disagreed and 12% strongly disagreed.

The mean = 3.60 corresponding to agree indicated that the majority of the respondents agreed that

budgeting and planning involves employee participation with the standard deviation of 1.12

indicating the deviation from the response.

As to whether devolution has made financing of the health center by the Central Government

timely and sufficient, the majority of the respondents, 71% agreed with the statement, 18% strongly

agreed, 00% were not sure, 03% disagreed and 09% strongly disagreed. The mean of 3.48

corresponding to agree indicated that the respondents agreed that devolution has made financing of

the health center by the Central Government timely and sufficient. The findings are supported by

key informant views:

One respondent noted that health Centers operate under devolution which is qualified

under policy and resources and yet these two are not in the mandate of H/C4. The

respondent cited that in Kenya devolution of health services is working well under the

district hospital concept as resources are managed at county level where all health

related challenges are handed and partners are easily directed where to offer health

services. But in Uganda health Centre resources are determined by OPM and MOH

and policy and mandate on resources is centered at MOH and not H/C4. H/C4 across

the country are run at the same level but under devolution, this would be handled

according to unique situation hence making devolution not to be real. However, under

Result Based Funding (RBF), the MOH has tried to lower the authority at the cost

Centres, so that the health Centre makes decisions, plan and budget and implement

plans and budgets. However, the respondent reported that the unfortunate part is that

the resources are not known to CAO not until when the H/C reports how much has

55
 been received. At H/C2 and 3 the s/c authority also has no control over the RBF

resources. (KII/001/24/07/2022).

Table 4.13: Pearson Correlation Matrix for Devolution and performance of Buyinja Sub

Hospital in Namayingo District Local Government.

Pearson Correlation coefficients

Devolution Performance
Devolution Pearson correlation 1 .875
Sig.(2-tailed) .000*
N 68 68
Performance Pearson correlation .875 1
Sig.(2-tailed) .000*
N 68 68
*Correlation is significant at 0.01 level (2-tailed) Source: Primary Data (2022)

The Pearson correlation results as presented in table 4.13 indicate that the coefficient was .875**, P-

value (P=0.000<0.05) and the significance level was 0.000. The result indicates that there is a

significant positive relationship between devolution and performance of Buyinja Sub Hospital in

Namayingo District Local Government. Therefore, the alternative hypothesis that was earlier stated

in chapter one is upheld. This implies that devolution in terms of budgeting & planning, revenue

generation and degree of autonomy assigned are all essential measures of performance of Buyinja

Sub Hospital in Namayingo District Local Government.

4.5 Multiple Regression Analysis Summaries

In order to understand the statistical significance and contribution of the Model and each individual

independent variable (De-concentration, Delegation and Devolution) on dependent variable

(Performance of Buyinja Sub Hospital in Namayingo District Local Government), a regression was

computed and the tests results are provided in Table 4.14.

Table 4.14: Multiple Regression Analysis Summaries for administrative decentralization and

performance

56
 Unstandardized Standardized
Model Variables Coefficients Coefficients
Std.
Beta Error Beta T Sig.
(Constant) 81.607 6.326 12.900 .000
De-concentration .224 .074 .688 3.041 .001
Delegation .769
1 .065 .142 .456 .000
Devolution .875
.260 .075 3.484 .000

R .657a

.774
R Square
Adjusted
.139
R Square
13.6
F statistic 57
b
Sig. .000
a. Dependent Variable: Performance
b. Predictors: (Constant), De-concentration , Delegation and Devolution

R square of .774 implies that De-concentration, Delegation and Devolution explain the variation in

Performance at Buyinja Sub Hospital in Namayingo District Local Government by 77%. This

suggests that holding other factors constant, one unit of improvement in De-concentration, Delegation

and Devolution would result into an improvement in performance by a magnitude of 0.774 units.

The regression model in table above shows that De-concentration had (Sig=.001), less than 0.05,

hence indicating that it is statistically significant result. This implies that De-concentration affects

Performance. The B (.688) Coefficients implies that a 0.688 unit increase in Devolution will lead to

0.688 unit increase in Performance of Buyinja Sub Hospital in Namayingo District Local

Government.

The regression model in table above shows that Delegation had (Sig=.000), less than 0.05, hence

indicating that it is statistically a significant result. This implies that Delegation influence

Performance of Buyinja Sub Hospital in Namayingo District Local Government. The B (.875)

57
Coefficients implies that a 0.875 unit increase in Delegation will lead to 0.5 unit increase in

Performance of Buyinja Sub Hospital in Namayingo District Local Government.

