Political economy analysis of subnational health management in Kenya, Malawi and Uganda - Rodríguez et al (2023)

This paper is based on a problem-driven political economy analysis in Kenya, Malawi and Uganda to explore local decision-making environments and how they affect management and governance practices for health. It finds that while decentralization should improve primary health care by supporting better decisions in line with local priorities from community input, it has been accompanied by thick bureaucracy, path-dependent and underfunded budgets that result in trade-offs and unfulfilled plans, management support systems that are less aligned to local priorities, weak accountability between local government and development partners, uneven community engagement and insufficient public administration capacity to negotiate these challenges. It also examines the impact of coronavirus disease 2019 (COVID-19) on primary healthcare provision.