The Impacts of Decentralization on Health Behaviors in Uganda

Author(s): Hutchinson P, Akin J, Ssengooba F

Year: 2003

Abstract:
This paper examines the impacts of a public sector decentralization program on the demand for health care in Uganda in the 1990s. This work is an extension of a previous paper, which provided evidence of a shifting of priorities by local governments in Uganda's decentralized health system away from provision of primary health care, in particular the provision of public goods or goods with substantial consumption externalities, and toward provision of private health goods such as curative care. This work furthers that analysis by examining how local planners allocation decisions among these different types of primary health care and curative care services affect individual-level health behaviors. This analysis finds that, while the country has been undergoing a multitude of changes in recent years, decentralization appears to have led to increases in the use of curative services with exclusively private benefits, perhaps at the expense of use of primary health care services and services with consumption externalities. A longer period of analysis is required to determine the persistence of these effects.