2018 Health and Social Protection Other

Health Systems Bottles – Necks and Evidence-based District Health Planning. Experiences from the District Health System in Uganda

Dorcus Kiwanuka Henriksson

Well-functioning health systems are key to the reduction of treatable, preventable and premature deaths, ensuring healthy lives and promoting well-being for all at all age This thesis contributes with knowledge on the utility of the modified Tanahashi model for bottleneck analysis at the district level; how tools that utilize district-specific evidence for decision making and priority setting can be adopted into the district planning process; understanding the barriers and enablers to use of district- specific evidence in the district planning process; and how the use of district- specific evidence affects the planning process and service delivery within the district health system.

The report was presented during the seminar Overcoming Barriers to Sexual and Reproductive Health and Rights.

Main findings

  • Findings showed that prioritizing interventions for child survival using district-specific evidence was influenced by several factors and did not depend only on the identification of health system bottlenecks or the ability for district managers to use tools that facilitate the use of evidence in the planning process.
  • A simplistic approach focusing on the planning process at the district level alone is insufficient to address the needs to improve care and service delivery for women and children.
  • Governance and leadership were considered a significant influence on the use of district-specific evidence in the planning process. This could be a barrier or enabler to the utilization of district-specific evidence.
  • The limited decision and fiscal space, limited financial resources and inadequate district health information systems were barriers to the use of district-specific evidence.
  • The modified model is an analysis tool that can be used to identify bottlenecks. However, it acquires accurate and timely data, which may not exist in the routine district health information system.
Dorcus Kiwanuka Henriksson is a health systems and public health specialist at Karolinska Institutet in Stockholm and the Chair of the Emerging Voices for Global Health Network (EV4GH).  In 2017 she defended her doctoral thesis Health systems bottlenecks and evidence-based district health planning: Experiences from the district health system in Uganda at the Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University. Dorcus has worked in sub-Saharan countries at the sub-national and national level and with bilateral and international organizations.