Abstract
BackgroundThe District Health System was endorsed as the key strategy to achieve ‘Health for all’ during the WHO organized inter-regional meeting in Harare in 1987. Many expectations were put upon the district health system, including planning. Although planning should be evidence based to prioritize activities, in Uganda it has been described as occurring more by chance than by choice. The role of planning is entrusted to the district health managers with support from the Ministry of Health and other stakeholders, but there is limited knowledge on the district health manager’s capacity to carry out evidence-based planning. The aim of this study was to determine the barriers and enablers to evidence-based planning at the district level.MethodsThis qualitative study collected data through key informant interviews with district managers from two purposefully selected districts in Uganda that have been implementing evidence-based planning. A deductive process of thematic analysis was used to classify responses within themes.ResultsThere were considerable differences between the districts in regard to the barriers and enablers for evidence-based planning. Variations could be attributed to specific contextual and environmental differences such as human resource levels, date of establishment of the district, funding and the sociopolitical environment. The perceived lack of local decision space coupled with the perception that the politicians had all the power while having limited knowledge on evidence-based planning was considered an important barrier.ConclusionThere is a need to review the mandate of the district managers to make decisions in the planning process and the range of decision space available within the district health system. Given the important role elected officials play in a decentralized system a concerted effort should be made to increase their knowledge on evidence-based planning and the district health system as a whole.
Highlights
The District Health System was endorsed as the key strategy to achieve ‘Health for all’ during the World Health Organization (WHO) organized inter-regional meeting in Harare in 1987
In Uganda, the District Health System is headed by appointed officials, the District Health Team (DHT) in collaboration with the wider District Health Management Team (DHMT) both headed by the District Health Officer (DHO) [10] and governed by a district council of elected officials [6, 11]
In district B, DHMT members generally expressed the need for additional training or support to improve their Evidence-based planning (EBP) skills: “I am not saying am very competent, if I got extra training, I don’t want a master in planning, for example, mentorships with somebody who knows these things.”
Summary
The District Health System was endorsed as the key strategy to achieve ‘Health for all’ during the WHO organized inter-regional meeting in Harare in 1987. The District Health System (DHS) received political endorsement as the key strategy to achieve ‘Health for all’ during the WHO organized inter-regional meeting in Harare, Zimbabwe in 1987 [1]. Other studies showed that priority setting in the planning process was in the context of budget cycles and driven by historical allocation of funds and not necessarily by evidence [16, 18] and others have documented the political and technical resistance to decentralization and the limited operational responsibility of the DHMT as being an influence to the district planning process [19, 20]. In Uganda, it has been described as occurring more by chance than by choice [23] with performance discrepancies reported across and within districts [24] This has led the Ministry of Health (MoH) in Uganda to initiate a critical review and reflection of the DHS strategy [21]
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