List of acronyms

AVSI- international service voluntary association

CAO – chief administrative officer

DHO/DDHS- District health officer/district director of health services

Et al: And others

GoU: - Government of Uganda

HC: - Health center.

HRH: Human resource for health

HSD- Health sub district.

HSSP- Health Sector Strategic Plan

LC: – Local council

MDG: Millennium development goal

NGO- Non Governmental organization

NHP:- National health policy

NRH:- National referral hospital

MoH:- Ministry of health

PHPs- private health practitioners

PNFPs- Private not for profit facilities

PPPH: private public partnership for health.

RRH- Regional referral hospital

UNOCHA- united nation office for coordination of humanitarian affairs.

WHO- world health organization

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 List of tables

Table one ………………………………………………………………………….18

Table two ………………………………………………………………………….22

Table two ………………………………………………………………………….22

List of figures

Fig 1………………………………………………………………………………….10

Fig 2………………………………………………………………………………….15

2
 Chapter one: INTROUCTION.

1.1 General introduction

This chapter will highlight the basic information about the study area and also describe briefly
what is meant by NGOs; there mandates and their contributions in primary health care activities
in the world and most importantly in Uganda. A conceptual framework for the study has also
been presented herewith.

Defining the concept NGO.

The concept NGO is quite amorphous and obtains what it is not rather than what it is. Green
1997, defined NGOs as organizations that are outside the direct control of the state, he further
says NGOs are non profit making and welfare promoting. Green’s definition however has some
limitations as some NGOs are controlled directly or indirectly by the state

In NGO literature, the umbrella term ‘non-governmental organization’ is generally used

throughout, although the category ‘NGO’ may be broken down into specialized organizational
sub-groups such as ‘public service contractors’, ‘people’s organizations’, ‘voluntary
organizations’ and even ‘governmental NGOs’ or ‘grassroots support organizations’ and
‘membership support organizations’ (Lewis, 2006)

NGOs are defined by the World Bank as "private organizations that pursue activities to relieve
suffering, promote the interests of the poor, protect the environment, provide basic social
services, or undertake community development" -NGO research council 2007

Non-governmental organizations (NGOs) as we know them today are generally thought to have
come into existence around the mid-nineteenth century, at least about 1839. It has been estimated
that by 1914 there were 1083 NGOs already.

It was only about a century later that the importance of NGOs was officially recognized by the
United Nations. At the UN Congress in San Francisco in 1968, a provision was made in Article
71 of the Charter of the United Nations framework that qualified NGOs in the field of economic
and social development to receive consultative status with the Economic and Social Council.
3
The development of modern NGOs has largely mirrored that of general world history,
particularly after the Industrial Revolution. NGOs have existed in some form or another as far
back as 25,000 years ago. Since 1850, more than 100,000 private, not-for-profit organizations
with an international focus have been founded. The growth of NGOs really took off after the
Second World War, with about 90 international NGOs founded each year, compared with about
10 each year in the 1890s. Only about 30 percent of early international NGOs have survived,
although those organizations founded after the wars have had a better survival rate. Many more
NGOs with a local, national or regional focus have been created, though like their international
counterparts, not all have survived or have been successful.

The growth and development of NGOs has been related to specific events in the world history as
they have unfolded, from the aftermath of the Industrial Revolution to the World Wars and
through the aftermath of the Cold War.

According to global civil society 2001, there are about 4,000 international NGOs operating
worldwide, the highest numbers being in India and Russia with 33,000 and 40,000 local and
international NGOs respectively while Uganda had about 3,000 NGOs by the end of 2009.

According to UNOCHA Kitgum district by the end of 2009 had 50 different NGOs both
international and local operating in areas of health, education and social welfare.

Rational for NGOs intervention in health service delivery.