The regression model in table above shows that Devolution had (Sig=.000), less than 0.05, hence

indicating that it is statistically a significant result. This implies that Devolution influence

Performance of Buyinja Sub Hospital in Namayingo District Local Government. However, since the

Beta coefficient is high (.875), it means that existing Devolution are the most significant factors in

improving Performance of Buyinja Sub Hospital in Namayingo District Local Government. The B

(.875) Coefficients implies that a unit increase in Devolution will lead to 0.875unit increase in

Performance of Buyinja Sub Hospital in Namayingo District Local Government.

58
 CHAPTER FIVE

SUMMARY, DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS

5.1 Introduction

The study examined the relationship between Administrative decentralization and performance of

Buyinja sub hospital in Namayingo district, Uganda. This chapter provides summaries of the findings

from the study, discusses the empirical results in view of the research objectives, and draws

conclusions and finally recommendations.

5.2. Summary of Major Findings

The summary of the major findings is presented based on the study objectives as laid out chapter one

of this report.

5.2.1: De-concentration and Performance

The study findings revealed that there was a positive significant relationship between de-

concentration and performance of Buyinja Sub Hospital in Namayingo District Local Government.

In particular, the positive effect implied that a change in de-concentration contributed to a strong

change in performance of Buyinja Sub Hospital in Namayingo District Local Government whereby

improvement in de-concentration caused improvement in performance of Buyinja Sub Hospital in

Namayingo District Local Government and vice versa.

5.2.2: Delegation and Performance

The findings established that Delegation had a positive significant relationship with performance of

Buyinja Sub Hospital in Namayingo District Local Government. The positive relationship meant that

Delegation had a positive contribution on performance of Buyinja Sub Hospital in Namayingo

District Local Government whereby improvement in Delegation caused an increase in performance

of Buyinja Sub Hospital in Namayingo District Local Government and vice versa.

59
5.2.3: Devolution and performance

The findings established that devolution had a positive significant relationship with performance of

Buyinja Sub Hospital in Namayingo District Local Government. The positive relationship meant that

devolution had a very positive contribution on performance of Buyinja Sub Hospital in Namayingo

District Local Government whereby improvement in devolution caused an increase in performance of

Buyinja Sub Hospital in Namayingo District Local Government and vice versa.

5.3. Discussion of Findings

The study findings are discussed here details according to the specific objectives of the study in order

to maintain the logical flow and proper analysis of the study findings as they have been presented and

interpreted in previous chapter as illustrated below:

5.3.1: De-concentration and Performance

The findings indicated that there was a significant relationship between De-concentration and

Performance. The findings are in line with Faust & Harbers (2012) who concluded that

deconcentration has had a positive effect on performance. They found that deconcentration enables

prominent redistribution and resource allocation proportions that aid central authorities to level

inequalities in access to health services while incorporating needs based decisions.

The study findings above are consistent with Namukuve (2019), who looked to lay out a connection

between decentralization of organization and the arrangement of administrations by nearby

legislatures in the Namutumba region of Uganda, prompted the improvement of more prominent

regulatory limit of neighborhood states by designation of power. The central government sector

minimizes or has no impact on the performance of health Centres by expanding its ability to

undertake functions that normally do not work well. The study concluded that the delegation of

medical services did not result in more participation by the general public and accountability of the

service provider to the community.

60
The findings above disagree with Utomo (2015) who found out that the elimination of concentration

led to the misappropriation of public funds. That is because it leads to potential double funding in

national and local budget arrangements. Studies in Senegal and Botswana have shown similar

results. According to Poteete & Ribot (2011), delegation limits the participation and involvement of

diverse groups, empowering a small number of local elites and stakeholders at the expense of service

provision and, in this context, the Ugandan Health Center is giving.

Similarly, Driscoll, Carroll, Dalton, (2018) and Press Ganey, (2015), indicated that doctor- patient

ratio rapidly affects the delivery of health services. Some scholars contend that vertical integration

has affected service quality in health services. However, Scott, Orav, Cutler, & Jha (2017)

conclude that increased integration leads to better coordination and health care. Universal and

subsidized access to health care and medical supplies are significantly related to improved

performance of health services (Guard, 2011).

The findings above are cognizant with Dick-Sagoe, (2017) who assert that about improving service

quality and service coverage. However, how these benefits can be realized is not known. Another

unknown is the exact impact of different health systems. Decentralizing health care comes with the

following benefits. Theoretically, these are improved implementation of health programmes,

reduction in duplication of health services at the target communities and the greater community

financing. The rest is greater community involvement, inequality between rural and urban areas is

reduced, and local preferences are factored in rationalizing and unifying health services.

