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Delivering on a gendered definition of health needs in local government budgeting: experiences and concepts

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Local governments are granted budgetary power in the Local Governments Act of the Republic of Uganda, which allows for local-level participation and flexibility in the allocation of financial grants channelled annually from central to local governments. The act prescribes a legal mandate to allocate public resources based on local priorities including the health needs of women compared with men. This study investigated the responsiveness of local government budgeting to the health needs of women as compared to men. A qualitative study was conducted in Mpigi district using a set of data collection methods including: a) three (3) focus group discussions with 8 female and 8 male respondents in each group; b) face-to-face interviews with a random sample of 120 households, 75% of which were male-headed and 25% female-headed ; c) key informant interviews with a sample of 10 administrative officers in Mpigi district ; and d) desk-review of the Mpigi district Budget Framework Paper. Health needs consist of the daily requirements, which, arise out of common disease infections and the socioeconomic constraints that affect the well-being of women and men. However, the primary concern of the district health sector is disease control measures, without emphasis on the differing socio-economic interests of women as compared to men. Local government budgeting, therefore, does not reflect the broad community-wide understanding of health needs. Local government budgeting should be informed by a two-fold framework for the gendered definition of health needs. The two-fold framework combines both disease-based health needs and socio-economic needs of women as compared to men.
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... In line with this need, National Health Policy, 2014 and Nepal Health Sector Program (2015-2020) have provisioned equity as a guiding principle of health programs. For this, as Buyana suggests, local government budgeting should be in a two-fold framework that combines both diseasebased health needs and socio-economic needs [39]. Thus, it is important in Nepal to look upstream to address the causes in a holistic and integrated manner for social justice and universal coverage of health. ...
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Background Infant mortality reflects not only the health of infants but societal well-being as a whole. This study explores distal socioeconomic and related proximate determinants of infant mortality and provides evidence for designing targeted interventions. Methods Survival information on 5391 live born infants (2006–2010) was examined from the nationally representative Nepal Demographic Health Survey 2011. Bivariate logistic regression and multivariate hierarchical logistic regression approaches were performed to analyze the distal-socioeconomic and related proximate determinants of infant mortality. Results Socio-economic distal determinants are important predictors for infant mortality. For example, in reference to infants of the richest class, the adjusted odds ratio of infant mortality was 1.66 (95 % CI: 1.00–2.74) in middle class and 1.87 (95 % CI: 1.14–3.08) in poorer class, respectively. Similarly, the populations of the Mountain ecological region had a higher odds ratio (aOR =1.39, 95 % CI: 0.90–2.16) of experiencing infant mortality compared with the populations of the Terai plain region. Likewise, the population of Far-western development region had a higher adjusted odds ratio (aOR =1.62, 95 % CI: 1.02–2.57) of experiencing infant mortality than the Western development region. Moreover, the association of proximate determinants with infant mortality was statistically significant. For example, in reference to size at birth, adjusted odds ratio of infant dying was higher for infants whose birth size, as reported by mothers, was very small (aOR = 3.41, 95 % CI: 2.16–5.38) than whose birth size was average. Similarly, fourth or higher birth rank infants with a short preceding birth interval (less than or equal to 2 years) were at greater risk of dying (aOR =1.74, 95 % CI: 1.16–2.62) compared to the second or third rank infants with longer birth intervals. A short birth interval of the second or the third rank infants also increased the odds of infant death (aOR = 2.03, 95 % CI: 1.23–3.35). Conclusions Socioeconomic distal and proximate determinants are associated with infant mortality in Nepal. Infant mortality was higher in the poor and middle classes than the wealthier classes. Population of Mountain ecological region and Far western development region had high risk of infant mortality. Similarly, infant dying was higher for infants whose birth size, as reported by mothers, was very small and who has higher birth rank and short preceding birth interval. This study uniquely addresses both broader socioeconomic distal and proximate determinants side by side at the individual, household and community levels. For this, both comprehensive, long-term, equity-based public health interventions and immediate infant care programs are recommended.
... The act allows them to allocate public resources based on local priorities, including the needs of women compared with men. In a study on the responsiveness of local government budgeting to the health needs of women as compared to men, Buyana (2009) found that the priorities of the district health sector do not reflect the broad community-wide understanding and gendered nature of health needs. The author concludes that local governments in Uganda need to move towards a holistic definition of health needs that encompasses not only common disease infections, but also the socio-economic constraints that impact on the well-being of women and men. ...