Non-Governmental Organizations (NGOs) have equipped themselves adequately and come up

enthusiastically in providing services like relief to the displaced, disadvantaged and helping the
government in , TB and HIV, malnutrition, water and sanitation ,mother and child health care,
including family planning programs among others. (A.Chitra 2009)

As a result, all concerned have realized the potential of NGOs and their considerable merit
compared to the public/private health sectors because of their staff’s motivation, dedication and
sympathy for the deprived sections of our society and their personalized approach towards the
solution of problems. (A.Chitra 2009)

The Health sector strategic support plan 2010 (HSSP III) and National Health Policy (NHP 2)
2009, states that there should be greater involvement of NGOs in the implementation of health
care services in the country. In recognition of the crucial role played by them, Government of
4
Uganda started granting financial aids to some NGOs for various schemes. (NH policy
2009/HSSP III 2010)

The important role played by the various national and regional level NGOs in Uganda is briefly
documented in the ‘The national health inventory 2009’ where special mention has been made of
such organizations like The AIDS Information center(AIC), the AIDS support organization
(TASO) Family Planning Association of Uganda (FPAU), Uganda Medical Association (UMA),
AVSI, Action contrẽ la faim/action against hunger (ACF) among others, the Greater roles of the
NGOs was seen to ensure Health for All through the primary health care approach. Their role
was also considered as most crucial to translate the concept of ‘People’s Health in People’s
Hands’ bestowed in the Uganda’s health policy into action.

1.1.1 Area of study.

The study shall be conducted in kitgum district in Northern Uganda.
1.1.2 Historical background

When the Imperial British East Africa (IBEA) was trying to establish authority and control in
Uganda, it initially intended to form two administrative units in areas occupied by the Acholi-
speaking ethnic group. The first district called Acholi was to occupy present-day Gulu district
and extend up to Nimule in today’s Southern Sudan.

The second district should have been called Chua with its headquarters in Dibolyec in present-
day Lokung sub-county, Lamwo County, Kitgum district.

The advance team of colonialists led by Corporal Musa and his soldiers brought to Acholi
aspects of Kiganda culture, including having all men concede that the Buganda Kabaka would
take any of the Acholi wives at will. The Acholis treasured wives because they earned them in
exchange for ivory.

Corporal Musa began to build a fort at Dibolyec (meaning an arena of elephants) using forced
local labour. He was an agent of Semei Kakungulu, the colonialist’s chief agent in the country,
who was still in Eastern Uganda.

The fundamental mistake they made was that while the able-bodied men were working on the
fort Corporal Musa and his soldiers was busy raping the wives of the men working on the fort.

5
The locals learnt of that dirty act and hatched a plan to kill Corporal Musa and all his soldiers.
Indeed Musa was killed during a pre-arranged Otole dance at Dibolyec.

That history is well recorded in one Otole dance song: "Lugot oneko Musa nyong; Odong
Kakungulu." meaning, “It is good the people from the mountain (read hills) have killed Corporal
Musa indeed. We are left with Kakungulu”.

The survivors retreated to a small hill, about 50km further south of Dibolyec in present day
Kitgum town. Acholi call this hill "Kidi Guu". Colonialists could not pronounce ‘Kidi Guu’ so
they instead called it Kitgum.

When finally demarcating the boundary between Imperial British East Africa (IBEA) and Anglo-
Egyptian Rule in 1926, the colonial masters decided to cut away part of northern Acholiland and
make it part of Sudan. This area included volcanic soil-rich Upper Talanga, Katire, Palutaka,
Parjok, Owiny-Kibul, Opari and Nimule.

Two reasons can be advanced for: One was to punish the Acholi ethnic community for resisting
colonialism. Many leaders like Rwot Awich (Payira) Rwot Ogwok (Padibe) and Rwot Olyaa
(Atiak) are known to have fought colonialism. The second reason was to divide the Acholi and
reduce their resistance to colonial authority.

At independence on 9th October 1962, there was one Acholi district in Northern Uganda. A
second chunk of Acholi speaking ethnic group occupied the immediate borderline in Southern
Sudan.

During the reign of Idi Amin (1971-1979) East Acholi district, later renamed

Kitgum was curved out of a united Acholi district during the Idi Amin of 1971-1979. The name
kitgum come from ‘kidi Guu’- (Guu Hills) . West Acholi district was later renamed Gulu, and
remained west of Aswa River which flows through the two districts. On December 4th 2001,
Pader district was curved out of Aruu and Agago counties of Kitgum district.

