RESOURCE MANAGEMENT AND HEALTH SERVICE DELIVERY IN RUKUNGIRI MUNICIPALITY: A CASE STUDY OF RWAMAHWA HEALTH CENTER IV 
BY 
NDYAMUHAKI FAITH REG: 2019/A/KBA/0660/F 

A RESEARCH REPORT SUBMITTED TO THE FACULTY OF ECONOMICS AND MANAGEMENT SCIENCE IN PARTIAL FULFILLMENT OFTHE REQUIREMENTSFOR THE AWARD OF BACHELOR'S DEGREEOF BUSINESS ADMINISTRATION 
OF KABALE UNIVERSITY 
DECEMBER, 2022 

DECLARATION 
I, Ndyamuhaki Faith, declare to the best of my knowledge that this research report is my original work and has never been presented by anyone in any University or any other Institution for an academic Award. 
Sign 
Date 
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14 -12- 2022 
NDY AMUHAKI FAITH REG: 2019/A/KBA/0660/F 

APPROVAL 
This research report titled "Resource management and health service delivery in Eastern Division Rukungiri Municipality. A case study of Rwamahwa health Centre IV" has been done under my supervision and is ready for submission to the Department of Business 
Studies. 
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Date 
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MR. AHAB WE EDWARD SUPERVISOR 
ii 

