Autonomy of apex hospitals in Uganda: too little, too slow

Hospital Autonomy, a sustained and purposeful change to improve the efficiency, equity and effectiveness of the health sector has been initiated to improve publicly-owned hospitals which, in many developing countries, consume large portions of scarce health sector resources and do not always use them effectively and efficiently. While the general consensus seems to be that public hospitals are in need of urgent reform, autonomy seems to be emerging in international debates as the main approach to be followed. Its central idea is the decentralization of management authority and responsibility away from the central or regional managers to a local level, focusing mainly on five main administrative and functional areas: Strategic/General Management, Financial Management, Human Resource Management, Procurement and Administration. In Uganda, the Ministry of Health (MOH) granted the two National Referral Hospitals, Mulago and Butabika, a very limited "self accounting" status of autonomy, with a view to extend greater autonomy to these two and ten other regional referral hospitals by 2003. The focus of this study was to assess the extent of implementation of the autonomy by the two that had been autonomous for over ten years.