5.3.2: Delegation and Performance

The findings indicated a significant positive relationship between Delegation and Performance of

Buyinja Sub Hospital in Namayingo District Local Government. The findings are in agreement with

Mushemeza (2019) who indicated that Governments in many parts of the world have embraced

delegations and transferred responsibility for decision-making and management of public missions to

lower levels of government. Such a government imagined that this would lead to better performance.

61
Further still, the findings are supported by Maria (2010) who in reading Decentralization and

performance of Local authorities concluded that delegation improves the performance of aid

allocation which results in higher organizational overall performance. Maria (2010) argues that

delegated degrees of presidency have their raison within the provision of products and offerings

whose intake is restricted to their very own jurisdictions. Delegation allows decreased administrative

devices to tailor provider outputs to the desires and possibilities in their constituencies. Maria (2010)

delivered that delegation will increase financial welfare therefore main higher organizational overall

performance for the reason that sub national administrative unit are towards the human beings than

the crucial authority, they are taken into consideration to have higher records approximately the

possibilities of nearby populations than the crucial authority.

The findings are in support with Bai (2014) who defined that delegation contributes to greater green

offerings. It helps right allocation of duties and new obligations amongst devices to equip their

attitudes and Judgments to satisfy preferred goals. Contradictory with the above finding, Darwish

(2018) determined that delegation negatively impacts on performance. He determined that maximum

people in nearby administrative devices with stand permitting autonomy and delegation of authority

which impacts their cap potential to make sure provider delivery. Poor overall performance is

likewise attributed to the problem of more than one accountability as properly sidelining of nearby

officers main to organizational battle, battle of hobby and ability gaps. This negatively affects overall

performance of health Centres.

In the identical vein Bardhan mentioned through Namukuve (2019) determined that delegated

decentralization undoubtedly effects overall performance of health Centres. He argued that

delegation allows the business enterprise to conquer the excessive boundaries of centrally managed

country wide making plans which have grown to be obtrusive in maximum growing international

locations over the last decades, through delegating more authority for improvement making plans

and control to officers who're working. Commenting in this Namukuve (2019) determined that

62
delegation complements overall performance through moving authority right all the way down to

local or nearby degrees which allow officers to disaggregate and tailor improvement plans and

packages to the desires of heterogeneous areas and agencies inside a country.

5.3.3: Devolution and performance

The findings revealed a significant positive relationship between Devolution and Performance of

Buyinja Sub Hospital in Namayingo District Local Government. The findings are supported by

Dedan (2016) who observed that decentralization decidedly affected the presentation of the medical

services framework. By delegating medical services from central authorities to subordinate

administrative units, it streamlined and integrated services that were previously autonomous and

privatized by top-level executives using governance tools effectively. This has improved the

efficiency of medical services.

Similar results were found in the study "Decentralization and Providing Local Services in Uganda"

by Bashaasha, Najjingo, and Nkonya (2011). They found that decentralization creates a supportive

environment that enables senior governments to oversee and develop effective policies, while at the

same time providing services that enable ownership and participation. The results show that

decentralization promoted oversight of subordinate administrative units, thus increasing

accountability and improving performance.

The findings above concur with Liwanag and Wyss (2018) who concluded that decentralization has

minimal impact on the performance of healthcare services in the Philippines. They argue that in most

cases elected local civil servants (politicians), who may not have experience, managing health

systems, make health decisions rather than local health authorities (doctors), the legal authorities of

the health sector. This was cited by study participants as an impediment to medical delivery.

However, in a study by Muchomba and Karanja (2015), examining the influence of devolution of

government service delivery on provision of Health care. The study revealed that devolved

procurement process, availability of infrastructure, resources allocation and availability of health

63
personnel as well as policy and regulatory frame work had a significant influence on the

performance of the Sub- Hospitals and overall health sector.

Still in their study on the impact of devolution of health care services on hospitals in Kenya. Savage

and Lumbasi (2016) found that due to devolution of health services, there has been increase in health

facilities (units) and infrastructure, increase in health personnel as while as improved performance.

Devolution of health care has positive effects through increasing local ownership and accountability,

improving health Centre infrastructure and responsiveness to local needs and strengthening

integration of services at the local level.

Further still, Simiyu, Mweru and Omete, (2014) in their study on the effect of devolved funding on

socio- economic welfare of Kenyans observed that successful decentralization calls for both

administrative and financial capacities and effective citizen participation, but many rural local

governments lack an adequate revenue base or sufficient professional management capacity.

This observation is true and similar in relation to the situation in the Local Governments in

Uganda taking Namayingo DLG specifically the health Centres at all levels suffer from low funding

hence poor performance.