1.1.3 Geographical background

Kitgum is one of the most remote districts in Uganda, lying on the border with the Republic of
Sudan, with Kotido District to its East, Pader District to the South and Gulu District to the West.
Its land area measures about 7,557 square kilometers.

6
The district receives average annual rainfall of 1330mm. Rain starts in late March or early April
and ends in November. Rainfall is bimodal with peaks in April and August. It is dry-hot and
windy from December to mid March. The average monthly maximum temperature is 27 0 c and
average monthly minimum temperature is 170 c.

1.1.4 Physical features

The land is semi-arid but about 80% of it is classified as arable. The vegetation is predominantly
savannah and the relief generally flat in most of the district except toward the border with Sudan,
where there are hills with gentle slopes. Kitgum District experiences dry and rainy seasons.

Population, morbidity and mortality (demographic) background.

Kitgum has a projected population of 228,900 in 2010, according to the 2002 housing and
population census, kitgum district had a population of 283,546 people. There were 137,186
males and 144,188 females. Of these, 42493 inhabitants were in kitgum Town council, Lamwo
county (now Lamwo district had 114,168) Chua county including town council (now kitgum
district) had a population of 168,378.

According to the Kitgum district population office 2003, the population of kitgum was reflecting
a relatively low population density of 29 persons per square kilometers. Its annual population
growth rate, estimated to be at 3.6% per annum, is just above the country’s average.

Kitgum district has two hospitals, one public and the other one is private (missionary hospital),
one health center IV, eight health center III and eight health center II and with three other non
functional health units.

The district has a total of 22 health facilities, out of these, 19 (80%) are functional; while 3
(20%) of the units are non functional. Most of the non functional health units have either just
been completed and not yet opened or have no health staff posted to run tem

7
Accessibility to health care, defined as the proportion of the population within a radius of 5km of
a Health Centre III, was in 2010 estimated at only 37.4%, against a national average of 49%
(UNOCHA 2010).

The burden of disease consists mostly of communicable diseases, including malaria, diarrhea,
Acute Respiratory Infections (ARIs), intestinal worms, trauma and injury.

The HIV prevalence rate in north-central Uganda, where Kitgum District lies, averages about
8.2%, significantly above the national average of 6.7%. The infant mortality in Kitgum is
estimated at 274/1000, more than three times the national average rate of 88/1000. At the height
of the insurgency, malnutrition among children, was acute in the affected areas, affecting up to
31% of under-fives and was a major underlying cause of their high death rate.

The district had cholera outbreak that was considered the longest outbreak ever in the history of
the nation with 1,714 cases with 31 deaths (cumulative fatality rate (CFR) = 1.6%) below the
recommended level 5% in complex emergencies. Then later, hepatitis E outbreak. And now
yellow fever disease (District health office kitgum 2010)

Political background

The district has only one administrative county i.e. Chua, and further subdivided into smaller
administrative units: 10 sub-counties (including kitgum town council) and 50 parishes.

Under Uganda’s decentralized administrative structure, most of the government funded services
are provided at the level of the district, which is administered by an elected Chairperson, his/her
cabinet and a quasi-legislature formally known as Local Council Five (LC V). The LC V is
constituted by elected representatives of sub-counties.

The second most important level of service delivery in the local government hierarchy is the sub-
county (Local Council III), with an administrative setup similar to that at the district level.

It’s at this point that most policies, planning and allocation of public fund in provision of social
services are done. It’s responsible for the implementation, coordination and monitoring of other
stakeholders in service delivery.

1.2 Statement of the problem

In an attempt to improve health sector performance, Uganda pursued a variety of health sector
reforms, including decentralization. Decentralization has been touted as the key management
8
strategy in the countries’ health policies of the last two decades. One of the components the
strategy seeks to address is the participation of the non-governmental organizations in helping
the government to achieve stated national health objectives. Within the framework of
decentralization, the extent to which the strategy has been implemented can be seen as an
indicator of progress towards the health goal through giving opportunity for the participation of
NGOs in providing health services

1.3 Purpose of the study

The study will be conducted to establish the challenges facing NGOs in the implementation of
primary health care service delivery in kitgum district with the view of offering some practical
solutions as well as literature for future researchers in the same field.