DEDICATION 
This research report is dedicated to my parents Mr. Rutaro Godfrey and Mrs. Aturinda Elizabeth who have supported me socially, economically, spiritually and cognitively in terms 
of finance and moral. 
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ACKNOWLEDGEMENT 
I thank the almighty God for His love and protection. I acknowledge the assistance both material and other support received from the individuals who contributed towards the 
completion of this report. 
Sincere gratitude goes to my supervisor Mr. Ahabwe Edward for his guidance through this Research season and proper guidance amidst Covid-19 pandemic. 
The researcher wishes to extend her great thanks to the lecturers and other staff members of Kabale University especially under the Faculty of Economics and Management Science for their academic support, encouragement, patience and great guidance during the course of this 
study. 
Appreciation goes to all administrators, and the entire community of Kabale University for allowing and cooperating with me in giving me all the necessary information during my study. Thanks a lot for that social and academic support. God bless you. 
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AHSPR CHOGM EMHS GOU HSSP MOH MRC OECD PAHO PHC PNFP WHO UPPAP VCT UBS 
ABBREVIATIONS Annual Health Sector Performance Report Common Wealth Heads of Government meeting Essential medicines and Health Supplies Government of Uganda 
Health Sector Strategic Plan Ministry of Health 
Medical Research Council 
Organization for Economic Co-operation and Development 
Pan American Health Organization 
Primary Health Care 
Private not for Profit 
World Health Organization 
Uganda Participatory Poverty Assessment Program Voluntary Counseling and Testing 
Uganda Bureau of Standards 
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TABLE OF CONTENTS 
DECLARATION 	i 
APPROVAL 	ii 
DEDICATION 	iii 
ACKNOWLEDGEMENT 	iv 
ABBREVIATION'S 	V 
ABSTRACT 	ix 
CHAPTER ONE 	I 
	INTRODUCTION 	1 
	1.0 Introduction 	1 
	1.1 Background of the Study 	I 
	1.2 Problem State1nent 	2 
	1.3 Purpose of the Study 	3 
	1.4 Specific Objectives 	3 
	1.5 Research Questions 	3 
	1 .6 Scope of the Study 	4 
	1 .6. 1 Content scopes 	4 
	1.6.2 Geographical scope 	4 
	1.7 Significance of the Study 	4 
1.8 Justification of the Study....................................................................................................... 
	1.9 Conceptual Fran1ework 	5 
	I. IO Operational Definitions 	5 
	CHAPTER TWO 	7 
	LITERATURE REVIEW 	7 
	2.0 Introduction 	7 
	2.1 Materials Resource Management and Service Delivery 	7 
	2.2Human Resource Management on Health Service Delivery 	10 
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2.3 Financial Resource Management on Health Service Delivery 	14 
CHAPTER THREE 	16 
METHODOLOGY 	16 
3 .0 Introduction 	16 
3.1 Research Design 	16 
	3.2 Study Population and Sample Size Determination 	16 
	3.3 Sampling techniques and procedure 	16 
	3.4. Simple Random Sampling 	17 
	3.5. Purposive Sampling Technique 	I 7 
	3.6 Data Collection Methods 	17 
	3.6.1 Interview Method 	17 
	3.6.2 Questionnaire Method 	18 
	3.7 Data Collection Instruments/Tools 	18 
	3 .7 .1 Questionnaire 	I 8 
	3.7.2 Interview Guide 	18 
	3.8 Date Collection Procedure 	19 
	3.9 Data quality control 	19 
	3.9.1 Reliability 	19 
	3.9.2 Validity 	19 
	3.10 Data Analysis 	19 
	3.11 Ethica!Considerations 	20 
	3.11 Anticipated limitations to the study and how they were handled 	20 
	CHAPTER FOUR 	21 
	DATA ANALYSIS, INTERPRETATION AND PRESENTATION OF FINDINGS 	21 
	4.0 Introduction 	21 
	4.1 Demographic characteristics of respondents 	21 
	4.1.1 Age of the respondents 	2 I 
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4.1.2 Sex of the respondents 	22 
4.2.3 Marital Status of the respondents 	22 
4.2.4 Highest level of educational attained by the respondent.. 	23 
4.3 Influence of material resource management on health service delivery at Rwamahwa health 
center IV Rukungiri Municipality 	23 
4.4 Influence of human resource management on health service delivery at Rwamahwa health 
center IV, Rukungiri Municipality 	25 
4.5 Relationship between financial resources management and health service delivery at 
	Rwamahwa health center IV, Rukungiri Municipality 	27 
	CHAPTER FIVE 	29 
	DISCUSSION, CONCLUSION AND RECOMMENDATIONS 	29 
	5.0 Introduction 	29 
	5.1 Summary of findings 	29 
	5.2 Conclusion 	34 
	5.4 Reco1n1nendations 	34 
	5 .5 Suggested areas for further research 	3 5 
	REFERENCES 	36 
	Appendices 	39 
	Appendix I: Survey Questionnaire 	39 
	Appendix II Interview Guide for Key Informants 	42 
	APPENDIX III: STUDY BUDGET 	43 
	APPENDIX IV: WORK PLAN OF THE STUDY 	44 
	Appendix V: Sampling Table 	45 
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ABSTRACT 
The study examined resource management and health service delivery in Rukungiri Municipality a case study of Rwamahwa health center IV. The objectives of the study were; to establish the influence of material resource management on health service delivery at Rwamahwa health center IV Rukungiri Municipality, to determine the influence of human resource management on health service delivery at Rwamahwa health center IV, Rukungiri Municipality and to examine the relationship between financial resources management and health service delivery at Rwamahwa health center IV, Rukungiri Municipality. The study employed a descriptive research design and data was collected using questionnaires and interviews. The study findings on the influence of material resource management on health service delivery at Rwamahwa health center IV Rukungiri Municipality were; the health centre has adequate stock of drugs and medicines which ease service delivery, the health centre has all the basic equipment and facilities in place to ensure better service delivery, the health equipments are well maintained to use provision of services and the health centre has a budget for maintenance to ensure that service delivery is to the desired standards. The study findings on the influence of human resource management on health service delivery at Rwamahwa health center IV, Rukungiri Municipality were; the health centre has all staffing gaps filled which helps to ensure better service delivery, the health centre has a medical doctor in place who delivers services promptly, health staff are facilitated to perform their tasks hence better service de! ivery in the organization, recruitment of health staff is on merit which leads to better provision of services and deployment of health staff is on merit which leads to better delivery of services. The study findings on the relationship between financial resources management and health service delivery at Rwamahwa health center IV, Rukungiri Municipality were; the health centre has a budget in place which helps to procure the required products foe effective service delivery, the budget is drawn based on stakeholders' priorities which helps all patients to have equal access to health services, the health centre carries out monthly cash reconciliations to ensure timely service delivery, political leaders can easily access information from departments which helps to identify lope holes to service delivery and financial resources management helps to cater for infant which leads to their low rate of mortality. The study recommended that the health centers should ensure that they procure the basic equipments and facilities to ensure that they can be able to provide better services to the intended beneficiaries, health centers should always adhere and follow their budgets so that they can be able to achieve their intended goals for better service delivery to their clients and there is a need to ensure that the right procedures for recruitment of the employees is followed so that competent staff can be employed which can lead to improved and better 
service delivery. 
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CHAPTER ONE INTRODUCTION 
1.0 Introduction 
The study was about resource management and health service delivery in Eastern Division  Rukungiri Municipality. A case study of Rwamahwa healthCentre IV. It covered material resource, financial resource and human resource management. Resource management was the independent variable and health service delivery was the dependent variable. This chapter presents the background to the study, statement of the problem, objectives, research questions, and the significance of the study. The area of study was Rwamahwa health Centre lV. The demand for healthcare services is on an increase world over, however health service delivery is still unsatisfactory in Africa and in eastern division, Rukungiri Municipality Uganda in particular (Koschinsky et al., 2021). 
1.1 Background of the Study 
Historically, resource management has evolved over time but focused mainly on human 
resource (Kaizenlog, 2016). Industrial welfare was the first form of human resource management as early as 1833. In this period, the Factories Act stated that there should be male factory inspectors. In 1878, legislation was passed to regulate the hours of work for children and women by having a 60-hour week. Difficulties arose in tracing the history of resource management (Lee, 2014). Some see it as a late modern conceptualization. Others viewed it as one of discovering issues and applying legislation and programmes to address them (Natural Resource Management Act 2004). According to Goldsmith (2015) the development of a holistic approach to resource management has been a long journey and it 
will continue to adjust in future. 
McGregor (2011) contended that resource management had a long history and an interdisciplinary base borrowing from and contributing to such fields as economics, organizational behavior, anthropology, psychology, and sociology. The discipline was originally called home management with emphasis on work simplification and household efficiency. In recent years the most commonly used term was management (Lee, 2010). Goldsmith (2017) noted that the study of resource management focused on order, choices and control, and how people used time, energy, money, physical space, and information with little 
effort on service delivery thus, a gap to be filled. 
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During the First World War, personnel development increased due to Government initiatives to encourage the best use of people. In the 2" world war, the focus was on recruitment and selection and later on training; improving morale and motivation; discipline; health and safety; joint consultations and wage policies. This meant that a personnel department had to be established with trained staff. ln the 1970's employment legislation increased and the personnel function took the role of specialist advisor ensuring that managers did not violate the law and that cases did not end up in industrial tribunals. In the l 990's major trend emerged, where employers were seeking increased flexibility arrangements in the hours worked by employees due to increase in number of part-time and temporary contracts and the 
invention of distance working. 
The concept of resource management has proven elusive Weber (2014). According to March (2014), literature suggested that resource management was applied in the logic of appropriateness of our people making decisions. Many authors reviewed the concept of resource management in terms of human resource management (Foa, 201 O; Ha levy et al, 2016; PMI, 2018). Therefore, conceptual analysis had been limited in terms of understanding the nature of resource management Frezatti (2015). 
The concept of health service delivery had received wide publicity but with varying definitions. WHO (201 lb) defined health service delivery as the way inputs are combined to allow delivery of a series of interventions or health actions. Australian Development Gateway in agreement with WHO considered health service delivery as the way inputs such as finance, staff, treatment, equipment and drugs all deliver a range of health interventions to consumers seeking access to health care. Improving service delivery depended on having key resources that were well organized and managed. One thing that clearly emerged from these concepts was that health service delivery was a process and not an end in itself. 
1.2 Problem Statement 
It is no longer a secret that the health sector is underfunded (Mamdani and Bangser, 2013). 
The allocation of financial resources to the health sector has increased only slowly over recent years from 7.5% in financial year 2008-2009 to 9.1 % in financial year 20 I 0-20 \ \, which is low in relation to the Abuja commitment of 15% of the country's Gross Domestic Product EPRC (20 0). This low level of funding however ought not to prohibit improvement of health services and eventually health outcomes. The recent surveys carried out by World Bank in Uganda revealed that health centers had diverted large sums of funds disbursed by 
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the centre to other uses constraining health service delivery Monica (2004). In Rukungiri, the Integrity Report (2022) highlighted that drugs don't reach the target poor in rural areas and worse still health infrastructure projects contracted 5 years ago have never been complete or handed over for service delivery especially in Buyanja and other parts near Kanungu District 
(Munengo). 
The current Development Plan (2022) for Rukungiri District indicated that all the 3 HSD don't have Medical Officers to serve the people. Given the above background, health service delivery in Eastern Division Rukungiri Municipality remains inefficient and unsustainable with weak institutional, technical and management capacity. This trend of affairs raised the question of how to make quality health care available to all-including the very poor in an atmosphere of dwindling financial resources and severely constrained human and materials resources in health sectors in Uganda. If this situation is not curtailed, the entire population in Eastern Division Rukungiri Municipality is at risks continuing to have ill health which ultimately affects their welfare. To date, there is no in-depth documentary evidence to explain the problem. Thus, it was necessary to examine how resource management contributes to health service delivery in Eastern Division Rukungiri Municipality. 
1.3 Purpose of the Study 
To examine the extent to which resource management influences health service delivery at 
Rwamahwa health center IV, Eastern Division, Rukungiri Municipality 
1.4 Specific Objectives 
1.	To establish the influence of material resource management on health service delivery 
at Rwamahwa health center TV Rukungiri Municipality. 
11.	To determine the influence of human resource management on health service delivery 
at Rwamahwa health center IV, Rukungiri Municipality. 
111.	To examine the relationship between financial resources management and health service delivery at Rwamahwa health center IV, Rukungiri Municipality. 
1.5 Research Questions 
1.	What is the influence of material resource management on health service delivery at 
Rwamahwa health center IV, Rukungiri Municipality? 
11.	What is the influence of human resource management on health service delivery at 
Rwamahwa health center IV, Rukungiri Municipality? 
111.	What is the relationship between financial resources management and health service 
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delivery at Rwamahwa health center IV, Municipality? 1.6 Scope of the Study 
1.6.1 Content scopes 
The study was focused mainly on the extent to which resource management influences health 
service delivery at Rwamahwa health center IV, Eastern Division, Rukungiri Municipality. The study established the influence of materials resource management, determine the influence of human resource management and examine the relationship between financial resources management and health service delivery at Rwamahwa health center IV, Eastern 
Division Rukungiri Municipality. 
1.6.2 Geographical scope 
The study was conducted in Rwamahwa health center lY, Rukungiri Municipality, 
southwestern Uganda.Rukungiri is approximately 80 kilometers by road, north of Kabale, the largest city in the Kigezi sub-region. This is about 115 kilometers southwest of Mbarara, the largest city in the Western Region of Uganda. Rukungiri is approximately 381 kilometersby road, southwest of Kampala, the capital and largest city of Uganda. The coordinates of the town are 0°47'24.0"S, 29°55'30.0"E (Latitude: -0.7900; Longitude: 
29.9250). 
1.6.3 Time scope 
The study considered data varying from 2018 to 2022. The research used 6 months to collect 
data, present and discussion of results. Conclusion and recommendations of the study were presented basing on the results of the study. 
1.7 Significance of the Study 
The study will be used by the health sector nationally to broaden their knowledge on ways of 
improving the sector performance in Rukungiri district. It will be significant to the academicians because it will form a body of knowledge which may be useful to other researchers. The study will enable the hospital to identify the gaps in their health service delivery and hence, provider ecommendations to improve on the health service in lower local governments. rt will thus act as a springboard to further research. 
1.8 Justification of the Study 
Health is an essential prerequisite in lower local governments as wet I as an outcome of sound 
development policies, the good health status of the population is vital for a country's economic growth (Wang and Yi, 2021).Resources management access to good health is a 
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human right hence; there was need to ensure that citizens have access to health services in Rukungiri Municipality. 
1.9Conceptual Framework 
The conceptual frame work provides a diagrammatic insight of the proposed study.The 
independent variable is resource management and the dependent variable is service delivery. 
Resource Management (IV) 
Service Delivery (DV) 
► 	Material 			
				