The findings are in line with Karachiwalla and Park, (2017) who indicated that accountability

Devolution may involve constitutional law reform to formalize the devolution of powers, roles and

accountabilities. Decentralization is also argued to promote accountability and reduce corruption in

the governments. Since subnational governments are closer to the people, citizens are considered to

be more aware of subnational governments’ actions than they are of actions of the central

government. Also, the resulting competition between sub-national providers of public goods is seen

to impose discipline on subnational governments, as citizens averse to corruption may exit to

alternative jurisdiction or providers.

5.4 Conclusions

Study conclusions were drawn based on the study findings.

64
5.4.1 De-concentration and Performance

The study findings revealed that there was a positive significant relationship between de-

concentration and performance of Buyinja Sub Hospital in Namayingo District Local Government.

In particular, the positive effect implied that a change in de-concentration contributed to a strong

change in performance of Buyinja Sub Hospital in Namayingo District Local Government. This

means that is important to ensure de-concentration through decision-making authority, financial

management authority and administrative authority. Thus the study concluded that there was a

positive significant relationship between de-concentration and performance of Buyinja Sub Hospital

in Namayingo District Local Government.

5.4.2 Delegation and Performance

The findings established that Delegation had a positive significant relationship with performance of

Buyinja Sub Hospital in Namayingo District Local Government. The positive relationship meant that

Delegation had a positive contribution on performance of Buyinja Sub Hospital in Namayingo

District Local Government. This means that is important to ensure creation of agencies, transfer of

responsibility and accountability. Thus the study concluded that there was a positive significant

relationship Delegation and performance of Buyinja Sub Hospital in Namayingo District Local

Government.

5.4.3 Devolution and performance

The findings established that devolution had a positive significant relationship with performance of

Buyinja Sub Hospital in Namayingo District Local Government. The positive relationship meant that

devolution had a very positive contribution on performance of Buyinja Sub Hospital in Namayingo

District Local Government whereby improvement in devolution caused an increase in performance of

Buyinja Sub Hospital in Namayingo District Local Government and vice versa.

65
5.5 Recommendations

In light of the study conclusions, the following recommendations were made in line with the

objectives of this study.

5.5.1 De-concentration and Performance

There is need for the government to increase its budget that is meant for Local Governments, the

current budget need to be adjusted if we are to have policies like decentralization to be implemented.

One hindrance has been the inadequate Finance which has limited its coverage, increasing the number

of human resource would mean governmental expenditure. The government needs to prioritize the

budget for Health because these are great determinants for the performance and existence of the

policies. Decentralization policy to large extent has been hindered by the limited Finance.

There is need for all the above mentioned stakeholders like the government, local government,

international community, local community and CSO’s to work hand in hand with all the concerned

authorities so as to see success in decentralization policy since its implementation still calls for and

demands for a greater combined effort of all concerned authorities.

5.5.2 Delegation and Performance

There should be separation of power between the central government and the local government. This

will help in making independent decisions hence ensuring accountability

The civil servants should always be given a chance to use their skills or vision to implement the

decentralization policy such that much of the interruptions coming from political leaders should be

reduced such that civil servants could get freedom to practice or utilize their skills.

There is need for massive awareness rising the role and responsibilities of all stakeholders in the

decentralization policy. This is there is general lack of knowledge about decentralization programs

and this will greatly change their attitudes. This will also help them identify their roles which makes

them part and partial of the decentralization programs.

66
The government needs to train more human resource so as to have its programmes implemented. This

is because the local beneficiaries-staffs ratio has been increasing in the past years hence playing a

critical hindrance in decentralization policy.

5.5.3 Devolution and performance

To enhance sustainability and to anchor firmly the benefits of decentralization, the education,

sensitization, and increased involvement of service receipts (beneficiaries) in planning and executing

service delivery programs must go hand in hand with capacity building for effective service delivery.

The central government needs to devise a means to rein in the tendency of local governments to

spend more on recurrent, rather than development, elements of the budget. This tendency leads LGs

to degenerate into consumption, rather than development, nodes (stages) of government. It is

practically possible for the central government to offer guidelines on the proportions of the budget to

be spent on development investments, as opposed to recurrent spending, without being accused of

interference.

The government should ensure that there is empowerment of decentralization project committees at

both parish and village levels so that there is efficient monitory of implementation of decentralization

policy. Since there is inadequate human resource that contributed to poor follow up on the

implementation of decentralization policy at lower levels and in order to allow for effective

implementation of policies at all levels of government, civil society and all stakeholders should

endeavor to raise awareness about the different policies that exist and how they should be

implemented.

5.6. Areas for future Research

Suggestions for further studies

The analysis in this paper has identified some outstanding issues that call for research to make a

contribution and allow for a better understanding of the opportunities and possible solutions to the

challenges facing rural services in Uganda.