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Question Identify literature on effective incentives for gender responsive budgeting. Where possible, focus on non-cash-based rewards and sanctions, and identify material on potential wider impacts on women's empowerment. Summary It is difficult to conclusively evaluate the impact of gender responsive budgeting (GRB) on gender outcomes and in turn the impact of incentives on GRB and on women’s empowerment more widely. This is both due to a limited evidence base about impact and to the complexity in assessing and interpreting impact (Combaz, 2013). Literature on GRB is primarily prescriptive and there are few documents that provide conclusive evidence on impact and effectiveness. Complexity in assessing and interpreting impact is, in part, because definitions of gender-responsive budgeting vary and the impact of gender-responsive budgeting is difficult to measure. Gender-responsive budgeting has been implemented in a very diverse and uneven fashion across time and place, under very different constraints and opportunities. The most relevant area of literature relates to including GRB as part of processes to monitor performance. This can be through: Performance-based indicators: These can monitor and incentivise performance. These indicators can be in performance contracts or with sub-national funding decisions, for example. Incorporation of GRB into personal staff incentives remains one possibility though research for this report was unable to find instances of this. Performance monitoring and performance-based indicators can be included in: Public Financial Management reform: GRB can be incorporated and presented as Public Financial Management (PFM) reform. Performance assessment frameworks (PAFs): PAFs for budget support contain indicators and targets, and disaggregating these by gender can ensure that the budget is in effect gender responsive. This approach can be supported with gender working groups. Institutional structure can impact on incentives. In particular: Organisational structure Legal structure Staff assignment Other potential incentives are: International influence Female political representation Media and civil society Taxation
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(CASE), Cape Town, South Africa. A founding member of the South African Women's Budget Initiative, she is the leading international adviser on gender responsive budget (GRB) initiatives, having worked in Africa, Asia, the Caribbean, Europe and the Americas. She has also written extensively on this area. Diane Elson: Diane Elson is a Professor in the Department of Sociology at the University of Essex, UK. She has written numerous books and articles on gender equality and economic life. She was responsible for Progress of the World's Women 2000, the UNIFEM biennial report, and co-editor of a special issue of the World Development journal (July 2000) on Growth, Trade, Finance and Gender Equality. She advised the Commonwealth Secretariat on the development of the expenditure tools for the GRB initiative and UNIFEM on the implementation of its global programme on gender responsive budgets. She is also a member of the UK Women's Budget Group. Guy Hewitt: Guy Hewitt is a Senior Programme Officer in the Gender Affairs Department at the Commonwealth Secretariat, and programme manager of the Commonwealth GRB initiative. He advises Commonwealth governments on the implementation of gender responsive budgets and also provides technical support to other intergovernmental organisations and developmental agencies. Tanni Mukhopadhyay: Tanni Mukhopadhyay is a Policy Specialist with the Human Development Report
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This text, the latest edition, explains the importance of health planning in both developing regions such as Africa, and those in transition, such as Central and Eastern Europe. It stresses the importance of understanding the national and international context in which planning occurs, and provides an up to date analysis of the major current policy issues, including health reforms. Separate chapters are dedicated to the distinct issues of finance for health care and human resource planning. The book explains the various techniques used at each stage of the planning process, looking first at the situational analysis and then looking in turn at priority-setting, option appraisal, programming, implementation, monitoring, and evaluation. The book ends by examining the challenges facing planners in the 21st century, particularly in the light of growing globalization. A major theme of the book is the need to recognise and reconcile the inevitable tension that lies between value judgements and 'rational' decision-making. As such, in addition to introducing techniques such as costing and economic appraisal, it also outlines techniques such as stakeholder analysis for understanding the relative attitudes and power of different groups in planning decisions. Each chapter includes a comprehensive bibliography (including key websites), a summary, and exercises to help with practise of techniques and understanding the content. The book argues that all health professionals and community groups should be involved in the planning process for it to be effective.
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Local Governments Act, Article 78 (1&2) 1997. Republic of Uganda: Kampala
  • Uganda Republic Of
Republic of Uganda. Local Governments Act, Article 78 (1&2) 1997. Republic of Uganda: Kampala; 1997.
CBOs to contribute towards health service delivery
  • Ngo Support
Support NGO/CBOs to contribute towards health service delivery.
Mpigi District Local Government Budget Framework Paper
  • Uganda Republic Of
Republic of Uganda. Mpigi District Local Government Budget Framework Paper 2005/2006-2007/2008: 121; 2005.
Fiscal Decentralization Strategy of the Republic of Uganda
  • Uganda Republic Of
Republic of Uganda. Fiscal Decentralization Strategy of the Republic of Uganda; 2002.
References 1. United Nations Center for Regional Development. Decentralization and Citizen Participation
References 1. United Nations Center for Regional Development. Decentralization and Citizen Participation in Africa 21(1); 2000.