An assessment on Decentralized Service Delivery in the Health Sector: The case of Ahferom Wereda

Abstract

This study attempted to investigate the An assessment on Decentralized Service Delivery in the Health Sector in Ahferom Wereda which is one of the administrative divisions of Tigray National Regional State. The main objectives of this study was to examine adequate human resources and health service availabilities including pharmaceutical commodities, the local level health service delivery arrangements in terms of accountability, the institutional capacity of local government in implementing and coordinating decentralized health service programs and policies and identify the challenges of decentralized governance in the process of health service provision. The study used a descriptive survey research design and employed both qualitative and quantitative data types, specifically semi -questionnaires, semi-structured interviews and focus group discussion. In addition to this, study was employed both primarily and secondary sources of data. The sampling designs used in this study are both probability and non probability sampling designs. These are, purposive, clustered, lottery method, proportionate sampling and finally convenience sampling was employed. For the purpose of this, the study used a sample of 190 house hold heads. In addition to this, the study used 20 key respondents purposely. The key respondents with regard to this objective were officials in health related management and health service providers of the wereda .The major findings of this study reveals that though decentralization is contributing better health services availability, it constrains ensuring of adequate human recourse, geographical accessibility and adequate pharmaceutical commodities for better health service delivery to the public. Besides, there is failure of accountability in relation to financial planning, reporting and implementation of activities, the availability of channeling procedures for complaints, strong institutional capacity in terms of leadership, human resources management and financial management capacity. In relation to the challenges in health service delivery; shortage of sufficient and competence human racecourses, inadequate pharmaceutical commodities, insufficient financial resources and weak leadership are identified as the major challenges. The study recommended organizing public to participate in financing and health service delivery, enhancing leadership and improvement, filling vacancies and enhancing competency of the staff, strengthening standardized auditing instrument and improving and strengthening inter-organizational relations with different NGOs are more relevant.