► 	Human 		► Access to services 	
► 	Financial 	. 	► Monitoring of staff 	
			Capacity building 	
			► Budget implementation 	
			Efficiency 	
Figure 1: shows the relationship between resource management and health service delivery. Proper allocation and management of resources leads to better access and quality of health services to the public. The relationship between resource management and service delivery is moderated by organizational policies like the human resource policy, financial policy and 
procurement policies. 
1.10 Operational Definitions 
Material resource management: It means the supervision of materials likes Planning, 
Purchasing, Store and Inventory Control, Care and Preservation, Issue of materials, Accounting and Disposal of scrap. It is in direct contact with the operator department in its daily activities. The most significant objective served by stores is to offer a constant service to the numerous user departments. In the case of a Hospital, the Operation Theatre, Wards, Specialty Clinics, Units, Refraction Departments, Registration, Admission Departments etc. are examples of the operator departments. The efficacious and resourceful functioning of a department depends mostly upon how best the materials are provided by stores department to the operators. Further, stores are mostly linked directly with money, as materials have money 
worth. 
Human resource management is that part of management concerned with all the decisions, strategies, factors, principles, operations, practices, functions, activities and methods related to the management of people as employees in a local Government setting, aimed at adding value to the delivery of goods and services, as well as to the quality of work life for 
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employees, and hence helping to ensure continuous organizational success in transformative environments. 
Financial resource management: This too is operational in that it looks at the funds and assets that finance an organization's activities and investments. In simple terms, financial resources are the monies that keep a business operating, and there are several ways a business will rise and use its financial resources. Every organization will have a framework or process in place for planning, organizing, directing, controlling, and monitoring its financial resources and activities in order to deliver on the goals of the business. This is known as financial resource management (FRM) or financial management. 
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CHAPTER TWO 
LITERATURE REVIEW 
2.0 Introduction 
This chapter provides the related literature reviewed for the study that was extracted from 
various publications from libraries and the websites in line with the study objectives. 
2.lMaterials Resource Management and Service Delivery 
Kaur (2009) noted that despite its role, choosing supplies and equipment and maintenance was often given little thought or attention. This can result in procurement of inappropriate supplies and equipment. Items can be inappropriate because they do not meet the needs of the patients and the level of a health facility. 
Kachieng'a etal (1999) observes that inadequate maintenance budget is frequently mentioned by experts in South Africa as a major problem in providing effective equipment maintenance in the public sector. He notes that most health facilities have equipment maintenance budgets of below 5% instead of the internationally recorded 10%. Rukungiri experience was worse given the fact that almost all health facilities don't have tangible maintenance budgets. This was confirmed by the National Assessment Report (2022) which reported that the District did not spend any funds on operations and maintenance of equipment during the financial year 
2021/2022. 
Kachieng'a (1999) suggested that training of equipment users and operators reduces equipment down time. However, the challenge in Rwamahwa health center IV, Eastern Division, Rukungiri Municipality was mobilization of resources for training and personnel to carry out continuous or periodic training on equipment. 
WHO (2004) pointed out that health facility staff play an essential role in routine care and maintenance of instruments and equipment especially cleaning, checking for damage and reporting defects. They recommended that putting written instructions near the equipment was a way of ensuring care and maintenance. Boiling was widely used for high level disinfection of equipment because either steam sterilizers were not available or because health staff believed boiling was the same as sterilization and guarantees that items were 
sterile. 
There was a growing recognition of the relationship between effective cleaning of health facilities and long-term care facilities and the health and safety of both patients and staff Tavakoli, Carriere and Torabi (2020). A welsh study evaluating hospital cleaning regimes 
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and standards argued that there was "no doubt that environmental surfaces can act as a source of pathogens which give rise to hospital acquired infections". This was equally true with Rukungiri District health facilities that were rarely mopped save for sweeping. Dust was all over the floor, while those which are not cemented lend way to continuous dust. 
Ayliff et al (1999) observe that risk factors for spread of health facility acquired infections are staff shortages, patient overcrowding, inadequately trained and supervised staff, and frequent transfers of patients and staffs between wards and health facilities. As demonstrated by Anderson and Rasch (2000), what is needed is rigorous standards for cleaning, versus the 
steady cutbacks in services that we are observing. 
Proper management of waste products helps to keep the health facility clean and tidy, prevents spread of diseases, reduces risk of injury, and prevents resale and reuse. Therefore, this implies that waste handling, treatment and disposal methods must be practical, safe, affordable, appropriate and sustainable. 
WHO (2004) recommends that drugs should be stored in dry, well ventilated premises that offer protection from direct sunlight and dust. Temperatures should normally be maintained 
between 15 and 250C. 
Ahmad (2005) asserts that local governments receive funds or material resources from central government, development partners, global health initiatives and locally raised revenue to deliver health services. Inadequate material financing remains primary constraint inhibiting the development of the health sector in Uganda(Odaga and Lochoro, 2006). The report states that the current level of funding of US Dollars 7.84 per capita falls far below estimated level of funding of district PHC conditional grants need to be addressed. 
No country can provide health services without material resources and resources to pay for them. Indeed, this is further supported by the Abuja Declaration which asserts that Uganda's health budget is far below the agreed which at least I billion US Dollars per year. This is clear evidence of the inadequate drug stocks and other health care consumables in Rwamahwa health center TV, Rukungiri district due to the limited resources allocated to the 
health budget in Uganda. 
According to Ministry of Health (2006), delivery of healthcare consumables is caused by the delay in disbursement of funds from Ministry of Finance planning and economic development to the districts usually in the first and second quarters of the financial year. The 
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report also notes that the government policy of funding Non-Governmental Organizations' hospitals to increase accessibility of health services to the poor has failed due to user fees that 
they charge. 
Material resource management helps organization to establish the proper inventory levels through the economic order quantity; and to keep track of this level (Ekakitie, Anthony and Nwaebuni2022). Health centres incur substantial costs in the procurement and maintenance of materials, which costs form a large portion of production costs such as storage of equipment ordering costs like transporting and store placement; and stock out costs like expiry of drugs. Health centres cannot achieve an outstanding performance without proper and efficient control of materials. Materials are as much as cash itself and any theft, wastage and excessive use of materials are of immediate financial loss and leads to poor performance of a health centre which cannot leave out Kyamahwa health centre IV in Rukungiri 
municipality. 
The majority of medicines and equipment of government aided health units commonly known as public health centers are obtained from NMS, an autonomous government agency charged with procurement, storage and distribution of essential drugs and supplies to the public sectors (Uganda pharmaceutical sector baseline survey 2002) The NMS regularly supplies essential drug kits to most public health facilities including Kyamahwa health centre IV. However, the management of those medical materials has proven to be challenging as it faces shortage of funds, and one of the main causes of its inability to carry out its various duties is the acute shortage of finance. Unavailability of money at that particular time is never enough to hire more staff and for local procurement of equipment or pharmaceuticals for small health center's needs like Kyamahwa and their management 
Material resource management challenges can interfere with the health center's customer service. They can cost the health center more money and can lead to an excess of drugs and equipment overstock that is difficult to move. Most of these problems are usually due to poor materials processes and out-of-date systems (Gourdin et al, 2011 ). According to Lambert et al (2015), mentions a number of challenges in material management which include: unqualified employees in charge of materials, using a measure of performance for their performance that is too flawed or having people in charge of materials without adequate training, experience or who neglects the job will lead to poor health service delivery problems that will result into 
poor performance. 
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The medicines situation in the public health facilities has also improved in the last five years with an increase in facilities reporting no regular stock outs of the indicator items. To-date, the pharmaceutical sector has made an improvement in availability of and access to Essential Medicines and Health Supplies (EMHS) from 43% in 2009/2010 to 63.8% in 2014/2015. There has been an increase in funding for medicines through both Government of Uganda and donor streams from USO 92 million to USD 410 million (including USO 85 million for procurement of Long-Lasting Insecticide Nets (LLIN)) over the same period, resulting into 
increased public confidence in the health system. 
In the financial year 2009/10, the District failed to spend over 2 billion shillings of which close to 700 million was from the health sector alone. Although issues of delayed procurement and bad weather are mentioned for the large unspent balance, one conclusion from this was lack of absorptive capacity in the District. Therefore, failure to deliver health services cannot be attributed to shortage of material resource management. 
2.2Human Resource Management on Health Service Delivery 
Yip et al. (2019)defines human resource management as the science of allocating human resources among various projects or business units, maximizing the uti I ization of avai !able personnel resources to achieve health service delivery goals, and performing activities that are necessary in the maintenance of the workforce through identification of staffing requirements, planning and oversight of payroll and benefits, education and professional development, and administering their work life needs. 
According to Abreu et al. (2022), health systems face a variety of human resource problems, primarily an overall lack of personnel in key areas, which is worsened by high numbers of trained personnel leaving the health sector to work overseas. This observation was the exact replica of the situation in Rwamahwa health center IV, Eastern Division, Rukungiri Municipality where currently the population Doctor ratio is 1: 360,000. 
Deussom et al. (2022)points out that these shortages weaken the quality of care by increasing professionals' workloads and patients waiting times and make infection control more difficult. A peculiar case in Rukungiri was more than a mere shortage but rather regional imbalance in human resources for health staff distribution with rural mountainous areas being most affected. It was not news in Rwamahwa health center IV, Eastern Division, Rukungiri Municipality to visit a health facility and fail to access service due to absence of health 
workers. 
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Mahapatro (2022)notes that countries and health organizations are adapting innovative ways of deploying and using the existing health human resources partly in response to the current and projected shortages of physicians and registered nurses and partly to meet the changing health and population needs. Some countries were moving towards use of more flexible health human resource planning models that can meet population health needs in areas where the recruitment and retention of professionals is problematic (like hilly areas of Munengo) and where there was no ready access to specialized services. Burke (2017) observes that flexibility can only be possible where there is a certain minimum number of the required health workers. However, for Rukungiri, almost all the key staff in disadvantaged health 
facilities was not there hence rendering flexibility difficult. 
According to Ayliff et al (2014) observe that risk factors for spread of health facility acquired infections are staff shortages, patient overcrowding, inadequately trained and supervised staff, and frequent transfers of patients and staffs between wards and health facilities. As demonstrated by Anderson and Rasch (2010), what is needed is rigorous standards for 
cleaning, versus the steady cutbacks in services that we are observing. 
Aranda et al. (2022)suggests that one way to deal with hour crisis in health is reassignment of clinical roles by shifting tasks to different cadres of health workers: nurses may become involved in prescribing drugs, lay counselors involved in testing, new cadres may be introduced to perform specific tasks, and patients may be engaged to take over some elements of their own care. According to OJRD, the objective is streamlined, rationalized chain of care that relieves pressure on each worker involved, while maintaining quality standards for 
patients and increasing access to interventions. 
However, the success of the above innovations calls for continuous training of lower cadre staff especially nurses and clinical aids to provide primary care. Unfortunately, limited funds for capacity building hampers health worker's training in Rukungiri. The few that have attempted to use their personal savings, something which demotivates staff. Another point to note is task shifting has not been reviewed or researched upon in Rukungiri District. Critics of task shifting (Phillip et al, 2018, Laurent, 20I5) argue that it has become a "bandwagon that is uncritically championed at the expense of existing health cadres, whose low pay and 
poor working conditions drive attrition. 
WHO (2021) highlights that lack of managerial capacity at all levels of the health system is increasingly cited as a binding constraint to scaling up services and achieving the millennium 
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development goals. 1t is therefore recognized that simply allocating greater public resources to basic health services is not enough to ensure that quality services are made available to the vast majority of poor citizens in the developing world. According to Miller etal (2003). strengthening managerial skills is necessary to coordinate patient care and well-updated data collection is a prerequisite for good analysis of health service quality. As observed by WHO (2014), the impact of public spending on actual outcomes in health service delivery depends 
critically on management of existing resources. 
As it was observed in numerous studies that human resources management plays a significant role in developing the quality of healthcare service and improves the performance of individuals working in health sector through incentives like 'motivation to work' tools as well as its "system of bonuses by competencies." Motivating people affects their important interests and creates the conditions for the self-realization in the process of life (Yakovytskaet al 2022) thus human resource influencing service delivery in health. This is also the same in 
Rwamahwa health centre IV in Rukungiri municipality. 
As it was observed in numerous studies that human resources management plays a significant role in developing the quality of healthcare service and improves the performance of individuals working in health sector through incentives and 'motivation to work' tools as well as its "system of bonuses by competencies." Motivating people affects their important interests and creates conditions for the self-realization in the process of life(Aranda et al.. 
2022). 
According to Rawashdeh, (2018) the investigation of the relationship between quality human resource management and health service delivery is considered important because the knowledge and competency to manage people are not necessary to hold a management position in most health service professions in Rukungiri Municipality. In the world's best hospitals, we find developed HRM with a positive impact on employee satisfaction and 
medical indicators. 
As well as the balance between the human and physical resources, it is also essential to maintain an appropriate mix between the different types of health promoters and caregivers to ensure the system's success. Due to their obvious and important differences, it is imperative that human capital is handled and managed very differently from physical capital (Malik et 
al, 2020). 
12 

