Overview and background
In April 2023, the World Health Organisation initiated a new agenda to tackle multiple health threats, by suggesting that response to health crises should not be left to the health sector alone. The article recommended that sectors including health, agriculture, environment must work together. What is not fully understood is how the siloed sectors will work together in an authoritarian regime like Uganda.
In Uganda, decentralisation has been foregrounded as a means of devolving power and budgets with the aim of improving service delivery, of which health services belong. With the decentralisation strategy, the national health sector led by the Ministry of Health is replicated at district level and it appears the District Health Office will have more power to plan, recruit staff, allocate funds and engage in service delivery. The reverse has been observed and experienced. The state has followed the decentralisation strategy to reinforce its authoritarianism and securitise disease threats, while at national level, the MOH will act in its silo and generate guidelines from its policy.
Below the hierarchy of power structures are sub-county chiefs, local councils and other authorities including chiefs and religious leaders. These power structures guide, or not guide response to all sorts of misfortunes. Thereby we have less siloed structures who must work with and even report to securitised system in preparedness for disasters. Villagers work work-with and experience these formal and informal authorities with various degrees of relevance, particularly during polycrisis.
The Ebola epidemic prompted NGOs and district authorities to work within this hybrid power structure to focus only on Ebola response, forgettingall other crises. Within this new power framework, there are health partners who guide, direct and finance preparedness and response to epidemics.
The researchers identify the need to shift from tackling one crisis at a time to addressing multiple threats concurrently. Although decentralisation created a disjuncture between siloed structures at national level, at district level it created a hybrid power structure in Uganda. The question that emerges is how the hybrid power structure manifests and if this innovation is suitable for handling polycrisis in health.
Objectives
Below the power structures, villagers manage everyday crises with or without help from the hybrid, non-siloed authorities. While examining this matter, we aim to investigate the following:
- The proposed rapid ethnographic study will employ qualitative techniques including interviews, key informant interviews at local, district and national levels.
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Two study siteswill be of interest. For national level perspectives, we will interview officers at the MOH, Prime Minister’s office and National Emergency Operation Centre in Kampala.
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In addition we will conduct individual interviews with officers in Kasese district, including the District Health Office, NGO representatives, the Resident District Commissioner, Surveillance teams and partners supporting diseases/polycrisis in Kasese district.
Researchers
Dr Grace Akello is an Associate Professor in the Faculty of Medicine at Gulu University in Uganda. Her main research interests include how young people in complex emergencies identify, prioritise and manage their health complaints.
Dr Akello's research interests include HIV/AIDS, young people and complex emergencies and health preparedness.
Email: akellograce@hotmail.com