An evaluation of the implementation of decentralization of the World Bank's operations of poverty reduction in Uganda
- Authors: Okiria-Ofwono Jacqueline Jane
- Date: 2012
- Subjects: Decentralization in government -- Uganda , Poverty -- Africa, Sub-Saharan , Sustainable development -- Africa, Sub-Saharan , Poverty – Uganda -- International cooperation
- Language: English
- Type: Thesis , Doctoral , DPhil
- Identifier: vital:9105 , http://hdl.handle.net/10948/d1012605 , Decentralization in government -- Uganda , Poverty -- Africa, Sub-Saharan , Sustainable development -- Africa, Sub-Saharan , Poverty – Uganda -- International cooperation
- Description: Continued debates on economic development, poverty eradication and the growing skeptism concerning the paradigms proposed through many decades, has led to a continued search for a paradigm that would, finally, resolve the issue of pervasive poverty in the Sub-Saharan Africa. Having implemented decentralization within government entities without any significant contribution to poverty eradication, the focus has now turned to the development agencies themselves. What are the inefficiencies in these agencies which if addressed might enable them deliver development aid more efficiently thus, providing more resources for development from being lost in the attrition of overheads? It is, therefore, argued that decentralization of development agencies will improve the efficiency and effectiveness of IFIs in delivering development aid. At the same time, decentralization reforms have been proposed as a response to the failures of highly centralized states (or organizations in this case). Empirical evidence, strongly, suggests that physical proximity and more "face-time", promotes better results-on-the-ground, delivered by staff who are better attuned to local conditions and have a better understanding of the client and their development agenda. But, will decentralization alone solve the issue of pervasive poverty? This research recognises that the factors affecting poverty are diverse and intricate and isolating just one part of the puzzle is not enough. Nevertheless, it is argues that decentralization, has a positive impact on poverty reduction thus, this study presents both practical and theoretical considerations from which policy measures can be derived. This thesis focused on establishing how the World Bank, changed its strategies through the implementation of decentralization of its operations as proposed in the ‗Strategic Compact‘, renewed the way it worked in order to maintain its relevance in the development world. The World Bank President, James Wolfensohn, proposed the Compact as a solution to the organization‘s self diagnosis that it was in distress, in a state of possible decline and was not fulfilling its mission of poverty eradication. This research, using Uganda Country Office as a case study, undertook, mainly, a qualitative review of the overall strategy of decentralization and its implementation organization wide and specifically, in Uganda. The research examined how the implementation of the strategy impacted on poverty trends in Uganda. This research found that the decentralization strategy was, fundamentally, the right one to deliver better results of the Bank‘s mission of ‗fighting poverty for lasting results‘ and its vision of ‗A World Free of Poverty‘. Contrary to the popular notion that the World Bank has been, largely ineffective in the delivery of its mission and its decentralization strategy just another one of its 'shams‘, this research established that the implementation of the strategy, although not having a direct or causal relationship, did have positive impact on poverty alleviation in Uganda. This study, therefore, makes a case for decentralization of donor organizations as a means of better delivery of the poverty eradication agenda in the developing world. The benefits though hard to measure in monetary terms are, nevertheless, real in terms of faster and better quality engagement with the clients which in turn, result into better delivery of services and programmes.
- Full Text:
- Date Issued: 2012
Guidelines for the management of patients with diabetes mellitus at health care clinics in the Cacadu region of the Eastern Cape Province of South Africa
- Authors: De Mendonça, Hester Magdalena
- Date: 2009
- Subjects: Diabetics -- Treatment -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: vital:10011 , http://hdl.handle.net/10948/1017 , Diabetics -- Treatment -- South Africa -- Eastern Cape
- Description: Diabetes Mellitus (DM) is the new epidemic in the world with 246 million people suffering from the disease at the moment and a projected increase to 380 million in 2025 (IDF, 2007b:36). The developing countries are the most vulnerable. Statistics state that SA and Egypt have the most diabetics on the continent. Globally, each year 3,8 million deaths are attributable to DM (IDF, 2007a). The Department of Health (DOH) and the Cacadu District Municipality (Eastern Cape) are serving a population of 102 721 in the Kouga and Koukamma areas, which covers an area of 5 992 km², with health care. There are 22 clinics with 28 registered nurses for all the clinics and between 3 and 9 lay health workers (LHWs) per clinic. For the purpose of this research study, the persons suffering from DM (±3550) in this area were taken into consideration (Strydom, 2005). DM is a chronic disorder and therefore patients should be able to manage their disease pattern for the rest of their lives (Healthline, 2008, Mbanya, 2006:12). In order to achieve this, continuous and effective patient education by health care providers are necessary. This disease affects more and more people each passing day, because of the rapid westernisation of the South African population, leading to more people attending clinics in the public health sector (Bonnici, 2002:32). There are specific guidelines laid down by the Department of Health (DOH) pertaining to the control and management of DM. Guidelines include the early diagnosis, treatment and patient education regarding DM (Department of Health, 1997, [revised 2004]). Evidence from previous research studies showed that not all registered nurses are aware of these guidelines and most have not been educated regarding the utilisation of these guidelines (O’Brien, van Rooyen & Carlson, 2006:36-40). In the clinics, the health care givers are confronted with a number of difficulties, such as a lack of funds to enable them to order adequate equipment and medicine. Another problem is the migration of registered nurses out of the country thus; there is also a shortage of staff to operate these clinics (Mkhize, 2004). The organisational structure in the clinics does not function optimally and there is a lack of communication between provincial, district and clinic level. Due to the above-mentioned challenges there is also a lack of efficient auditing systems to ensure quality assurance. Furthermore, a knowledge deficit pertaining to DM and the management thereof in all the groups participating in this study, namely the registered nurses, the lay health workers (LHWs) and the diabetic patients was found. The empowerment process of the LHW is not explored fully and therefore not executed to its full potential. To be able to improve the management of DM in this region, it is important to know what the difficulties are that the health care givers as well as the patients experience in relation to this issue. This study therefore explored and described these difficulties. The research was based on a qualitative, quantitative, explorative, descriptive and contextual research design. Health care givers as well as diabetic patients attending clinics in the Cacadu region of the Eastern Cape have been requested to complete questionnaires pertaining to their knowledge of Diabetes Mellitus. The current organisational structure of the provincial department of health was explored and findings analysed using the activities of the management process (Muller, 2006:106). The SA Government is committed to combining the national human resource development strategy with the rapid upgrading of service delivery to all of the nation’s communities. Stemming from this undertaking, suitable members of the community are to be trained as LHWs. LHWs are to play an integral role in strengthening the abilities of the community to empower themselves to participate and take responsibility for their own health and wellness (Department of Health, 2001a:4). From the research, it was found that the above-mentioned national plan had been implemented, but is not functioning at optimum level due to several shortcomings/deficits. Proposed guidelines were therefore designed to address the shortcomings and fragmentation of the plan. As specific knowledge deficits in DM were identified during this research study, general educational guidelines were included for the registered nurses and the diabetic patients. The LHW was identified as an indispensable link in the chain of efficient health care and therefore, specific educational guidelines on DM were generated to prepare her for the role. With her knowledge, insight into DM and the management thereof and newly required skills in educating and supporting of the patient, she could be an asset in the road to optimum self-care for the diabetic patient.
- Full Text:
- Date Issued: 2009