Despite ongoing investment in health systems strengthening, delivery of reproductive, maternal, neonatal, child and adolescent (RMNCAH) health services has continued to perform poorly. In 2017/18, health facility deliveries were low at 60% representing 3.3% change from the performance of the previous year and against a target of 80%. Health Centre IV offering Comprehensive Emergency Obstetrical Care services was rated at 48%, a 3% gain on the performance of the previous year against a target of 57%. Failure to realize the performance targets has, among others, been associated with weak health sectors management structures at decentralized levels.
Underpinned by the bureaucracy theory and the leadership and management strengthening framework, this study seeks to assess the factors enabling and hindering proper functioning of health sector management structures in the delivery RMNCAH services at district and community levels. It will further identify practical options to improve policy and programmatic actions for delivery of RMNCAH services in Uganda.
This is a cross-sectional qualitative study that will collect data from health system managers, service providers and stakeholders at the national, decentralised and health facility levels by conducting review of relevant documents, key informant interviews, focus group discussions and stakeholder consultations specifically in Kampala and eight other districts that are equally distributed across the four regions of Uganda. Research participants will include District Health Officers, Chief Administrative Officers, members of the District Health Team and District Health Management Teams, Hospital Directors and Human Resource Managers, Health Facility In-charges, members of Hospital Boards and Health Unit Management Committees, Local Council Chairpersons and Secretaries for Health at district and sub-county levels, RMNCAH service providers, and other stakeholders. All data will be entered into NVivo qualitative data management software, coded, and analyzed inductively and deductively in accordance with themes of the research questions and objectives.