Strengthening Health Service Quality Through Financial Accountability in Decentralised Health Systems: Evidence from Otuke District - Northern Uganda

Abstract

Purpose: This study examined the influence of financial accountability on health service quality in decentralised health facilities in Otuke district, northern Uganda, focusing on budgeting, financial reporting, and auditing practices. Anchored in public finance management, the agency and stewardship theories, and informed by the SERVQUAL model, it offers empirical evidence to advance theory, guide managerial practice, and inform policy for enhancing healthcare quality outcomes in developing economies. Methodology: The study utilised an explanatory sequential research design and a sample size of 268 respondents who were selected using purposive and stratified sampling. Data was gathered using questionnaires and interview guides and analysed using SPSS version 21 data analysis software. Descriptive statistics summarised the demographics, financial accountability, and healthcare quality sub-constructs, while correlation and linear regression procedures examined the relationships between financial accountability and healthcare quality and the predictive effects of financial accountability on healthcare quality. Findings: The study registered significant moderate positive associations between budgeting (r=0.452, p<0.000), financial reporting (r=0.543, p<0.000), and auditing practices (r=0.494, p<0.000) and healthcare quality. The linear regression results revealed that budgeting (R2=20, p<0.001), financial reporting (R2=29.1, p<0.001), and auditing practices (R2=24, p<0.001) significantly predicted health service quality in Otuke District health facilities. Unique contribution to theory, managerial practice, and policy: The study affirms that financial accountability accelerates healthcare quality in decentralised health governance systems of emerging economies. It advances the public finance management, agency, and stewardship theories by explicating how financial accountability predicts healthcare quality, while incorporating the SERVQUAL model. Practically, it guides healthcare administrators on institutionalising financial accountability mechanisms to boost healthcare quality. Policy-wise, our study recommends stricter financial governance enforcement by the Ugandan government to enhance public healthcare outcome