Data were analyzed using thematic analysis.
A total of 62 in-depth interviews were conducted in June 2017 (round 1) and November 2017 (round 2) with facility in-charges ( n = 13), ART clinic managers ( n = 12), representatives of PEPFAR implementing organizations ( n = 14), district health managers ( n = 23) and 12 patient focus group discussions ( n = 72) to elicit perceived effects of transition on HIV service delivery. Five out of the six selected facilities had experienced transition. Six facilities were purposefully selected as case studies seeking to ensure diversity in facility ownership, size, and geographic location. We report qualitative findings from a larger mixed-methods evaluation. Our analysis intends to explore patient and provider perspectives on the impact of loss of PEPFAR support on HIV services in transitioned health facilities in Uganda.
Between 20, PEPFAR implemented the ´geographic prioritization´ (GP) policy in Uganda whereby it shifted support from 734 ‘low-volume’ facilities and 10 districts with low HIV burden and intensified support in select facilities in high-burden districts. In many countries in SSA, it is a narrowly political process that ruling governments pursue for their own benefit (or accept to pursue when pushed by donors where it hurts them least) and not for the nicely written policy statements of improving services.Īlthough donor transitions from HIV programs are more frequent, little research exists seeking to understand the perceptions of patients and providers on this process. Decentralization can be a facade behind which quite different practices take place. Until they understand the political economy of decentralization in Africa they will always be bewildered not only by the mismatch between policy objectives and outcomes but also by many unspoken rationales for implementing decentralization reforms. Instead, the practice conforms to central government gerrymandering tactics of forging an electoral alliance with small jurisdictions and to extend neo-patrimonial networks to win votes in order to stay in power.ĭonors and development practitioners have often expressed their frustrations on decentralization policies and outcomes in sub-Saharan Africa (SSA) because they have analysed the policy based on what governments say their intentions are. The article concludes that creation of LG jurisdictions in Uganda neither conforms to the policy objective of bringing services closer to the people nor to promoting participatory democratic governance. This article pursues five propositions concerning the rationale for creating LG jurisdictions and examines their relevance in the Uganda context. Often, these are considered to be an accident of history, but the reality is not so. Much less attention has been given to the number and size of LG jurisdictions. However, most decentralization studies have focused on fiscal, political and administrative assignments between levels of government. Many governments in Africa and elsewhere in Asia and Latin America have created new local government (LG) jurisdictions as part of their decentralization policies.
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