The impacts of decentralization on health care seeking behaviors in Uganda
International Journal of Health Planning and Management
Department of International Health and Development, School Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA 70112, United States; Department of Economics, University of North Carolina, Chapel Hill, NC, United States; Institute of Public Health, Makerere University, Kampala, Uganda
This paper examines the impacts of a public sector decentralization program on health care seeking behaviors in Uganda in the 1990s. Shifting 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 are linked to shifts in individual-level care utilization 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 largely private benefits, perhaps at the expense of the 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. Copyright © 2006 John Wiley & Sons, Ltd.
decentralization; health policy; health services; public sector; acquired immune deficiency syndrome; article; budget; decentralization; evidence based practice; government; health care delivery; health care policy; health care system; health care utilization; health program; health service; help seeking behavior; Human immunodeficiency virus infection; immunization; outcomes research; primary health care; Uganda; vaccination; Health Care Reform; Health Care Surveys; Health Priorities; Humans; Patient Acceptance of Health Care; Politics; Primary Health Care; Privatization; Regional Health Planning; Uganda; Africa; East Africa; Sub-Saharan Africa; Uganda