When Popular Participation Won't Improve Service Provision: Primary Health Care in Uganda


  • Frederick Golooba-Mutebi

    1. Frederick Golooba-Mutebi (mutebi@soft.co.za) is at the Agincourt Health and Population Unit, School of Public Health, University of the Witwatersrand Johannesburg and Makerere Institute of Social Research, Makerere University.
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  • The author wishes to thank Lucy Gilson and James Putzel for valuable comments on this article and the London School of Economics and Political Science, the Gilchrist Educational Trust, the Kulika Educational Trust and the African Educational Trust for funding the research. Responsibility for its contents, however, is his alone.


Advocates of participatory approaches to service delivery see devolution as key to empowering people to take charge of their own affairs. Participation is portrayed as guaranteeing the delivery of services that are in line with user preferences. It is assumed that people are keen to participate in public affairs, that they possess the capacity to do so, and that all they need is opportunities. Using evidence from ethnographic research in Uganda, this article questions these views. It shows that, to succeed in the long term, devolution and participation must take place in the context of a strong state, able to ensure consistent regulation, and a well-informed public backed up by a participatory political culture.