This dissertation project explores the question, "How and why have Uganda's population and sexual and reproductive health and rights (SRHR) policies failed to realize change despite clear, implementable policies, frameworks, and significant financial resources?" This project examines the extent to which population and SRHR is present in the policy environment and explores the political, environmental, cultural, and social factors that have facilitated and hindered political support for and implementation of SRHR policies and programs.
The findings of this dissertation are drawn from qualitative analysis of primary and secondary data sources. Primary data sources include in-depth, semi-structured interviews with key respondents involved in policymaking and implementation in Uganda. Participant observation and secondary data analysis of relevant policies, reports, and related documents was also utilized.
There are four key findings from this research project. First, implementation does not automatically flow from the existence of numerous policies. Rather, implementation of policies is dependent upon tangible political commitment through funding commensurate to need and through ensuring top-down accountability.
Secondly, five factors (a critical juncture, a clear consensus, political incentive, collective action/social cohesion, and bureaucratic structure) played the largest role in Uganda's success in reducing HIV prevalence, as well as its failure to improve population and reproductive health indicators.
Third, the wider macro-environment, policy characteristics, and policy formation are key factors preventing successful policy implementation for reproductive health commodities in Uganda. Policy implementation is clearly a political issue, and thus both academic literature and program-relevant research need to address specific political factors in implementation, rather than viewing implementation as a technical function of the state and NGOs.
And finally, the findings of this dissertation challenge the good governance consensus and indicate that the "developmental patrimonialism" approach to governance may be a better fit for developing countries to move from extreme poverty to moderate poverty than the current "best practice approach". This dissertation argues that a "good enough" approach to governance that takes into account local context may be a better path to guiding country policies and the global approach to governance.