According to Kabeneet al (2016) both the number and cost of health service consumables (drugs, prostheses and disposable equipment) are raising astronomically, which in turn can drastically increase the costs of health service delivery. ln publicly-funded systems, expenditures in this area can affect the ability to hire and sustain effective practitioners. HRM practices must be developed in order to find the appropriate balance of workforce supply and the ability of those practitioners to practice effectively and efficiently. A practitioner without adequate tools is as inefficient as having the tools without the practitioner. 
Bourgeault et al (2020) asserts that workforce training is another important issue health service delivery. It is essential that human resources personnel consider the composition of the health workforce in terms of both skill categories and training levels. New options for the education and in-service training of health care workers are required to ensure that the workforce is aware of and prepared to meet the health centre's present and future needs. A properly trained and competent workforce is essential to any successful health service 
delivery. 
Many human resources initiatives for health sector reform also include attempts to increase equity or fairness. Strategies aimed at promoting equity in relation to needs require more systematic planning of health services Shelton, Chambers and Glasgow (2020).Some of these strategies include the introduction of financial protection mechanisms, the targeting of specific needs and groups, and re-deployment services. One of the goals of human resource professionals must be to use these and other measures to increase equity in their countries. 
Human resources in health sector reform also seek to improve the quality of services and patients' satisfaction (Gong et al 2018). Health care quality is generally defined in two ways: technical quality and socio cultural quality. Technical quality refers to the impact that the health services available can have on the health conditions of a population. Socio cultural quality measures the degree of acceptability of services and the ability to satisfy patients' 
expectations (Gong et al 2018). 
According to Chowdhury, Sunna and Ahmed (2021) human resource professionals face many obstacles in their attempt to deliver high-quality health care to citizens. Some of these constraints include budgets, lack of congruence between different stakeholders' values, absenteeism rates, high rates of turnover and low morale of health personnel. Better use of 
13 