67
The effect of decentralization policy on economic development of citizens

Decentralization policy in the relation to on the performance to the nationals

Implementation of administrative decentralization and enhancement of Human capacity on the

performance of selected local government in the district

68
 REFERENCES

Akampurira, A. (2013). Decentralization, Local Governance and Development: An Aspect of

Development. Hamburg: Anchor Academic Publishing.

Approach Paper, Evaluation of the World Bank Group Engagement on Strengthening Sub

National Government (2018).

Babughirana, G., Gerards, S., Mokori, A. et al. Maternal and Newborn Healthcare Practices:

Assessment of the Uptake of Lifesaving Services in Hoima District, Uganda. BMC Pregnancy

Childbirth20, 686 (2020). https://doi.org/10.1186/s12884-020-03385-x

Bai, H.J. (2014). Delegation in nursing management: common errors. Asian J . Nursing

Education and Research, 4(2), 242- 244.

Bashaasha, B., Mangheni, M. N., &Nkonya, E. (2011). Decentralization and rural service delivery

in Uganda. Internet Food Policy Research Inst.

Bashasha, B, Magheri, M.and Nkonya E. (ends). (2011). Decentralization and Rural Service Delivery

in Uganda. International Food policy Research Institute, Discussion paper 01063,

Uganda.

Berkes. F. (2010). Devolution of environment and resources governance: trends and future.

Environmental Conservation, 489-500.

Berfat, D. (2018). Assessment of the Process of Decentralization and District level Decentralization

in Ethiopia: The case of Amhara National Regional State. Journal for Studies in Management

and Planning, 4(7), 95-107. htt;// edupedia publication s.org/ Journals/ index. php/ JSMaP/

[Google Scholars].

Booth, D. (2010). Towards a Theory of Local Governance and Public Good’s provision in Sub-

Saharan Africa. ODI working paper 13. London: Overseas Development Institute.

69
Christine Kirunga Tashobya, Freddie Ssengooba, Juliet Nabyonga (2018). BMC Health Services

Research. Critique of the Uganda district league table using a normative health system

performance assessment frame work.

Creswell, J.W. (2013). Qualitative Inquiry & Research Design: Choosing among Five

rd
Approaches (3 ed.). Thousand Oaks, CA: SAGE.

Darwish, al-Shammari., And Maher Sabry Ibrahim Rashid (2010). Delegation of authority to the best

method to raise the efficiency of job performance - a study of the views of a sample of

managers in the General Company for the manufacture of fertilizer - Central Region - Kufa -

Iraq- Journal of Management and Economics, Issue 82.

Dick-Sagoe, C. (2016). Does decentralisation address allocative efficiency at the local level?

Evidence from Jomoro District Assembly in Ghana. In P. P. balan, G. Sunny, & T.

P. Kunhikaman (Eds.), Marginalisation and deprivation: Studies in multiple vulnerabilities.

KILA’s International Conference Series- 5 (International conference on

MARGINALISATION, POVERTY AND DECENTRALISATION (pp. 37–49). Kerela Insititue

of Local Administration. http://dspace.kila.ac.in:8080/jspui/bitstream/123456789/276/1/

Marginalisation%20and%20Deprivation%20Studies%20in%20Multiple

%20Vulnerabilities.pdf#page=37 [Google Scholar]

Driscoll. A. Grant .M. J, Carroll .D, Dalton. S, Deaton .C, Jones I… Austin F, (2018). The effect of

nurse to patient ratios on nurse sensitive patient outcomes in acute specialist units. Systematic

review and meta- analysis. European Journal of Cardiovascular Nursing, 17,

6-22.doi:10.1177/1474515117721561.

Faguet, J.P. (2012). Decentralization and popular democracy; Governance from below in

Bolivia. Ann Arbor: University of Michigan press.

Faguet, J.P. (2014).Decentralisation and Governance. World Development.53, 2-13.

70
Faust, J. and I. Harbers, (2012). On the local politics of administrative decentralization: Applying for

policy responsibilities in Equador. Publius: J. Federalism, 42:52–77.

Habbash, M. (2010). The effectiveness of corporate governance and external audit on constraining

earnings management practice in the UK. Unpublished PhD thesis, Durham: Durham

University. Retrieved from: http://etheses.dur.ac.uk/448/

Hassan, J.K. (2013). Human resource planning practice in management human resources.

International Journal of Human Resource Studies, 3(34-47).

Hiskey, J.T. (2010).The Promise of Decentralized Governance. In: Connerley, E., Eaton, K. and

Smoke, P., Eds., Making Decentralization Work: Democracy, Development and Security,

Lynne Rienner Publishers, Boulder London.

Karmel, E. (2017). Decentralizing Government What You Need to Know Democracy Reporting

International, Briefing Paper, 87, p. 1-13.

