Social accountability and quality health service delivery in the district local governments of Busoga region, Uganda.
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Date
2026
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Busitema University
Abstract
This study investigated the influence of social accountability mechanisms on quality health service delivery (QHSD) in the district local governments of Busoga region. Specifically, the study sought to assess the relationship between community involvement, transparency, Using a cross-sectional, mixed-methods design, governance structures and quality health service delivery. The study used a cross-sectional research design with a mixed methods approach. From a population of 140, a sample of 103 was used. Quantitative data from 256 respondents (74.2% response rate) through structured questionnaires and qualitative data from 17 key informants (70.8% response rate) through interviews was analyzed using correlation, simple linear regression, and thematic analysis with triangulation. Results showed that community participation (ß = .593, R² = .352), transparency (ß = .433, R² = .187), and governance structures (ß = .620, R² = .385) each significantly and positively predicted QHSD, while social accountability as a composite construct produced the strongest overall effect (ß = .636, R² = .405), supporting all four hypotheses; qualitative findings revealed that participation was often seasonal and donor-driven, transparency was undermined by technical, English-language disclosure, and Health Unit Management Committees remained under-capacitated and under-trained. The study concludes that an integrated approach to social accountability, rather than isolated interventions, is essential for improving QHSD in decentralized health systems, recommending institutionalized community forums, simplified budget disclosure, and standardized HUMC training, while extending Stakeholder Engagement Theory to resource-constrained African health contexts and calling for further longitudinal and mediation-focused research.
Keywords: Social accountability, quality health service, service delivery, district local governments, Busoga region
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Wabwire, H. A. (2026). Social accountability and quality health service delivery in the district local governments of Busoga region, Uganda. Uganda. [Unpublished dissertation]. Busitema University.