Motivation and retention of health workers working in district health units under a decentralised system and its impact on health service delivery. A case point of Nakaseke Hospital, Nakaseke District

Abstract

The study focused on the impact created by decentralization of health workers in view of motivation and retention under the themes of Governance, Human Resource Management (HRM) and Financial Decentralization and how performance and service delivery is affected in Nakaseke Hospital ,Nakaseke District. Decentralization, motivation and retention constituted the independent variable while staff performance and health service delivery constituted the dependent variable. The quantity, quality, personnel accessibility to local people and clients’ satisfaction of personnel services under decentralization was studied. Personnel performance factors such as job expectation, performance facilitation and encouragement, and the quality of service were similarly examined. Questionnaires and interviews were used to gather primary data which was corroborated with secondary data from the district identified by use of a documentary review checklist.

A cross-sectional design was used, where both quantitative and qualitative data collection methods were employed. The study found out that decentralization of the HRM functions have contributed significantly to employee performance and thus improved service delivery at Nakaseke Hospital. However, there is continued reliance on Central Government grants/ releases, to fund the Local Government, as locally generated revenues are not forthcoming. Budget cuts, delayed release of funds and poor accountability were found to negatively affect the performance of the employees and service delivery. It was noted that the stakeholders are involved in the planning process which makes decision making quicker. Decentralized governance has provided numerous local opportunities of bringing services like recruitment, local contracts and staff management nearer to the people.

The study recommended that not only should full decentralization of HRM be adopted as a policy issue but it will also reduce the cost of public administration. The other benefits will be that it will remove duplication between the centre and the Local Governments and solve problems of mismanagement of the wage bill, payroll, pensions and scholarships. The study recommended that establishment of a salary review commission be done in order to provide for adequate remuneration and uniform terms and conditions of service, including provision of motivational schemes, across all levels of government. The study recommended that Local Governments be allowed to identify, develop and implement taxation policies based on their local situations without undue influence.