Submission ID 118408
| Issue/Objective | Background Empowering local councils to adopt national programs in ways that resonate with their unique needs improves efficiency. Notably, last-mile service users purposefully participate in program conception and implementation, aligning projects to their needs. This is better directed by epidemiological, geospatial and ecological data unique to these different societal bands, curtailing wasteful expenditure and streamlining accountability. Constraints in health financing globally ought to motivate health managers to adopt innovative health governance mechanisms which minimize costs while maximizing benefits. The current structure of the same in Uganda's health system is largely centralized, where district health teams only adapt plans for implementation downstream. Parish health committees grapple with implementing incompatible programs with inadequate oversight and capacities, which greatly compromises efficacy. As the country embraces the parish development model which is embedded in extending the reach and impact of social services, there is an urgent requirement for public health contextualized evidence to direct this shift in program governance. Objective: This study aimed to analyze organizational implications of district-led and parish-led public health program management. The core objective was to compare the administrative implications and last-mile uptake of programs at both levels, to recommend an efficient and sustainable managerial model. |
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| Methodology/Approach | A qualitative comparative analysis (QCA) was conducted between district and parish level public health programing, using the national malaria control program as a prototype. Data from this program and relevant insights from the state-run parish development model - poverty eradication program, were used to estimate the outcomes. A Crisp set for conditions; expenditure, technical capacity and operational infrastructure were measured and calibrated. These were analyzed against the outcomes; last-mile utilization, community acceptability and administrative costs using R software. |
| Results | a) parish-level: technical capacities*operational infrastructure*community participation = cost-saving*greater last-mile utilization; b) district-level: technical capacities*operational infrastructure*~community participation = higher administrative costs*lower last-mile utilization |
| Discussion/Conclusion | Parish-led decentralization of public health programming is relatively cheaper to manage than district-led programming. It additionally has greater potential for a bigger reach and uptake. |
| Presenters and affiliations | Irene Jean Kagogwe University of Leeds Margaret Nanyonjo Qstats Health Consulting |
