Recentralisation and Urban Service Delivery in Kampala Capital City Authority—Uganda

Recentralisation in of Kampala City took effect in 2010 under the Kampala Capital City Authority (KCCA) Act with responsibility to manage the city on behalf of government of Uganda with the view to improve service delivery. The dynamics provided for both decentralization and Recentralisation policies during its implementation which led to shift of powers back to the centre. The study focused on quantitative data analysis and finding reviled 60.8 percent of female under school going age are not attending school, there is 98.9 percent have access to clean piped water, 62 percent of solid waste is from residential areas, 8.2 percent use commercial toilets and 72.6 percent are 5 kilometers away from the health facility hence a significant improvement in service delivery.


Introduction
In 1947, Kampala was traditionally recognized as a municipality thus named as the Capital City of Uganda at independence in 1962. Originally Kampala city was acknowledged to be located on seven hills, but currently its bounds have greatly been extended to contain numerous neighbouring societies.
Consequently, Kampala has grown to be the main municipal centre. It is the Uganda's economic centre, contributing to 80% of the country's commercial and industrial activities and produces over 60% of the national Gross Domestic Product (GDP) (Imaka, 2017). Kampala as a zone is fully urbanized, a substantial percentage of (60%) is semi-urbanized, and the other remaining area is to be rural settlements.
the Ministry of Local Government operating as an independent unit with five division were each division acted as a unique local government of its own.
For the last decade there has been interest in the current regime to wrestle control of the city's political leadership from opposition. The draft of KCCA Act 2010(GoU, 2010 and its implementation was meant to have a better clean city however the implementation of the KCCA Act brought a number of stiff conflicts that later resulted into altering the powers of Lord Mayor, Executive Director and Minister for Kampala (Sabiiti, 2019). This implies that Kampala was recentralized under central government owned by the Ministry for Kampala.
The aim of the education and social service directorate is to provide; support, guide coordinate, regulate and promote quality Education, Sports, Recreation and tourism activities to the community in Kampala City that are geared towards individual and national development (KCCA, 2010a). The strategic direction was to foster a learning and productive community that focuses on development of tourism information in the City. The core function of the education and social services directorate include; design Education Management System; Plan and Manage the Pre-primary, Primary, Secondary, Special Needs Schools and Institutions of the City including provision of the facilities and learning materials, conduct periodic supervision and inspections to ensure quality assurance the quality of curriculum, methods of teaching, and classroom and dormitory facilities, conduct professional development programs for the teachers and education managers including formal training, refresher, knowledge exchange and work-based programs in the primary, secondary, special needs schools and vocational institutions, provide Adult and Children Library services for the Community and Library support to the Schools in the City, conduct sensitization and awareness of the education services in the City and manage provision of alternative education programs for children without access to the formal education, monitor and supervise the private educational providers in the City to ensure conformity with the educational standards, monitor the implementation of sports and recreational programs in the City and develop, monitor and evaluate the impact of the tourism development strategies on the City.
The Public Health and Environment Directorate (PH&ED) has the mandate to facilitate and provide support to ensure health and productive citizens; and a clean, habitable and sustainable community for the city. The Directorate guides the Authority on the efficient management of public health and the environment (KCCA, 2010c(KCCA, , 2010d. The strategic direction of PH&ED has defined its strategic direction to institute frameworks to proactively research and stem the occurrence and spread of communicable, acute and chronic diseases; foster health equity and nurture a healthy, conducive and sustainable community and environment. The core functions include; develop, monitor and evaluate the effectiveness of the KCCA Public Health Legislation; and institute frameworks and standards to ensure the promotion of health and wellbeing of the community, conduct research, develop and monitor the implementation of strategies on epidemiology and disease control including emergency management, vaccination/immunization, testing treatment and health impact assessment surveys, set benchmarks and monitor the implementation of health and wellbeing promotion through periodic inspections and   KCCA has ten health centers in five divisions in Kampala they include Kiruddu, Kiswa, Kawempe, Kisugu, Kawaala, City Hall, Kitebi, Kisenyi and Komamboga among others. The health centers supported Mulago hospital during renovation were deliveries including antenatal cases, family planning, immunization, HIV-Testing, counselling, dental, sputum tests for T.B, circumcision, simple infections like malaria, typhoid, cough and general medicine in 2016. The mothers who were then seven months pregnant complained of the distance, transport charges their health conditions to reach the two hospitals. Although most KCCA hospitals work on mainly out-patients due to inadequate staff and equipment this didn't stop the increase of patients from following in KCCA central health center that led the patient number to increase from 300 to 900 patients (Nakabugo, 2016).