the spectrum of health care providers and better coordination of patient services through interdisciplinary teamwork. 
2.3 Financial Resource Management on Health Service Delivery 
Adhikari et al. (2022)observed that funding shortages severely affected implementation of basic health services. The Australian Development Gateway noted that part of the problem limiting scaling up of health services was lack of managerial capacity at all levels of the health system especially in the area of financial management. In Rukungiri district, the entire health center in-charges have never received training in basic financial management. Therefore, continued allocation of public resources to basic health services at Rwamahwa health center IV, Eastern Division, Rukungiri Municipality are not enough to ensure that quality services are availed to the vast majority of the poor people. 
Luu et al. (2022)noted that one way to promote health care is to involve the community in participative decision- making especially as far as health care priorities are concerned and where funds should be allocated. However, for the case of Rwamahwa health center IV, Eastern Division, Rukungiri Municipality, rarely are stakeholders involved in priority setting and funds allocation more so at village and parish level yet these are points of actual need of health care. This was partly attributed on the side of the public to lack of knowledge about rights and recent health financial reforms. 
Issues of governance and accountability are further constrained by lack of adequate financial management systems in place to ensure generation and allocation of locally generated funds to the health sector. Financial mismanagement and corruption are often mentioned as constraining health service delivery. The public rarely access information on financial resource allocation to health facilities for example, whereas the central government (Ministry of Finance) has started publishing information on priority sector allocations for each District, failure by the Districts to disaggregate such funds made it impossible to monitor expenditures at parish and village facility level (Riffin et al., 2022). 
Goryakin et al. (2017)noted that health centers are not clear on financial management rules and procedures and cases of financial mismanagement were noticed in about 59% of the implementers. In some instances, they found that funds were not utilized and hence remained idle at the local level. Lack of regular and periodic audit of health facilities was also mentioned as another problem hindering health value for money services. 
14 

In the financial year 2020/2021, the health centers at the District levels failed to spend over 2 billion shillings of which, close to 700 million was from the health sector alone. Although issues of delayed procurement and bad weather are mentioned for the large unspent balance, one conclusion from this was lack of absorptive capacity in the Rukungiri District(Sheiman & Shevsky, 2019). Therefore, failure to deliver health services cannot be attributed to 
shortage of financial resources only. 
Financial management relates to how governments manage resources through the budget cycle. This makes it a key vehicle through which governments implement policy including health policy and achieve their economic and societal objectives. Thus far, the associations between budget formulation and approval, budget execution, and budget evaluation and health service delivery have not been examined. A discussion of how these elements of the budget cycle affect health service delivery is thus important(Goryakin et al., 2017). 
Financial management enhances production management of the business concern, which helps to multiply the money into profit. Profit of the concern depends upon the production performance and production performance needs finance, because production department requires drugs materials, wages, and operating expenses (Paramasivan, 2016). 
These expenditures are decided and estimated by the financial department and the finance manager allocates the appropriate finance to production department. The financial manager must be aware of the operational process and finance required for each process of production 
activities(Madura, 2020). 
The pharmacists' obligation to establish and maintain standards assuring the quality, proper storage, control and safe use of all pharmaceutical and related supplies (Brenner el o/2013). This responsibility must not be delegated to another individual. Although the actual purchasing of drugs and supplies may be performed by a non-pharmacist, the setting of quality standards and specifications require professional knowledge and judgment and must be performed only by the pharmacists (Chiu, Thow and Bero, 2022) 
15 

CHAPTER THREE METHODOLOGY 
3.0 Introduction 
This section was centered on the study design and methodologies: the research design, target 
population, sampled populace, sample size and selection. It also examined the data collection devices, specimen techniques and processes, pre-testing gadgets, methods and measures for 
data collection and analysis. 
3.1 Research Design 
The study employed a descriptive research design in gathering information about the resource 
management influences health service delivery in Eastern Division Rukungiri Municipality, Rwamahwa health center IV(Creswell, 2017). The study utilized both quantitative and qualitative data collection and analysis approaches (Kiiza, 2019). 
3.2 Study Population and Sample Size Determination 
The study considered a total sample size of sixty five (65) as in table (Table 3.1 ). 
Table 3.1: Determination, Selection of Study Population and Sample Size 
Category of Respondents 
Population 
Sample 
- 
Medical Officers 
- 
17 
Administrative Officers 
Dental pharmacy 
-	- 
9 
15 
Nursing officers 
Support Staff Total 
Sources: Primary data, (2022) 
27 10 78 
	Sampling Method 	
I4 	Simple Random Sampling 	
9 	Purposive sampling 	
12 	Simple Random Sampling 	
20 	Simple Random Sampling 	
10 	Simple Random Sampling 	
65 	Simple Random Sampling 	
3.3 Sampling techniques and procedure 
According to Korstjens & Moser (2017), a sampling technique refers to the method by which 
the researcher selects representative elements/ subjects from the population. Sampling techniques are methods of selecting samples from the population. Sampling allows an in- 
16 

depth study of objects in the population; it is also cheaper in terms of time, cost and effort to collect data from a sample than entire population. 
According to Pace (2021), both probability and non-probability sampling was used in the study in Rukungiri district. This technique was beneficial because chances of an element, person and object being included in the sample are not the same. The researcher used these methods of sampling to avoid high sampling error and bias about the study hence, beneficial 
for the study. 
3.4. Simple Random Sampling 
This sampling technique required that all elements to have an equal chance of being selected 
in the study area. The method was beneficial as it was used to select random samples from respondent thus, minimizing bias (Jawale, 2012). This method of sampling was important for this study as it was a fair method of sampling, and if applied appropriately, it also helped to reduce any bias involved compared to any other sampling method involved (Malela-Majika et 
al., 2021 ). 
3.5. Purposive Sampling Technique 
According to Campbell & Walker (2020), purposive sampling method, involves non-random 
selection of a sample centred on the researcher 's judgment and knowledge about the population. The researcher used this method reason being that it enabled the selection of members based on their experience about the resource management and health service 
delivery. 
3.6 Data Collection Methods 
According to Harrell and Bradley (2009), data collection are the general strategies or a plan 
of work that has to be followed in gathering information. To collect data, on the extent to which resource management influences health service delivery at Rwamahwa health center IV, Eastern Division, Rukungiri Municipality. The study employed interviews, and 
questionnaire as discussed below. 
3.6.1 Interview Method 
An interview is defined as verbal communication between a person-to-person in which an 
interviewer asks the other questions intended to stimulate information or opinions (Griffee, 2005:Mukumbang et al., 2020). The researcher used unstructured interviews to control the flow of questions given to the respondents. The method was based on personal contact where by the researcher was engaged in question-answer talk with the respondents by asking them 
17 

questions as she notes. This method was important for the study because it acquired specific data and information from respondents believed was more knowledgeable and skilled with 
the content. 
3.6.2 Questionnaire Method 
A questionnaire is defined as an instrument that collects data over a large sample (Griffee, 
2005). This study adopted self-administered questionnaires to provide support to the questionnaire method of data collection. As a strategy to achieve the required sample size of 56 completed questionnaires, the researcher visited Rwamahwa health center IV, Rukungiri Municipality and explain to them what the study was all about to ease proper and accurate data collection as in line with Chrisostom and Ruth Komunda (2020) whereby they collected data from a sample of 56 respondents with the aid of self-administered printed survey questionnaire to ease data collection. The use of the survey questionnaire was important for the study because of its advantages. 
The study constituted of both open ended and closed ended questions to ease data collection in an area in line with the self-administered survey questionnaires to solicit the respondents· views (Oketch and Komunda, 2021). Closed-ended questions with both solicited and unsolicited responses were designed to quantitatively draw out the respondent's characteristics involved in the study(Sugiura et al., 2017). 
3.7 Data Collection Instruments/Tools 
Research instruments can be defined as materials, objects, and tools that help to use the 
research methods. The tools applied included the following; interview guide and a questionnaire, (Cohen, 2007) as described below. 
3.7.1 Questionnaire 
A questionnaire is a tool that collects data from a selected sample. Data was both primary and 
secondary got from reports and records that were published within the facility and outside. Questionnaires were provided to support the questionnaire method of data collection. The researcher gave out the designed questionnaire to respondents to fill them during data collection. Specifically, self-administered questionnaires were administered to (89 respondents involved in the study) (See Appendix A). 
3.7.2 Interview Guide 
An interview guide is a set of topics and/ or questions on which the interview is conducted. 
These included structures of the questions that gave direction to the study when a researcher 
18 

