Golooba-Mutebi’s report on decentralization and popular participation in Uganda highlights the shortcomings of participatory development. He traces the development path followed within the primary health care sector and concludes that decentralization and popular participation have failed to correct the short comings thought to have been a result of the top-down political system previously in place. He does not support the top-down approach and acknowledges its shortcomings, but argues that decentralization fails to correct them.
Enthusiasts of participatory development stress empowerment and accountability. Golooba-Mutebi correctly argues that the transfer of power does not necessarily lead to empowerment, and that local level management does not lead to greater accountability. While decentralization and popular participation in Uganda’s primary health sector did yield improvements in infrastructure, it failed to address service delivery and accountability. This is where Golooba-Mutebi makes his greatest contribution. Following authors such as Hyden and Chaason, he argues that participatory development makes little significance in states that are weak. He does not argue, as do authors like Cooke, against the usage of participatory development. But rather states that efforts made using the participatory development model, within the framework of a weak state, are bound to be insignificant.
Golooba-Mutebi identifies two broad obstacles present in weak states that hinder participatory development efforts; limited access to resources and restricted information and knowledge. He argues that community health workers failed to provide adequate services as a result of not receiving their salaries on time. This lead to various forms of corruption that all impacted negatively on service provision. In addition, medicine and other medical supplies were also in short supply which lead to many users of the public health system going elsewhere (often to the private practices set up by the community health workers themselves) to find what they were looking for. He goes on to argue that community health workers, individuals in managerial positions, and those serving on the boards of the various ‘watchdog’ organizations were, as part of the participatory approach, drawn from local sites, and in many instances lacked the appropriate knowledge and information to fulfill their duties correctly. Many educated Doctors refused to take direction from their uneducated counterparts. As a result the, participatory development failed to increase accountability.
I do, however, question Golooba-Mutebi emphasis on participatory development. Undoubtedly, Uganda pursued a set of reforms based on a platform of decentralization and popular participation. These ideologies influenced and dictated the actions taken, and...