Health Policy and Planning; 18(1): 68-73
© Oxford University Press
2003
Restructuring a ministry of health – an issue of structure and process: a case study from Uganda
1 Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda,
2 Department of Community Medicine, Lund University, Malmö, Sweden and
3 National Institute for Working Life, Malmö, Sweden
This paper analyzes the recently undertaken restructuring of the Ministry of Health in Uganda, which was carried out because the previous structure did not comply well with the decentralization framework or policy. The Ministry was put under pressure by higher political levels, supported by the donor community, to restructure. The paper describes the principles that were guiding this operation, and assesses whether these principles relate to the final outcome and whether the outcome was actually as expected. This paper also analyzes the reasons for the achieved, or not achieved, results and suggests the way forward.
The outcome of the restructuring procedure in terms of change in number of employees was small. The foundation, in terms of a certain structure, has been laid for the Ministry of Health to function in its new role as a coach more than a player, but the work to establish a functioning process is far from complete.
The issue is to make actors at various levels relate to each other, and thereby establish appropriate processes within the existing structure that will help the Ministry develop into a dynamic body. The importance of finding forms for interaction, involving face-to-face relationships between the Ministry and service delivery level, is stressed.