was conducting interviews. The interviews conducted for the purposes of this study was carried out in accordance with the approved design of the study, which provided for the collection of quantitative data by means of a survey instrument, followed by the collection of qualitative data through semi-structured interviews. 
An interview guide (Appendix B) was developed during the proposal stage and approved by the Kabale University to guide the interviewer and collect data on specific areas of the study from all respondents. Open-ended questions were used to qualitatively investigate key 
constructs that related to the study subject. 
3.8 Date Collection Procedure 
The researcher requested authorisation from Kabale University to collect data from the field. 
I was also requested from the District Health Officer, the Distict Community Development Officer, Chairman LCI in the study area to ease collect data. 
3.9 Data quality control 
3.9.1 Reliability 
The researcher pre-tested the research instruments particularly the questionnaire which was 
the most used instrument to a group of respondents that did not participate in the study. 
3.9.2 Validity 
Validity is the degree by which the sample of test items represents the content the test is 
designed to measure. Validity is an indication of how sound your research is. The researcher gave the research instruments to a team of experts who made a review. Thereafter, content validity index was calculated. Amin (2015) puts it that for any instrument to be accepted as valid the overall average index should be 0.70 and above. Therefore the researcher got a validity content index of 0.90 which was considered valid for the study. 
3.10 Data Analysis 
According to Kothari (2014), defines data analysis as a process of systematically applying 
statistical and logical techniques to describe, summarize and compare data. The data collected was processed and analyzed both quantitatively and qualitatively. During processing, the data was edited, coded and tabulated for proof reading. This ensured clear and easy presentation of research findings. After thorough sorting, data obtained from questionnaires was edited, coded and responses were entered into computer using Microsoft excel to generate tables. 
19 

3.11 Ethical Considerations 
The researcher requested for a letter of introduction from the Head of Department Kabale 
University. As the researcher starts collecting data, a copy of this letter was presented to the respondents that were approached during data collection in order to get their consent and approval of the genuineness and purpose of the study. Observation was done and interviews 
were held with the respondents. 
3.11 Anticipated limitations to the study and how they were handled 
The time the researcher had to collect data and analyze it was not enough. However, the researcher worked overtime, worked as well using research assistants to help in data 
collection. 
Weather changes; these included rain and strong sunshine which was also seen as a limitation to this study. The use of sweaters, jackets, raincoats and umbrella helped in solving the 
problem of weather conditions. 
Poor means of transport; the conditions of the roads were poor. The researcher personally walked and where possible use motorcycles to finish the research work in time. 
Financial constraints; this also was a limitation to this study. Stationary, printing, transport and rent costs was too high. The researcher solicited financial help from parents, brothers, sisters and friends to ensure that the costs were covered and data collected. 
20 

CHAPTER FOUR 
DATA ANALYSIS, INTERPRETATION AND PRESENTATION OF FINDINGS 
4.0 Introduction 
This chapter presents the findings and interpretations from the research study. The findings 
are based on the information collected from the respondents using the research instruments that were designed in the methodology section. Data was presented basing on the research 
objectives of the study. 
4.1 Demographic characteristics of respondents 
The researcher considered the age, sex and marital status of respondents. This biographic data 
was very essential for the researcher and the study in order to describe the best respondents 
that were selected for the study as presented below. 
4.1.1 Age of the respondents 
The researcher considered the age of respondents and the results in Table 4.1.1 below were 
recorded: 
Table 4.1.1: Showing the age of the respondents 
Age 
20-25 
26-30 
31-40 
41-50 
51> 
Total 
Frequen 	cy 	
14 		
10 		
11 		
22 		
8 		
65 		
Percentage 
22 
15 
17 
34 
12 
100 
Source: Primary Data 2022 
Table 4.1. l shows that 34% the highest numbers of the respondents had between 41-50 years of age while 12% the least numbers of respondents had above 51 years. The rest of the respondents included 15% had 26-30 years of age and the remaining 17% had 31-40years of age and 22% had 20-25 years of age. The researcher considered the age of respondents with 
21 

the view of acquiring data from respondents in relation to their understanding on the issues related to the health center. 
4.1.2 Sex of the respondents 
The researcher considered the sex of respondents and the results in Table 4.1.2 below were 
recorded 
Table 4.1.2: Sex of respondents 
Sex 	Frequency 	Percentage 	
Female 	30 	46 	
Male 	35 	54 	
Total 	65 	100 	
Source: Primary Data 2022 
Table 4.2.2 shows that most of the respondents were males represented by 54% of the total population whereas females were only 46% of the respondents. This shows that there was fair distribution of job opportunities among males and females at Rwamahwa health center IV 
Rukungiri Municipality. 
4.2.3 Marital Status of the respondents 
The researcher considered the marital status of respondents and the results presented below in 
Table 4.2.3 were recorded. 
Table 4.2.3: Showing the marital status of the respondents 
Marital Status 	Frequency 	Percentage 	
Widowed 	10 	15 	
Single 	16 	25 	
Engaged 	11 	17 	
Married 	28 	43 	
Total 	65 	100 	
Source: Primary Data 2022 
Table 4.2.3 shows that 43% the highest numbers of the respondents were married while 15% the least number of respondents were widowed in this case meaning that they had lost their 
22 

spouses through death. The rest of the respondents included: 17% who were engaged with their partners with the aim of getting married in the future and 25% the remaining number of respondents living single I ives. The researcher considered the marital status of the respondents in order to get information from respondents of all categories. 
4.2.4 Highest level of educational attained by the respondent 
The researcher further considered the highest levels of education attained by respondents and 
the results presented below in Table 4.2.4 were recorded. 
Table 4.2.4: Showing the highest level of educational attained by the respondents 
Level of education 	Frequency 	Percentage 	
Non formal Education 	00 	00 	
Certificate 	5 	8 	
Diploma 	19 	29 	
Bachelors 	41 	63 	
Total 	65 	100 	
Source: Primary data, 2022 
Table 4.2.4 shows that 63% the highest numbers of the respondents had bachelors and they made the biggest number of the literate respondents whereas 8% the lowest number of respondents had certificates. The other respondents included 29% who had diplomas and the remaining none of the respondents had attained none formal education and this indicated that the respondents who had attained bachelors were many because most the workers of Rwamahwa health center IV had studied enough and qualified to with the health center. 
4.3 Influence of material resource management on health service delivery at Rwamahwa 
health center IV Rukungiri Municipality 
The researcher further considered the respondent's opinions on influence of material resource 
management on health service delivery at Rwamahwa health center IV Rukungiri 
Municipality and the results presented below in Table 4.3. 
23 