Problem Statement
Uganda is a primary destination for refugees from South Sudan, Somalia, Democratic Republic of Congo and rural migrants from rural areas. The refugees need access to basic services among which are health services and since most refugees settle and seek for employment opportunities in Urban centres mainly in sub-standard neighborhood Kampala city, the continuous influx of vulnerable urban dwellers put pressure on already overburdened basic services on Kisenyi health center III which led to KCCA to collaborate with Nowegian Refugee Council and ACT to improve service delivery (AGORA, 2018).
To improve health service delivery the ministry of health handed over seven ambulances to KCCA in support of coordination of health centers in line with emergencies. The stakeholders must avoid complacency, wastage of resources, and neglect of their duties (Joel, 2018;Katungulu, 2018). There is inadequate access to safe water in Makindye division, the challenges with knowledge gaps and sanitization, lack of citizen involvement in health matters, slums need upgrading, there is still uncollected waste were garbage heaps of uncollected garbage in areas of Namuwonge (KCCA, 2016).
There continued outbreaks of diseases like cholera, typhoid, malaria etc as a result of vendors using contaminated water to produce juice and drinking water at low prices (Mulondo, 2011) and the uncollected garbage possess a health threat since KCCA fails to collect 1000 tons of solid waste in the city on a daily basis Mulondo, 2011;Ngwomoya, 2019a). Therefore, this paper provides an analysis on service delivery in KCCA majorly focusing on education, health and hygiene, and access to community services. The objective of this study was to assess the extent of urban service delivery in Kampala City.

1)
To establish the level of accessibility to education services in Kampala.
2) To examine the household health and hygiene in Kampala.
3) To establish the level of accessibility to community services by households in Kampala.

1) What is the level of accessibility to education services in Kampala?
2) What is the household health and hygiene in Kampala? 3) What is the level of accessibility to community services by households in Kampala?

Methodology
The investigation used a cross-sectional descriptive survey design to assess the extent of service delivery in KCCA. The design was appropriate for this study because secondary data from Uganda Bureau of Statistics (UBOS), Global Green Growth Institute, and KCCA was utilized. The study focused only on quantitative data and the findings were presented using tables and graphs.

Analysis of the Findings
The study presents findings on health and hygiene of HHs, and the level of accessibility to education and community services by HHs in KCCA.

Access to Education Services in KCCA
The study investigations presented findings on the persons not attending school and those attending primary and secondary school in KCCA.  Source: Author's computations from UBOS (2014).
The evidence in Table 2 above shows that more females (50.5%) attend primary school compared to males (49.5%). The findings imply that there is equality in providing primary education services in Kampala among male and female pupils.

Health and Hygiene of HHs in KCCA
The study assessed the health and hygiene services provided to the households in Kampala and the findings are presented in different sections below;  The findings from Figure 2 above show that most of the waste that is dumped in Kiteezi dumping site are collected from low income residential areas (62%), followed by those from high income residential areas (18%), and the least is collected from market places (9%). The findings imply that most of the waste that is collected from Kampala capital city is generated from low residential areas due to their population density.
KCCA is expected to collect 1,000 tons of garbage daily but only collects 470 tones and this attributed to shortage of trucks. This uncollected garbage affects the drainage since its recklessly dumped by the dwellers and residents in Kampala hence causing floods. KCCA's master plan revealed that they lack Shs 700 billion to roll the implementation but noted that the floods had killed over seven people in Kampala (Ngwomoya, 2019a).

