Accountability mechanisms in results based financing and their implementation in Lira District Northern Uganda

Abstract

Introduction: Results-based financing has been proposed as an innovative reform to enhance systems performance in Uganda. Lira District is one of the districts implementing the national results-based financing (RBF) scheme under the Uganda Reproductive Maternal and Child Health services Improvement Project (URMCHIP). The diversity of relationships among various actors in RBF implementation underscores the need for mechanisms to ensure accountability among them. This was a case study which aimed at exploring the RBF accountability mechanisms, their implementation and related factors in Lira District.

Methods: The study was a descriptive case study employing qualitative methods. The data collection methods included a) focus group discussions with the health workers from RBF facilities, b) key informant interviews with key actors in the RBF program at the MOH as well as in the district including district managers, health facility in charges, verifiers, members of the health facility management committees c) review of RBF documents, annual progress and audit reports. Data were analyzed thematically guided by a framework that explored the relationships and related accountability mechanisms in RBF.

Results: Several accountability mechanisms existed among different actors in the RBF program. The accountability mechanisms between MOH and the districts included regulatory approaches such as contracts, while between the district and health facilities mechanisms included reporting, data verifications and financial audits. Public disclosure through display of results on notice boards and feedback through complaint boxes were the mechanisms employed between the facility and the community. Intrinsic health system arrangements such as support supervision, administrative health facility meetings were some of the enablers’ .Challenges hindering accountability mechanisms included infrequent financial support to enable regular support supervision/verification visits by EDHMT and corruption.

Conclusion: Implementation of RBF accountability mechanisms in Lira was suboptimal due to the various RBF design and implementation challenges. The factors were likely to constrain RBF from reaching its full potential. More effort needed to be directed towards supporting the EDHMT and facility managers in terms of capacity building and facilitation to do their work. Additionally, efforts need to be undertaken to address the downstream challenges such as delayed disbursement of funds and corruption impeding the implementation of RBF accountability mechanisms in the district.