Public participation in health planning and priority setting at the district level in Uganda

OBJECTIVE: To explore the experiences of the public and leaders with participatory planning and priority setting in health, in a decentralized district in Uganda. METHODOLOGY: An exploratory qualitative approach, involving in-depth interviews with health planners at the national, district and community levels (n = 12), and five group discussions at community level with women (two groups), men, youths and adolescents (n = 51). The analysis adapted some principles from grounded theory. The five levels of the participation framework by Rifkin (1991) were used to assess the actual level of participation in the study population. RESULTS: Uganda has established structures for participatory planning. Within this context, district level respondents reported to have gained decision-making powers, but were concerned about the degree of financial independence they had. The national level respondents were concerned about the capacity of the districts to absorb their new roles. Actual involvement of the public in priority setting and poor communication between the different levels of the decentralization system, despite the existing structures, were additional concerns. Public participation is mainly through representatives. Majority participation is mainly at health benefits and programme activity levels. Decision-making, monitoring and evaluation, and implementation are still dominated by the locally elected leaders due to reported economic, social and cultural barriers that hinder the participation of the rest of the public.