1.4 General objectives

The overall objective of this study is to establish the challenging facing NGOs in health service
delivery in kitgum district.

1.5 Specific objectives

1. To establish the challenges within the NGOs themselves (internal) facing NGOs in the
delivery of health services in kitgum district.

2. To establish the external challenges facing NGOs in the delivery of primary health care
activities in Kitgum district.

3. To establish environmental challenges facing NGOs in the delivery of primary health

care .

1.6 Research question

1) What are internal challenges facing NGOs in the delivery of primary health care activities
in kitgum district?

2) What are the external challenges facing NGOs in the delivery of primary health care
activities in kitgum district?

9
 3) What are the environmental challenges facing NGOs in the delivery of primary health
care activities in kitgum district?

1.7 Scope of the study

1.7.1 Geographical scope

The study shall be conducted in Kitgum district. The district is located in northern Uganda. It is
bordered by Lamwo district from the north, Pader in the south, Kotido in the east and Gulu in the
south east. Kitgum district has two hospitals, one public and the other one is private (missionary
hospital), one health center IV, eight health center III and eight health center II and with three
other non functional health units.

The district has coverage of 37% of the population within areas covered by operational health
center within 5km, and with 32 out of 50 parishes without any health center. Kitgum has a
projected population of 228900 in 2010, according to the 2002 housing and population census,
kitgum district had a population of 283,546 people. There were 137,186 males and 144,188
females. Of these, 42493 inhabitants were in kitgum Town council, Lamwo county (now Lamwo
district had 114,168) Chua county including town council (now kitgum district) had a population
of 168,378.
Content scope
This study will concentrate in finding out the major challenges facing NGOs in the delivery of
primary health care in district especially the internal, external and environmental challenges in
the delivery of health services in kitgum district.
1.7.3Time scope
The scope will be conducted between December 2010 to June 2011.

Significance of the study

Primary health care Service delivery under NGOs system seems to be far from reaching its
intended primary purpose, increasing efficiency and effectiveness while popularizing local
participation, staff involvements, compliance with local laws and increasing sense of ownership
and responsibility at the same time while reserving the sense of meeting the universal human
rights to access health service and attaining MDGs is a big challenge and yet its of focus.. The
study will therefore

10
 1. Provides an opportunity to Kitgum District Local government to deepen learning on the
dynamics surrounding the health service delivery under NGOs systems and harness such
lessons to deliver quality but also easily accessible health services by all.
2. Provides insights into other related studies that may be taken for academic interest and or
for pragmatic actions by stakeholders at various levels in the decentralized system of
governance.
3. Offer firsthand experience for the researcher to understand the dynamics of PHC
research.

fig1. Conceptual framework of NGOs involvement in health service delivery in Kitgum district.

INDEPENDENT VARIABLES DEPENDENT VARIABLE

Structures and functions Efficient and effective health service delivery
District level Management /Health service Functional structures of the health structures
Delivery (hospital) Transparent and accountable health service
Sub County Level health service delivery delivery
(Heath Centre) Healthy Population in Kitgum Districts.
Parish Level Health service Delivery (Clinic)
Village level health Service delivery (Village
Health teams)
Outreach workers of NGOs

Planning and Budgeting NGOs Extraneous Variables

Lower level inputs Attitudes
Prioritized service delivery Cultural practices (tradition)
Adequacy of the services Incomes levels among the
population
Political influence

Community participation
Consultations with community structures
Active Village Health Teams
Ownership and sustainability
Demand for health services

Accountability mechanism
Public information system
Audit/assessment of the sector
Monitoring mechanism

11
 Chapter two: LITERATURE REVIEW.

2.0 Introduction
This chapter will explore theories relevant to the study. It will deepen the understanding of the
concept of NGOs participation in health service delivery with particular emphasis on the
functionality of the various stakeholders in the system, planning frameworks, accountability
mechanisms and participation of all the key players in the system.

2.1 Health service delivery in Uganda

The delivery of health services in Uganda is done by both the public and private sectors with
GoU being the owner of most facilities. GoU owns 2242 health centers and 59 hospitals
compared to 613 health facilities and 46 hospitals by PNFPs and 269 health centers and 8
hospitals by the PHPs.

