Institutional dynamics and health service delivery in regional referral hospitals in Uganda: What lessons from a case of Jinja Regional Hospital?

Abstract

This paper reports on a study that examined the institutional dynamics affecting health service delivery at Jinja Regional Referral Hospital in Eastern Uganda. The institutional dynamics examined included the supply of essential medicines and other health supplies, physical infrastructure and the availability of medical equipment. While other factors were likely to affect the capacity of a health facility in improving its service delivery system, our hypotheses relied on institutional factors as the most likely dominant. Although contemporary analysis of development emphasises the central role of institutions, little work looks at how institutions matter for healthcare workers and health care delivery and that’s the focus of this paper. One reason for the scarcity of work in this field is that it is unclear what the relevant theory is in this area. We used the institutional theory. The study population comprised of referral hospital top management, healthcare workers and a few purposively selected patients. The overall findings confirm that two institutional factors, namely physical infrastructure and medical equipment, are the dominant factors in explaining the level of health service delivery. Medical supplies were not found to be a significant predictor, suggesting that government health facilities are perhaps not seriously affected by lack of drugs but by inadequate facilities. This raises a governance issue among the health facilities. We suggest that the Ministry of Health should budget more funds for infrastructural development and emphasise more support supervision and monitoring strategies to ensure full utilisation of lower level health centre facilities so that referral hospitals are decongested and left to handle only referrals and emergency cases by specialists. The implementation and operation of the policy to standardise equipment procurements at different health facility levels is likely to have positive implications in improving the situation.

Key words: health delivery, infrastructural development, support supervision monitoring, medical equipment procurement, Uganda