Administrative Decentralization and Maternal Healthcare Service Delivery in Rural Communities of Mitooma District

Decentralization has been promoted globally as a means to improve health service delivery by bringing decision-making closer to communities. In Uganda, despite decentralization reforms, maternal health care outcomes remain suboptimal in many parts of the country but largely in Mitooma district where the study was conducted. This study explored the implications of decentralization on maternal health service delivery, focusing on the experiences, challenges, and perspectives of stakeholders at community, facility, and district levels.An interpretivist phenomenological qualitative design was employed, using in-depth interviews and focus group discussions (FGDs) with key stakeholders, including healthcare workers (Midwives, and nurses), pregnant and lactating mothers, and local government officials. Participants were purposively selected across multiple communities served by four health facilities at the level of HC111, and HC11 within Mitooma districts. Data were transcribed, coded, and thematically analyzed using ATLAS.ti software to identify key themes and patterns. Ethical principles were observed throughout the research, including informed consent and confidentiality.Findings revealed that while decentralization has enhanced local autonomy and community engagement in some districts, significant challenges persist. These include limited financial and human resources, inadequate decision-making capacity at the local level, poor referral systems, and delays in emergency health care for expectant mothers. Participants also highlighted disparities in service availability and quality, particularly in rural and hard to reach communities like Kanyabwanga HC111. Despite these constraints, decentralized structures offered opportunities for locally tailored interventions and improved accountability when adequately supported.In conclusion, it was observed that decentralization alone is not sufficient to ensure improved maternal health outcomes. Strengthening district-level capacities, enhancing coordination mechanisms, and addressing systemic resource constraints are critical for the success of decentralization reforms. The study recommends targeted policy actions to bridge implementation gaps and promote equitable health care package mostly maternal health for which the gaps were identified in service delivery.