Figure 3. Type of Toilets Used by People in Kampala
Source: KCCA, 2017.
The findings in Figure 3 above indicate that the highest proportion of people (88.5%) in Kampala use residential toilets, followed by those who use commercial toilets while few use public and industrial toilets. The findings imply that residential toilets are majorly used by people in Kampala. Commercial and public toilets face challenges of vendors littering human waste on the floor especially at night or during load shedding which allows hygiene related diseases like cholera, stomach upset and Urinary Tract Infection (UTI) to spread. The situation is worse in the market areas where they have a challenge of inadequate toilet facilities yet lavatories are always congested (Kwiringira, Atekyereza, Niwagaba, & Günther, 2014). The toilet users leave them dirty after use and dump sanitary towers hence blockage.
In a market like Baalikudembe they have 50,000 and Naksero has 800 vendors. The doors on the toilets are in bad shape hence no privacy and toilets produce a terrible smell. The toilets are shared with people of opposite sex yet they are not free each vendor is required to pay 300-500/-per usage time.
There is no ready soap to allow proper hand washing and some lack ventilators. Unfortunately university toilets in Kampala are not any better then those of markets they are always filthy and shaky and regularly run out of water (John Semakula, 2019). These findings are similar to findings discovered by (Tumwebaze, Orach, Niwagaba, Luthi, & Mosler, 2013) were users are dissatisfied with toilet facilities.

Access to Community Services in KCCA
The study investigated the proximity of health and police services to the households in Kampala. This was aimed at assessing how health and police services are brought close to the HHs by the government.

Conclusion
Service delivery in Kampala has had a significant improvement since the last eight years to provide a path for sustainable city development (Note 1). There has been a significant improvement in waste management, education, health, and roads among others (Note 2).

Level of Accessibility to Education Services in KCCA
The study found that the persons attending both primary and secondary school in KCCA exceed those who do not attend school. More importantly, it was evident that females are more enrolled in school compared to males. In early 90s, Uganda used to have a gender inequality in school where few females would be attending school compared to males. Therefore, the government together with its partners should continue with their interventions geared towards encouraging children and adults to join school.

Household Health and Hygiene in KCCA
The study found that health and hygiene of people in Kampala have improved since most homes have access to toilets and manage well their solid wastes which is later dumped in kiteezi by KCCA garbage collectors. However, it was revealed that most of the HHs have access to piped water for drinking.
Therefore, there should be wareness campaigns to ensure that HHs cook drinking water obtained from piped water since it would reduce their risks to diseases (Ngwomoya, 2019b). KCCA has undertaken a number of sanitation projects aimed at improving hygiene although there is general lack of interest by dwellers to participate in a planning and monitoring activities of their respective areas (KCCA, 2016).
KCCA should construct close to 300 public toilets to address the shortage. This will reduce on the outbreak of cholera in Kampala Suburbs. KCCA should work with donors to support the efforts of reducing the number of Ugandan dying of curable diseases like Bill and Melinda Foundation.

Access to Community Services in KCCA
The study found that most HHs in Kampala have close access to health services compared to police services. Thus, the government should also ensure that police posts are brought closer to communities in Kampala especially in informal settlement where crimes are rampant.

Recommendations
There is need for economic empowerment of community members in Kampala through poverty eradication programmes. This would help them to take their children to school since the study found a significant number of persons not attending school.
The study recommends that the government should construct more boreholes for HHs to have access to safe drinking water. In addition, it is suggested that HHs who access piped water should cook it before drinking in order to make it safe. KCCA should work closely with Ministry for Local Government, National Water and Sewerage Corporation, Donor agencies to support projects related to provision of water services.
People living in low residential areas of Kampala should be trained on how to use recycling, reducing, and reusing methods to reduce on the amount of solid waste dumped in Kiteezi.
Lastly, the government should provide police posts nearer to the communities in Kampala since this would help in cubing crimes. This is due to the fact that few HHs in Kampala have close access to the police posts or services. Government should be ready to ring-fence the health budget since the authority continues to decry continued underfunding which affects service delivery and will not support improved quality of life and environment for sustainable urban development.