Financial Accountability and Health Service Delivery in Local Governments in Uganda: A cross-sectional Case of Kamwenge Town Council.

Abstract

Background.

Health service delivery in Uganda continues to face persistent challenges despite decentralization reforms and financial accountability initiatives. This study examined the relationship between financial accountability and health service delivery at Kamwenge Town Council.

Methodology

A descriptive cross-sectional research design was adopted, involving respondents selected from town council leaders, technical officers, CSO representatives, private sector actors, committee members, and beneficiary community members. Data were collected using structured questionnaires and analyzed using descriptive statistics, Pearson correlation, and multiple regression.

Results.

Majority of respondents were male (66%), and with 48.5% holding university degrees. Most participants (51%) had served in the Town Council for less than four years. Descriptive results showed moderate satisfaction with financial accountability practices, with the highest mean reported for financial reporting (M = 3.589). Health service delivery indicators also registered moderate performance (M = 3.469). Correlation analysis demonstrated a strong and significant relationship between financial accountability and health service delivery (r = .606, p < .05). Financial reporting (r = .526) and budgetary control (r = .656) showed stronger associations with health service delivery than financial planning (r = .231). Regression results indicated that financial accountability explains 47.1% of the variation in health service delivery (R² = .471). Budgetary control (β = .568, p < .05) and financial reporting (β = .279, p < .05) were significant predictors, while financial planning was not.

Conclusion

The study concludes that strengthening financial reporting systems and enforcing effective budgetary control enhances timely, efficient, and quality health services.

Recommendation

There is need to Improve transparency, community involvement in budgeting, capacity-building in financial reporting, and shifting from incremental to program-based budgeting.