Because of the limited resource envelope with which the health sector operates, a minimum
package of health services has been developed for all levels of health care for both the private
and the public sector and health services provision is based on this package.

The social services provided by local governments are financed mainly by grants from the
central government, supported by multilateral and bilateral donors, and supplemented by local
revenues. Uganda runs a liberalized economy, where both the profit-motivated and not-for-profit
private players are also involved in the provision of social services like healthcare and education.

The health sector in Kitgum District is headed by the District Director of Health Services
(DDHS), who chairs the District Health Team.

Primary health care

The c o n c e p t of primary health care was defined by World Health Organization (WHO) in
1978 September 12 at Alma-Ata as both a level of health care delivery and an approach to health
care practice. It was estimated that 75- 85% of the population seek care at this level yearly and
therefore, it provides both the initial and majority of health care services of a person or the
population. This is in contrast to tertiary health care which is consultative, short termed and
12
disease oriented for the purpose Primary health care tackles the root causes of ill health, and
attacks threats to health, better use of existing interventions could prevent 70% of the global
disease burden. (WHO 1978)

Primary Health Care (PHC) is defined as: Essential health care based on practical, scientifically
sound, and socially acceptable methods and technology made accessible to individuals and
families in the community through their full participation and at a cost that the community and
country can afford to maintain in the spirit of self-reliance and self-determination. (Health for All
by the Year 2000, WHO 1978, Alma Ata)

Health Service Delivery is conceptualized as the relationship between health policy makers,
health service providers, and the poor people. It encompasses services and their supporting
systems that are typically regarded as a state responsibility.

PHC is based upon the following components: Promoting good nutrition , Access to safe water
and basic sanitation , Improving maternal and child health care, including family planning,
immunizing against major infectious diseases, Preventing and controlling locally endemic
diseases, Fostering education on common health problems their prevention and control
measures, Treating common diseases and injuries , Access to essential drugs(The Johns Hopkins
Public Health Guide for Emergencies 2003)

The implementation of primary health care requires a minimum of preconditions as follows:

Availability of a sufficient number of qualified human resources for health, Availability of
adequate infrastructure according to the guidelines/norms, Availability of financial resources,
Availability and accessibility of affordable quality essential medicines

Health Service Delivery is conceptualized as the relationship between health policy makers,
health service providers, and the poor people. It encompasses services and their supporting
systems that are typically regarded as a state responsibility.
The broad purpose of a health system calls for many players addressing the complexities in the
system , Having many players working towards better health, good organization is paramount; he
recognized that ,the National Policy must respond to people’s needs and expectations.,
Institutions need to be well organized, facilitated, and regulated for the purposes they serve
towards better health.
13
Roles of the Uganda health system
A health system is Complex to define, however, a health system is taken to include “all activities
whose primary purpose is to promote, restore or maintain Health” This definition encompasses
Health actions and Non-Health actions within and outside the Health Sector that lead to desired
health results.

According to Dr. Francis Runumi, commissioner health planning MoH Kampala, the Uganda
health system has the following roles ; Stewardship Roles: which include Policy development
and Appraisal; Standards Setting; Accreditation; Quality Assurance; Coordination of sector
players:

The Sector Wide Approach – working with Development Partners; Public Private Partnerships in
Health; Inter-sectoral Collaboration; Ensuring community involvement; Ensuring fairness and
equity to access and financing health services; Accountability to ensure the sector is responding
to people’s needs and expectations; Health financing , developing and mobilizing management
of resources for health , however, this functions have been greatly challenged by human
resource crisis, leadership crisis, low sector budgeting and low opportunities invested in training
and capacity building

There are significant barriers to access to health services Uganda by the poor people. Quality of
services, distance from health services and the cost of using services present major obstacles.
Most medical staffs are in the hospital sector and in urban areas and productivity tend to be low.
(Health briefing IHSD)

NGO in Uganda have been pivotal in the last years, providing a unique contribution in
channeling the huge funding coming from the so-called “western countries” and international
institutions such as the International Monetary Fund, the World Bank and the UN agencies.
NGOs represent a fundamental link in the aid chain

