Emmanuel Nshakira Rukundo
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- Health and sanitation
MA Poverty and International Development (Institute of Development Studies, University of Sussex)
BA Development Economics (Makerere University)
Making Services Work: Decentralization, Community Health Insurance and Micro-level Relationships: Case Studies from Uganda
The weak linkages between sector spending in health, agriculture and other sectors and actual outcomes for the population is often attributed to weakness in service delivery. And in some instances, poor people might be unequipped to demand for better services. Decentralization has therefore evolved over the last few decades in developing countries as, among other reasons, a pathway for better service delivery and to promote a governance system in which poor people can demand for these services. However, in many countries, rigorous research has not been undertaken as to how decentralization policy influences services for poor, often rural communities. Part of this research will attempt to answer pertinent questions concerning agriculture and health. For the agriculture sector, this research will try and answer these questions: Does decentralisation lead to improved agricultural productivity? Do subnational governments bring agricultural extension services closer to farmers? Does farm output increase with decentralised governance? Health care is also an important ingredient of agricultural productivity and development. Important to understand is whether the developments in agriculture such as productivity and access to extension services improved on nutrition status.
Developing countries face resource constraints to provide public services such as health and agriculture services to their population. A large section of these services are therefore privately provided by non-state actors, mainly non-for profit institutions and private sector. But the crucial question is: do privately provided services reach the poor? And, does health insurance really improve health outcomes? This research will utilise an example of health insurance in rural Uganda to answer this question. Using agriculture, access to infrastructure, information, health services, nutrition, social capital and household asset holding as covariates, the study will establish the differences and effects of insurance on health outcomes. The research will use nutrition, measured by child anthropometric indicators (wasting, stunting and underweight) and household diet diversity scores (HDDS) as measures for health. Theoretically and as has been empirically proved, better health contributes to increased agricultural productivity. This should in turn lead to improved access to and availability of food and reduction of food security.
Prof Dr. Joachim von Braun
Dr. Evita Pangaribowo
Dr. Nicolas Gerber
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