Accountability Mechanisms In Result Based Financing And Their Implementation In Lira District, Northern Uganda

Abstract

Introduction: Results based financing has been proposed as an innovative reform to enhance systems performance in Uganda. Lira District is one of the districts implementing the national results-based financing (RBF) scheme under the Uganda Reproductive Maternal and Child Health services Improvement Project (URMCHIP). The diversity of relationships among various actors in RBF implementation underscores the need for mechanisms to ensure accountability among them. This was a case study which aimed at exploring the RBF accountability mechanisms, their implementation, and related factors in Lira District. Methodology: The study was a descriptive case study employing qualitative methods. The data collection methods included a) focus group discussions with the health workers from RBF facilities, b) key informant interviews with key actors in the RBF program at the MOH as well as in the district including district managers, health facility in charges, verifiers, members of the health facility management committees, c) document review of RBF documents, annual progress and audit reports. were analyzed thematically guided by a framework that explored the relationships and related accountability arrangements in RBF. Results: Several accountability relationships do exist among actors in RBF program and each relationship has associated accountability mechanisms for example, accountability mechanisms between MOH and the district include MOUs and business plans, while between the district and facilities mechanisms include reporting, data verifications, financial audits while display of results on notice boards, complaint boxes are mechanisms between the facility and the community. Regular support supervision and facility innovations such as meetings complimented RBF-specific designs. Challenges hindering smooth implementation of accountability mechanisms included infrequent financial support to enable regular support supervision/verification visits by Expanded District Health Management Team (EDHMT) and corruption tendencies. Conclusion: Implementation of accountability mechanisms in RBF in Lira is suboptimal due to the various RBF design and implementation challenges. There is need to support the EDHMT and facility managers’ in terms of capacity building and facilitation to do their work. Additionally, efforts need to be undertaken to address delayed disbursement of funds and corruption impeding the implementation of accountability mechanisms in the district.