RESUMEN
In Uganda; decentralisation of the health sector is not an isolated event but an integrated part of the decentralisation of the whole Government. The fact that local authorities have been empowered to set priorities and to make decisions on the budget; has enabled them to change priorities between different sectors. The health sector has not been a priority relative to feeder roads and education. Given the limited resources; priority setting has not been simple; and compettition has been fierce. In most districts; the amount allocated for primary health care has been less than the amount allocated to it before decentralisation. Whereas technical officers had a considerable say vis-a-vis the political leaders in the old; centralised system; this situation has changed with decentralisation. In fact; authority has in principle been transferred from the technical domain at central level to the political domain at district and lower levels. The views on decentralisation differ between the different actors at district level. Professional staff favor independence from the centre; but also fear the local political leaders. Politicians are unambiquously in favor of the decentralisation and prefer greater automony; since this is likely to give them more power over resources at local level (Lubanga 1998). There are currently many indications that the technical health care system has problems at lower levels. Immunisation coverage rates are declining (Ministry of Health 1999); and drug leakage remains a problem (Adome et al 1996); Economic Policy Research Centre et al. 1996; McPake et al. 1998). A big proportion of the funds spent by households on health is actually spent outside the government health care system. The response from government to such indications had been mainly to increase the resources without much change in strategy. However; if the technical and political structures are compared; it appears that the technical health structure is weak at lower levels. The lower in the system one goes; the less number of staff one finds. Furthermore; the proportion of qualified staff is even lower. In addition the relationship between health staff and the local communities is not often a smooth one. The political structure is strong at lower levels. LC I and LC II are in principle a formalisation of existing structures of civil society. LC III level is a body corporate with the authority to collect revenue. Also the administrative structure has civil servants down to the LC II level. These structures are; however; rarely involved in health issues. Nonetheless; their relationship with the local communities is very strong