Knoema (2019) Uganda - Under-5 mortality rate. World Data-Atlas Uganda-Topics Health-

Health Status. https://knoema.com/atlas/Uganda/topics/Health/Health-Status/Under-5-

mortality- rate.

Krejeie, R.V. & Morgan, D.W. (1970). Determining Sample Size for Research Activities.

Educational and Psychological Measurement, 30, 607-610.

Leroux, R. (2012). French liberalism in the 19th century: an anthology. Routledge.

Maluka, S., Kamuzora, P., Sebastiån, M.S., Byskov, J., Olsen, T.E,, Shayo, E. and Hurtig,A.K.

(2010). Decentralized health care priority setting in Tanzania: Evaluating against the

accountability for reasonableness framework. Social Science and Medicine, 71(4), 751-759.

Maria. T. B.-C.-A. (2010). Decentralization and efficiency of Local government. The Annals of

Regional Science, 571-601.

71
Masanyiwa ZS, Niehof A, Termeer CJ. (2015). A gendered users’ perspective on decentralized

primary health services in rural Tanzania. International Journal of Health Planning and

Management 30: 285–306.

Masanyiwa, Z.S., Niehof, A. and Termeer, C.J.A.M. (2013). Institutional arrangements for

decentralized water and health services delivery in rural Tanzania: Differences and

constraints. Basic Research Journal of Social and Political Sciences, 1(4), 77-88.

Ministry Of Local Government (2015). Principles of Service Delivery in Uganda’s Local

Governments. Handbook

Mio, C., Fasan, M., Marcon, C., & Panfilo, S. (2020). The predictive ability of legitimacy and

agency theory after the implementation of the EU directive on non ‐loan information.

Corporate

Social Responsibility and Environmental Management, 27(6), 2465 -2476.

Mitnick, M. (2013). Origin of the Theory of Agency: An Account by one of the theory's

Originators. SSRN Electronic Journal, 10.2139/ssrn.1020378.

MoLG, (2015). The second phase of the 10th joint annual review on decentralization: Alignment,

Revitalization and Wealth Creating for Local Development, Kampala.

Muchomba, F, & Karanja, N. (2015). Influence of devolved Governance and Performance of

Health Sector in Kenya. The Strategic Journal of Business and Change Management, 2(51),

67-105.

Mudalige, P.W., (2019). The Discussion of Theory and Practice on Decentralization and Service

Delivery. European Scientific Journal May 2019 edition Vol.15, No.14 ISSN: 1857 –

7881 (Print) e-ISSN 1857-7431.

Mushemeza, E.D., (2019). Decentralization in Uganda: Trends, Achievements, Challenges and

Proposals for Consolidation. ACODE Policy Research Paper Series No.93, 2019.

72
Mwatsuma K., Mwamuye, I., and Nyamu, H. M., (2014). Devolution of health care system in Kenya:

A strategic approach and its implementation in Mombasa County, Kenya. International

Journal of Advanced Research, Volume 2, Issue 4, 263-

Namukuve. F., (2019). Administrative Decentralization and Local Government Service Delivery at

Namutumba District. A Research Dissertation Submitted to the College Of Humanities and

Social Sciences, Kampala International University.

Nannyojo, J and Okot, N. (2013). Decentralization, local Government Capacity and Efficiency of

Health Service Delivery in Uganda. Journal of African Development spring 2013 1

Volume 15#1.

OECD. (2016). Subnational Governments around the World Structure and Finance -A Firs

Contribution to the Global Observatory on Local Finances. Preliminary version.

Olum, Y. (2014). Decentralization in developing countries: Preconditions for successful

implementation. Commonwealth Journal of Local Governance, (15), pp.23-28.

O'Neill, A., (2022). Uganda: Infant mortality rate from 2009 to 2019 (in deaths per 1,000 live

births). Economy & Politics ‘International.

https://www.statista.com/statistics/807832/infant-mortality-in-uganda/

Patrick, I. M. (2013), September 20. University of kwazulu -Natal. Retrieved from University of

kwazulu -Natal website:

Republic of Uganda. Local Governments Act, 1997

Rondinelli, D. A. (2017). Decentralization and development. In International development

governance (pp. 391-404). Routledge.

Samithamby Senthilnathan (2019). ‘‘Usefulness of Correlation Analysis’’.

Savage, A. & Lumbasi, L. (2016). The Impact of Decentralization in Kenya. Unpublished

Thesis. Trinity College Dublin.

73
 Simiyu, R.S., Mweru, J.N. & Omete, F.I (2014). The Effect of Devolved funding on Socio –

Economic Welfare of Kenyan: A Case of Constituency Development Fund in Kimilili,

(Kenya). European Journal of Accounting Auditing and Faineance Research, 2(7), 31-51.

