Expenditure and health service delivery in Ngai sub-county, Oyam District

This study assessed the impact of budgeting on health service delivery in Ngai Sub-County, Oyam District, within Uganda’s decentralized public financial management context. Using a descriptive cross-sectional mixed-methods design, data were collected from health workers/facility managers, local government officials, and community members, with a sample of 367 determined using the Krejcie and Morgan approach; quantitative data were analyzed in SPSS and qualitative data were thematically analyzed. Descriptive results indicated moderate perceptions of budget adequacy, transparency, alignment to priority needs, fairness, and visible facility improvements, but respondents strongly agreed that delays in budget approval negatively affect service delivery (mean = 3.58). Correlation and regression analyses showed a strong positive and statistically significant relationship between budgeting and health service delivery (r = 0.621, p = 0.000), with budgeting explaining 38.6% of variation in service delivery outcomes and a positive predictive effect (B = 0.658). The study concludes that budgeting significantly improves service delivery when it is credible and timely. It recommends shortening approval timelines, ensuring predictable releases, strengthening transparency and community participation, improving needs-based allocation, and allowing controlled flexibility with stronger facility capacity in budgeting and procurement.