Table 4.3: Respondent's opinions on the influence of material resource management on health service delivery at Rwamahwa health center IV Rukungiri Municipality 
Influence of material resource 	Strongly 	Agree 	Not sure 	Disagree 	Strongly 	
management on health service 	agree 									disagree 	
delivery at Rwamahwa health 														
		% 		% 			% 			% 			% 	
center IV Rukungiri 	> 		> 			> 			> 			>--. 		
	o 		o 			o 			o 			o 		
	C: 		C: 			C: 			C: 			C: 		
Municipality 	(I) 		(I) 			(I) 			(!) 			(!) 		
	::I 		::I 			::I 			::I 			::I 		
	r 		er 			5 			v 			er 		
	(!) 		(!) 			(!) 			(!) 			9 		
	... 		... 			... 			,_ 		z 		
	L. 		LL 		L. 		µ.. 				
The health centre has adequate 	26 	40 	32 	50 	7 		10 	- 		- 	- 		- 	
stock of drugs and medicines 														
which ease service delivery 														
The health centre has all the basic 	40 	62 	13 	20 	12 	18 	- . 	- 	- 		- 	
equipment and facilities in place to 														
ensure better service delivery 														
													,_ 	
The health equipments are well 	19 	30 	13 	20 	7 	10 	26 	40 	- 		- 	
maintained to use provision of 														
services 														
The health centre has a budget for 	39 	60 	26 	40 	- 		- 	- 		- 	- 		- 	
maintenance to ensure that service 														
delivery is to the desired standards 														
Source: Field data, 2022 
The study findings indicate that 40% of participants strongly agreed that the health centre has adequate stock of drugs and medicines which ease service delivery, 50% agreed. I 0% were not sure. This imp\ ies that 90% of the respondents were in agreement with the statement that the health centre has adequate stock of drugs and medicines which ease service delivery. 
Table 4.3 shows that 62% of the respondents strongly agreed that the health centre has all the basic equipment and facilities in place to ensure better service delivery, 20% agreed and 18% were not sure. This implies that 82% of the respondents were in agreement with the statement that the health centre has all the basic equipment and facilities in place to ensure better 
service delivery. 
24 

Table 4.3 shows that 30% of the respondents strongly agreed that the health equipments are well maintained to use provision of services, 20% agreed, 10% were not sure and 40% disagreed. This means that respondents 50% were in agreement that the health equipments 
are well maintained to use provision of services. 
Table 4.3 shows that 60% of the respondents strongly agree, 40% agreed that the health centre has a budget for maintenance to ensure that service delivery is to the desired standards. This means that majority of the respondents 100% were in agreement with the statement that the health centre has a budget for maintenance to ensure that service delivery is to the desired 
standards. 
4.4 Influence of human resource management on health service delivery at Rwamahwa health center IV, Rukungiri Municipality 
The researcher considered the respondents views on the influence of human resource 
management on health service delivery at Rwamahwa health center IV, Rukungiri 
Municipality and the results presented below in Table 4.4.0 
Table 4.4.0 Respondents views on the influence of human resource management on health service delivery at Rwamahwa health center IV, Rukungiri Municipality 
Influence of human resource 	Strongly 	Agree 		Not sure 	Disagree 	Strongly 	
management on health service 	agree 								disagree 	
delivery at Rwamahwa health 													
		% 		% 		% 			% 			% 	
center IV, Rukungiri Municipality 	>-. 		, 		> 			> 			>-. 		
	0 		0 		0 			0 			0 		
	C: 							C: 			C 		
	(t) 		<l) 		<l) 			(t) 			(t) 		
	::l 		::l 		::l 			::l 			::l 		
	r 		cr- 		cr- 			cr- 			o 		
	(t) 		(t) 		(t) 			(t) 			(t) 		
	.... 		.... 		.... 			.... 		t 		
	L. 		µ.. 		L. 		• 				
The Health Centre has all staffing 	19 	30 	29 	44 	17 	26 	- 		- 	- 		- 	
gaps filled which helps to ensure 													
better service delivery 													
											- 		
The Health Centre has a medical 	32 	50 	14 	22 	7 	10 	12 	18 	- 		- 	
doctor in place who delivers services 													
promptly 													
Health staff are facilitated to 	39 	60 	18 	28 	8 	12 	- 		- 	- 		- 	
perform their tasks hence better 													
service delivery in the organization 													
25 

Recruitment of health staff is on 	34 	52 	31 	48 	- 	- 	- 	- 	- 	- 	
merit which leads to better provision 											
of services 											
Deployment of health staff is on 	8 	12 	33 	50 	5 	18 	13 	20 	- 	- 	
merit which leads to better delivery 											
of services 											
Source: Field data, 2022 
Table 4.4.0 shows that 30% of participants strongly agreed that the Health Centre has all staffing gaps filled which helps to ensure better service delivery, 44% agreed, 26% were not sure, this implies that 74% of the respondents were in agreement with the statement that the Health Centre has all staffing gaps filled which helps to ensure better service delivery. 
Table 4.4.0 shows that, the study results revealed that 50% of the respondents strongly agreed that the Health Centre has a medical doctor in place who delivers services promptly, 22% agreed and 10% were not sure and 18% disagree. This implies that 72% of the respondents were in agreement with the statement that the Health Centre has a medical doctor in place 
who delivers services promptly. 
Table 4.4.0 shows that 60% of the respondents strongly agreed that the health staff are facilitated to perform their tasks hence better service delivery in the organization, 28% agreed, 4% were not sure. This means that majority of the respondents 88% were in agreement that the health staff are facilitated to perform their tasks hence better service 
delivery in the organization. 
Table 4.4.0 shows that 52% of the respondents strongly agreed that recruitment of health staff is on merit which leads to better provision of services, 48% agreed. This means that majority of the respondents 100% were in agreement that recruitment of health staff is on merit which 
leads to better provision of services. 
Table 4.4.0 shows that 12% of the respondents strongly agreed that deployment of health staff is on merit which leads to better delivery of services, 50% agreed and 18% were not sure and 20% disagree. This implies that 68% of the respondents were in agreement with the statement that deployment of health staff is on merit which leads to better delivery of 
services. 
26 

4.5 Relationship between financial resources management and health service delivery at 
Rwamahwa health center IV, Rukungiri Municipality 
The researcher considered the respondent's opinions on relationship between financial resources management and health service delivery and results were presented in table below. 
Table 4.5: Relationship between financial resources management and health service 
delivery at Rwamahwa health center IV, Rukungiri Municipality 

Relationship between financial 	Strongly 	Agree 	Not sure 	Disagree 	Strongly 	
resources management and 	agree 										disagree 	
health service delivery 														
		% 	>--. 	% 			% 			% 			% 	
	>--. 		o 		>--. 			>--. 			, 		
	o 		C: 		o 			o 			o 		
	C: 		(I.) 			C: 			C: 			C 		
	(I.) 		::l 		(I.) 			<l) 			<l) 		
	::l 		CT 			5 			5 			::; 		
	o 		(I.) 		o 			o 			CT 		
			,_ 										
	(I.) 	J:.1-; 		(I.) 			(I.) 			(I.) 		
	h 			a 			a 			.... 		
	L. 				1. 		I. 		u.... 		
The Health Centre has a budget 	29 	44% 	30 	46% 	6 		10% 	- 		- 	- 		- 	
in place which helps to procure 														
the required products foe 														
effective service delivery 														
											-· 		
The budget is drawn based on 	40 	62% 	14 	22% 	11 	16% 	- 		- 	- 		- 	
stakeholders' priorities which 														
helps all patients to have equal 														
access to health services 														
The health Centre carries out 	20 	30% 	22 	34% 	13 	20% 	10 	16% 	- 		- 	
monthly cash reconciliations to 														
ensure timely service delivery 														
Political leaders can easily 	39 	60% 	26 	40% 	- 		- 	- 		- 	- 		- 	
access information from 														
departments which helps to 														
identify lope holes to service 														
delivery 														
Financial resources management 	40 	62% 	14 	22% 	11 	16% 	- 		- 	- 		- 	
helps to cater for infant which 														
leads to their low rate of 														
mortality 														
Source: Field data, 2022 
27 