Schoher Boer and Schwarte (2018). Correlation Coefficient: Appropriate Use and Interpretation

Pub Med.

Stake. R. E. (2011). Quantitative Research: Studying how things Work. New York, NY: Guilford

Press.

Uganda Demographic Health Survey (2016)

Wagana, D. M., Iravo, M. A., Nzulwa, J. D., &Kihoro, J. M. (2016b). The Moderating Effects of E-

Government on the Relationship between Administrative Decentralization and Service

Delivery in County Governments in Kenya. European Scientific Journal, 12(17), p. 459-481.

Yusuf, F., Yousaf, A., & Saeed, A. (2018). Rethinking agency theory in developing countries: A

case study of Pakistan. In accounting forum (Vol. 42, No. 4, pp. 28

Goel, R. K., Mazhar, U., Nelson, M. A., & Ram, R. (2017). Different forms of decentralization and

their impact on government performance: Micro-level evidence from 113 countries. Economic

Modelling, 62(3), 171–183. https://doi.org/10.1016/j.econmod. 2016.12.010

Dick-Sagoe, C. (2020). Decentralization for improving the provision of public services in developing

countries: A critical review. Cogent Economics & Finance, 8(1), 1–3.

https://doi.org/10.1080/23322039.2020.

74
 APPENDICES

APPENDIX I: TABLE FOR DETERMINING SAMPLE SIZE

N S N S N S N S N S
10 10 100 80 280 162 800 260 2800 338
15 14 110 86 290 165 850 265 3000 341
20 19 120 92 300 169 900 269 3500 246
25 24 130 97 320 175 950 274 4000 351
30 28 140 103 340 181 1000 278 4500 351
35 32 150 108 360 186 1100 285 5000 357
40 36 160 113 380 181 1200 291 6000 361
45 40 180 118 400 196 1300 297 7000 364
50 44 190 123 420 201 1400 302 8000 367
55 48 200 127 440 205 1500 306 9000 368
60 52 210 132 460 210 1600 310 10000 373
65 56 220 136 480 214 1700 313 15000 375
70 59 230 140 500 217 1800 317 20000 377
75 63 240 144 550 225 1900 320 30000 379
80 66 250 148 600 234 2000 322 40000 380
85 70 260 152 650 242 2200 327 50000 381
90 73 270 155 700 248 2400 331 75000 382
95 76 270 159 750 256 2600 335 100000 384

Adapted from Krejcie, Robert V., Morgan, Daryle W, “Determining sample size for research

Activities, Educational and psychological measurement, 1970.Note:“N” is population size“S” is

sample size.

i
 APPENDIX III: RESEARCH QUESTIONAIRE FOR THE HEALTH WORKERS,

ADMINISTRATIVE OFFICERS / CADRES, PATIENTS OR CARE TAKERS AND LOCAL

LEADERS, CSO/ NGO REPRESENTATIVES

Dear respondent,

I am Mukyala Constance, a Student at Uganda Management Institute undertaking a study on the effect

of administrative decentralization and performance of Buyinja Health Centre IV in Namayingo District,

Uganda. The study is in partial fulfillment of the requirements for the award of master degree in Public

Administration. To enable me accomplish this task, kindly spare few minutes of your busy schedule to

fill this questionnaire. Your responses was strictly used for academic purposes only and was kept

confidential. Most questions require ticking the most appropriate options or filling in short answers. I

thank you for your assistance.

SECTION A: BACKGROUND INFORMATION OF THE RESPONDENT.

Background information (Please use a tick in the space provided)

1. Gender/Sex

(a) Female (b) Male

2. Age Bracket (in years)

(a) 18-30 (b) 31-50

(c) 51-60 (d) Above
3 Marital Status
60
(a) Married (b) Single

(c) Others ……………………………………………………………………

4. Level of Education you have attained

(a) Masters (b) Degree

ii
(c) Diploma (d) Certificate

5. Position in Organization?

Administrator Health worker District Health Unit HoDs & Others

Management

6. Work Experience

a) Less than 2 years b) between 2 – 5years c) Above 5 years

SECTION B: ADMINISTRATIVE DECENTRALIZATION AND PERFORMANCE OF

BUYINJA HEALTH CENTRE IV

In the next part, kindly rate the statements below by ticking the appropriate box to show your level

of agreement or disagreement of the statement. (5SA-Strongly Agree, 4 –A Agree, 3-Not sure, 2-

Disagree, 1- SD-Strongly Disagree).