The NGO sector, however, still faces a number of obstacles that are hampering its rapid
development. One of the main constraints has been the fact that they are still insufficiently
organized as a sector. This limits their ability and capacity to influence policies that affect them
and the people they serve. It has also limited their capacity to effectively interface with
government, especially at the local levels. In addition, the NGO sector in Uganda today is
struggling to assert its own identity. The challenge however, is not so much about the differences
14
between NGOs and Government, but rather what collaborative relationship should exist between
the two. The challenge for NGOs now is to assert their own values more confidently (David
Kalete 2009)
Research into this area produced a number of common problems and dilemmas that NGOs
experienced. One of the most mentioned was that of the decision-making processes. Tensions
often occurred between staff and senior managers because of the staff expectations that they
would be equal partners in the decision-making process, in addition there is governance crisis
and decision making problems (Mukasa, 2006).

In addition to the above, the other problem is about staff; such as; recruitment, assignment and
layoff as well as human resources development and administration and finally everyday
management of staff (Vilain, 2006).
According to AVSI, an international NGO operating in Uganda, Cultural barriers, political
instability and limited staffing levels are among the strong challenge facing the implementation
of its project in Hoima district and in the north, these challenges have impeded on
implementation of its programs.
The most common inter organizational weaknesses of the NGO sector include; limited financial
and management expertise, limited institutional capacity, low levels of self-sustainability,
isolation/lack of inter-organizational communication and/or coordination, lack of understanding
of the broader social or economic context (Malena, 1995).
According to Moore and Stewart 1998, there is also structural growth problems besides
accountability, sustainability evaluation of their performance against set goals and objectives,
economy of scale challenges, volunteer relationship as well as future needs problems as put
forward by marcuello in 2001.he argued that younger NGOs are interested management and
information advice whereas older NGOs are interested in more paid staffs with technical
expertise.
The health service delivery framework in Uganda
a) (The policy framework)
In the 1980s the government of Uganda carried out a number of reforms, including the
decentralization health services delivery to the districts and local councils. One of the other
reforms was the adaptation of the sector wide approach (SWAP) in developing a policy with the
objective of providing an enabling environment that would allow for effective coordination of
efforts among all partners in Uganda’s national health development, increase efficiency in
15
resource application and ensure effective access to essential health care. It especially aims at
improving health status and services through a coordinated framework for better use of
resources.
The SWAP approach has been used as a guiding principle in health planning and resource
mobilization, planning and management of health services by the MoH, the districts other
ministries and development partners including NGOs.
Health care delivery services in Uganda are guided by the Uganda health policy II emphasis on
the minimum health care package (MHCP) and detailed plans for its implimenions are outlined
in HSSP III including the monitoring system.

b) Fig 2. Institutional framework

HOUSEHOLDS / COMMUNITIES /
VILLAGES
HC HC HC HC HC
II II II II II H
S Distr
HC H HC D ict
III C III
Healt
III
Referral Facility h
(Public or NGO)
Servi
(HC IV or
HOSPITAL) ces
District Health
Services HQ
Regional
Referral

HOSPITALS
National Referral
HOSP
MOH
Headquarte
rs
The MoH headquarters is the leading center for management of the MoH which was restructured
with the new constitutional mandates in 1995. The MoH is responsible for national planning,
policy formulation setting standard guidelines and protocols, capacity building and technical
support in program area as well as monitoring and evaluation in districts and others lower level
government structures. The MoH also manages the RRHs and NRHs.
The district health service is responsible for coordinating an equivalent level of care as the MoH
headquarter in the district. It’s headed by the DDHS, under this is the HSD at the level of health

16
center IV and supports the lower levels of HC III and HC II. This structure is accountable to and
is supervised by the district authority and functionally supported by the MoH. (MoH Kampala
2010/NHP II)

Partnership in health service delivery/roles of other actors

The MoH acknowledges the importance of each partner and considers partnership an important
guiding principle of the NHP.
This partnership recognizes the public and private sectors, other Ministries and departments,
HDPs, Civil Society Organizations (CSOs), and the community as important players in health.
The private sector includes 3 subsectors: PNFPs, PHPs and TCMPs. The contribution of each
sub-sector varies widely. With coordination structures between the MoH and the private sector
only established at national l level.
The major challenge in strengthening of the public private partnership is the fact that the PPPH
policy is still in draft form and once this is passed it will facilitate coordination and integration
with the public health sector, private sector and the NGO world.