Qn.6. Please tick the response that best describes your experience with respect to the effect of De-

Concentration on Performance of Buyinja HC IV

No. EFFECT OF DE-CONCENTRATION ON SA A NS D SD

PERFORMANCE OF BUYINJA HC IV

B.1.1 De-concentration has increased doctor-patient ratio in

Buyinja HC IV.

B.1.2 Buyinja HC IV involves local people in planning for

health delivery

B.1.3 Namayingo District mobilizes its own resources

B.1.4 Buyinja HC IV calls for stakeholder meeting to present

accountability

B.1.5 Buyinja HC IV publishes the receipt of funds in open

iii
 for public to view

B.1.6 Buyinja HC IV reports health gains to stakeholders

B.1.7 Buyinja HC IV publishes the expenditure of funds in

open for public to view

B.1.8 Buyinja Sub Hospital has powers to make its on

administrative decisions.

Qn. 7 Please tick the response that best describes your experience with respect to delegation effect on

performance of Buyinja HC IV

No. DELEGATION EFFECT ON PERFORMANCE OF SA A NS D SD

B.2.1 BUYINJA HCauthority

Delegation of IV is practiced in Buyinja HC IV
B.2.2 Buyinja HC IV board is responsible for planning,

B.2.3 Budgeting
The Healthand oversight
center roleshas full autonomy to
leadership

formulate health center policies

B.2.4 Transfer of responsibilities in Buyinja HC IV has

B.2.5 improved on thehave

Health Centres responsiveness of improved
increased and health workers
access to

B.2.6 health care services

Delegation of authority in Buyinja HC IV has

contributed to more efficient services

Qn. 8 Please tick the response that best describes your experience with respect to the effect of

Devolution on Performance of Buyinja HC IV

No. EFFECT OF DEVOLUTION ON PERFORMANCE SA A NS D SD

B.3.1 Healthcare provision has improved since

B.3.2 implementation
Devolution hasofled
devolution
to an increase in the number healthcare

B.3.3 workforce
Devolutioninhas
Buyinja HCimprovement
led to IV and addition of Health

Centre infrastructure
iv
B.3.4 As a result of devolution, health care has been moved closer to the

local citizens at the grassroots

B.3.5 Medical supplies and financial allocations to health sector has

B.3.6 improved with

Devolution hasdevolution
made financing of the health center by the Central

Government timely and sufficient

B.3.7 Budgeting and planning involves employee participation

NO PERFORMANCE OF BUYINJA HEALTH SA A NS D SD

CENTRE IV
B.4.1 Buyinja Health Centre provides appropriate health

services to clients
B.4.2 Clients are satisfied with the services offered
B.4.3 Most clients are happy about our timely services to them
B.4.4 The accessibility of our services are satisfactory to our

clients
B.4.5 Resources are properly utilized by Buyinja Health

Centre to provide health services

B.4.6 Buyinja Health Centre HUMC is functional and plays its

oversight role.

END

Thank you very much for your cooperation!

v
APPENDIX III: INTERVIEW GUIDE FOR THE KEY INFORMANTS AT THE

DISTRICT AND BUYINJA HC IV (HOD& SECTION, HEALTH UNIT MANAGEMENT

COMMITTEE AND DISTRICT HEALTH OFFICE (REPRESENTATIVES)

Dear Respondent,

This interview guide is aimed at obtaining in-depth information relating to the effect of

administrative decentralization and performance of Buyinja Health Centre IV in Namayingo

District, Uganda. The information obtained will help assess the linkages between administrative

decentralization and performance of Buyinja Health Centre IV and was purely for academic

purposes .Feel free to answer the questions, seek clarifications or interpretations whenever

necessary. Our discussion will take between 15 - 30 minutes.

Thank you

SECTION A: DE- CONCENTRATION

1) How is de- concentration of health services implemented in Buyinja Health Centre IV? Please

give your view about the influence of de-concentration on performance of health care systems

in Buyinja Health Centre IV?

2) Please indicate some of the challenges that you faced during the de-concentration of

health services at Buyinja Health Centre IV?

3) Suggest possible solutions to the challenges mentioned above?

SECTION B: DELEGATION

4) How is delegation of health services implemented in Buyinja Health Centre IV?

5) Please give your view about the influence of delegation on performance of health care

systems in Buyinja Health Centre IV?

6) Please indicate some of the challenges that you faced during the delegation of

health services at Buyinja Health Centre IV?

Suggest possible solutions to the challenges mentioned above?

6
SECTION C: DEVOLUTION

7) How is devolution of health services implemented in Buyinja Health Centre IV?

8) Please give your view about the influence of devolution on performance of health care

systems in Buyinja Health Centre IV?

9) Please indicate some of the challenges that you faced during the devolution of health

services at Buyinja Health Centre IV?

10) Suggest possible solutions to the challenges mentioned above?