Constraints in meeting the minimum health care package (MHCP)

the Uganda National Minimum Health Care package (UNMHCP) is divided into four clusters
namely: (i) Health Promotion, Disease Prevention and Community Health Initiatives; (ii)
Maternal and Child Health; (iii) Prevention and Control of Communicable Diseases; and (iv)
Prevention and Control of Non-Communicable Diseases (NCDs). Emphasis during the
implementation of the HSSP II was placed on a limited set of interventions which have been
proven effective in reducing morbidity and mortality.
The achievements in these clusters was however greatly affected by corruption and
embezzlement of public funds, funding deficits, example only 31% of the districts trained VHTs,
HRH crisis with about 42% of health staffs on private and PNFP facilities besides absenteeism
and poor attitudes, high levels of poverty, inadequate awareness, poor enforcement of public
health bye-laws and cultural factors in some regions (e.g. in Karamoja) are major challenges that
have affected the implementation MHCP
The above challenges therefore influenced the trends in achieving the MDG as well as the
national target example Uganda still remain at 16th/20 most burden TB countries in the world,
HIV prevalence still remain at 6.7% against a target of 3% and 7.4% against 4.4% among
pregnant mothers attending ANC in HSSP II, the proportion of deliveries in the health facilities
is still low at 32% against 50% in HSSP II yet maternal and child health carry the highest total
17
burden of disease with most HC IV yet not able to provide a comprehensive RHS, inadequate
information sharing and research, weak supervision and monitoring of programs even so, some
programs are even not sustainable example the yellow star program meant to enhance
supervision.

Chapter three: METHODOLOGY.

3.0 Introduction
This Chapter presents detailed descriptions of the methods that will be deployed to collect,
analyze and present data. It will entail research design, population and sampling techniques,
target population, sample size, data collection methods, research instruments and procedures,
data and assumptions.

3.1 Research Design

The study envisages the use of both qualitative and quantitative methods. Qualitatively, the
study will seek to establish facts on the ground basing on an elaborate observation and in depth
interviews that may lead in non-numerical data presentation.

Similarly, the researcher will use descriptive and exploratory research designs. The researcher
will explain and describe his findings thoroughly in words. Quantitatively, the study will
involves measurement of the problem situation. The outputs will then be presented as statistical
data in figures by use of tables, graphs and charts.

3.2 Area of study

The study shall be conducted in kitgum district.

3.3 Population

The study population will include all NGOs staffs, patients, local government leaders, NGOs
mangers, local government mangers in the health department.
18
3.4 Sample size determination
The sample size will be determined by random sampling among the selected study population
above.

Below is a tabular presentation of the study population

Table 1: Study population

DEPARTMENT Total population Sample size

Category A: district health mangers

DDHS staffs 15 03

HC in charges 08 08

HC staffs 160 30

Category B: District leaders

Administration ( technical staffs) 50 10

politicians ( elected leaders ) 25 5

Category C: Community beneficiaries Representatives

Village Health Team 150 30

Opinion leaders (retired civil servants, 50 10

politician and NGOs staffs)

Health inspectors 5 5

Category D: NGOs staffs

Managers 25 05

Field staffs 100 20

19
 TOTAL 388 126

3.5 Sampling procedure

A sample will be obtained by picking the 5th number out of a population of about 400 and about
126 respondents will be picked by probability sampling methods. However, purposeful selection
will also be made where the number of respondents seems low for probability sampling.

3.6 Size and selection of the study population

The study is envisaged to cover 10 sub-counties that form Kitgum District. The coverage thus is
wide and will necessitate sampling procedure to determine actual places and people that will be
included for the study. Non probability sampling will be useful. However, all the NGOs involved
in primary health care service delivery and health facilities will be included in the study

3.7 Data Collection methods.

The study will involve the use primary and secondary sources of data. The primary sources will
be obtained by the moving out to the field and picking first hand information directly from the
various respondents. By way of observation, some salient and required data shall be obtained
from the field as well.

The Researcher will also make use of questionnaires which will be in the form of self-
administered and guided questionnaires.

Secondary source of data, here the researcher will use all sorts of data which will be collected,
processed and sorted for other purposes which will be related to the researchers’ area of interest.
Such information will be used to supplement and back up the primary data collected

The secondary source of data will include among others text books, journals, magazines, media
(radios, TV, and news papers), and study reports of other researchers.

Specifically, the following study instruments shall be deployed throughout the process of data
collection;-

3.7.1 Questionnaires
Simple questionnaire of about 5-7 pages will be developed with structured sets of questions
which will be designed and administered to appropriate respondents. It will be in these

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questioners that the respondents will give their ideas and knowledge as required to the problem
on the ground.

The respondents will be required to tick in or make explanation according to the demand and or
requirements of the questions. The use of questionnaires will be convenience and time saving.

3.7.2 Observations

During the study, the researcher will physically be present to the people as he asks them a few
questions. This will grant him opportunity to make his own assessments at the end of the data
collection process.

3.8 Ethical Procedure

Firstly the researcher will obtain a letter of introduction from the Head of Department
Management, Faculty of Business and Development Studies Gulu University.

In the areas of study, it will in order to gain smooth entry by passing through authorities from
the district level to the sub-county levels where the study will be conducted. This also implies
that after the study, there is need for the researcher to share the research findings with all these
relevant authorities in the areas of study. Two to three research assistants will be engaged to ease
the process of data collection from the field as well as the analysis of the data.

3.9 Data Analysis

During the process of analyzing data, the researcher will engaged in organizing, manipulating
and interpreting of data collected from the field. Tables, charts and graph as a way of analyzing
quantitative data, in the analysis of qualitative data, the researcher will describe data collected
using words.

1.1 Delimitation of the study.

Time; time is one of the most crucial factor in this research in the sense that the duration of the
study is short, this will be mitigated by incorporating activities in the work plan so that more than
one activity runs at the same time.

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The other limitation in the study is financial weakness to the extend that the researcher has to
borrow a small loan to support the research assistants who will help in data collection.

Reference

1. Kitgum district information portal; www.kitgum.go.ug accessed 1/1/2011

2. The health sector strategic support plan III 2010.

3. The Rise and fall of Transnational Civil Society: The Evolution of International Non-
Governmental Organizations since 1839. By T. R. Davies City University London
Working Paper. Steve Charnovitz, "Two Centuries of Participation: NGOs and
International Governance, Michigan Journal of International Law, Winter 1997

4. The Uganda National health policy II 2009 draft

5. Statistical abstract 2010- Uganda bureau of statistics

6. Subcontracting Peace - The Challenges of NGO Peace building. Edited by: Richmond,
Oliver P., and Carey, Henry F. Published by Ashgate, 2005. Page 21.

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 Appendices

Budget estimate

S/NO. ITEMS QUANTITY RATES TOTAL

EACH AMOUNT(UG.SHS)
1 Stationary
-Pen 6 200= 1,200=
-Ream of paper 2 8,000= 16,000=
-Note book 3 2,000= 6,000=
-Clip board 1 5,000= 5,000=
2 Secretarial services
-per page 60 pages 1,000= 60,000=
3 Flash disk 1 40,000= 40,000=
4 Binding services 3 copies 2,000= 6,000=
5 Refreshment
-Food/water - 10,000= 10,000=
TOTAL 129,800/=

Proposed work plan

S/NO. ACTIVITIES S O N D J F M A M J J PER.RESPN.

1 Topic formulation x Student/Richard
2 Approval of topic x x Research committee
3 Synopsis writing x X Student/Richard
4 Draft proposal writing x x Student/Richard
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5 Approval of proposal X x Supervisor/Dr.
Mshilla
6 Data collection X x x x Student/Richard
7 Data analysis and x x x Student/Richard
limitation.
8 1st draft of research x x Student/Richard
report
9 Correction of 1st draft x Student/sup.
10 Pdn. Of final research x Student/Richard
report.
11 Approval x Supervisor/Dr.Mshill
a

Map of kitgum district

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