Table 4.5 indicated that 44% of participants strongly agreed that the Health Centre has a budget in place which helps to procure the required products foe effective service delivery, 46% agreed, 10% were not sure. This implies that 90% of the respondents were in agreement with the statement that the Health Centre has a budget in place which helps to procure the 
required products foe effective service delivery. 
Table 4.5 indicated that the study results revealed that 62% of the respondents strongly agreed that the budget is drawn based on stakeholders' priorities which helps all patients to have equal access to health services, 22% agreed and 16% were not sure. This implies that 84% of the respondents were in agreement with the statement that the budget is drawn based on stakeholders' priorities which helps all patients to have equal access to health services. 
Table 4.5 indicated that 30% of the respondents strongly agreed that the health Centre carries out monthly cash reconciliations to ensure timely service delivery, 34% agreed. This means that majority of the respondents 50% were in agreement with the statement that the health Centre carries out monthly cash reconciliations to ensure timely service delivery. 
Table 4.5 indicated that 60% of the respondents strongly agree, 40% agreed that political leaders can easily access information from departments which helps to identify lope holes to service delivery. This means that majority of the respondents 100% were in agreement that political leaders can easily access information from departments which helps to identify lope 
holes to service delivery. 
Table 4.5 indicated that the study results revealed that 62% of the respondents strongly agreed that financial resources management helps to cater for infant which leads to their low rate of mortality, 22% agreed and 16% were not sure. This implies that 84% of the respondents were in agreement with the statement that financial resources management helps to cater for infant which leads to their low rate of mortality. 
28 

CHAPTER FIVE 
12.	
DISCUSSION, CONCLUSION AND RECOMMENDATIONS 
5.0 Introduction 
This chapter contains summary, conclusions and recommendations based on analysis of the 
results and on the order according to the objectives of the study. 
5.1 Summary of findings 
The study considered a total number of 65 respondents from the study area, considering the 
age of respondents, the highest numbers of the respondents had 41-50 years of age with 34% while the least numbers of respondents had 51 < years and above of age with 12%. In relation to the sex of respondents, the study results indicated that the highest numbers of respondents were males with 54% whereas the least number of respondents were females with 46%. With regard to the marital status of the respondents the highest numbers of the respondents were married with 43% while the least number of respondents were widowed with 15%. The highest number of the respondents had good levels of education for they were educated and can formally read and write. 

5.1.1 Influence of material resource management on health service delivery at Rwamahwa health center IV Rukungiri Municipality. 

The study findings indicate that 40% of participants strongly agreed that the health centre has adequate stock of drugs and medicines which ease service delivery, 50% agreed as WHO (2014) recommends that drugs should be stocked and stored in dry, well ventilated premises that offer protection from direct sunlight and dust. Temperatures should normally be maintained between 15 and 250C, 10% were not sure. This implies that 90% of the respondents were in agreement with the statement that the health centre has adequate stock of drugs and medicines which ease service delivery. 

Table 4.3 shows that 62% of the respondents strongly agreed that the health centre has al I the basic equipment and facilities in place to ensure better service delivery, 20% agreed as Kachieng'a (2017) suggested that training of equipment users and operators reduces equipment down time although, the challenge in Rwamahwa health center IV, Eastern Division, Rukungiri Municipality was mobilization of resources for training and personnel to 
29 

carry out continuous or periodic training on equipment and 18% were not sure. This implies that 82% of the respondents were in agreement with the statement that the health centre has all the basic equipment and facilities in place to ensure better service delivery. 
Table 4.3 shows that 30% of the respondents strongly agreed that the health equipments are well maintained to use provision of services, 20% agreed as Yip et al. (2019) argued that human resource management as the science of allocating human resources among various projects or business units, maximizing the utilization of available personnel resources to achieve health service delivery goals, and performing activities that are necessary in the maintenance of the workforce through identification of staffing requirements, planning and oversight of payroll and benefits, education and professional development, and administering their work life needs., 10% were not sure and 40% disagreed. This means that respondents 50% were in agreement that the health equipments are well maintained to use provision of 
services. 
Table 4.3 shows that 60% of the respondents strongly agree, 40% agreed that the health centre has a budget for maintenance to ensure that service delivery is to the desired standards as Kachieng'a etal (2014) observes that inadequate maintenance budget is frequently mentioned by experts in South Africa as a major problem in providing effective equipment maintenance in the public sector. He notes that most health facilities have equipment maintenance budgets of below 5% instead of the internationally recorded 10%. This means that majority of the respondents 100% were in agreement with the statement that the health centre has a budget for maintenance to ensure that service delivery is to the desired standards. 
5.1.2 Influence of human resource management on health service delivery at Rwamahwa health center IV, Rukungiri Municipality. 
Table 4.4.0 shows that 30% of participants strongly agreed that the Health Centre has all staffing gaps filled which helps to ensure better service delivery, 44% agreed as WHO (2014) pointed out that the Health Centre has all staffing gaps filled which helps to ensure better service delivery and also the health facility staff play an essential role in routine care and maintenance of instruments and equipment especially cleaning, checking for damage and reporting defects and they recommended that putting written instructions near the equipment was a way of ensuring care and maintenance, 26% were not sure, this implies that 74% of the 
30 

respondents were in agreement with the statement that the Health Centre has al I staffing gaps filled which helps to ensure better service delivery. 
Table 4.4.0 shows that, the study results revealed that 50% of the respondents strongly agreed that the Health Centre has a medical doctor in place who delivers services promptly, 22% agreed as Mahapatra (2022) notes that the Health Centre has a medical doctor in place who delivers services promptly, countries and health organizations are adapting innovative ways of deploying and using the existing health human resources partly in response to the current and projected shortages of physicians and registered nurses and partly to meet the changing health and population needs and 10% were not sure and 18% disagree. This implies that 72% of the respondents were in agreement with the statement that the Health Centre has a medical 
doctor in place who delivers services promptly. 
Table 4.4.0 shows that 60% of the respondents strongly agreed that the health staff are facilitated to perform their tasks hence better service delivery in the organization, 28% agreed as Burke (2011) observes that the health staff are facilitated to perform their tasks hence better service delivery in the organization and flexibility can only be possible where there is a certain minimum number of the required health workers, 4% were not sure. This means that majority of the respondents 88% were in agreement that the health staff are facilitated to perform their tasks hence better service delivery in the organization. 
Table 4.4.0 shows that 52% of the respondents strongly agreed that recruitment of health staff is on merit which leads to better provision of services, 48% agreed as Ayliff et al (2017) observed that recruitment of health staff is on merit which leads to better provision of services which is a risk factor for spread of health facility acquired infections are staff shortages, patient overcrowding, inadequately trained and supervised staff, and frequent transfers of patients and staffs between wards and health facilities. This means that majority of the respondents 100% were in agreement that recruitment of health staff is on merit which 
leads to better provision of services. 
Table 4.4.0 shows that 12% of the respondents strongly agreed that deployment of health staff is on merit which leads to better delivery of services, 50% agreed as Aranda et al. (2022)suggests that the deployment of health staff is on merit which leads to better delivery of services and one way to deal with hour crisis in health is reassignment of clinical roles by shifting tasks to different cadres of health workers: nurses may become involved in 
31 

prescribing drugs, lay counselors involved in testing, new cadres may be introduced to perform specific tasks, and patients may be engaged to take over some elements of their own care and 18% were not sure and 20% disagree. This implies that 68% of the respondents were in agreement with the statement that deployment of health staff is on merit which leads to 
better delivery of services. 
5.1.3 Relationship between financial resources management and health service delivery. Table 4.5 indicated that 44% of participants strongly agreed that the Health Centre has a budget in place which helps to procure the required products foe effective service delivery, 46% agreed as Rawashdeh, (2018) stated that Health Centre has a budget in place which helps to procure the required products foe effective service delivery and the investigation of the relationship between quality human resource management and health service delivery is considered important because the knowledge and competency to manage people are not necessary to hold a management position in most health service professions in Rukungiri Municipality, 10% were not sure. This implies that 90% of the respondents were in agreement with the statement that the Health Centre has a budget in place which helps to procure the required products foe effective service delivery. 
Table 4.5 indicated that the study results revealed that 62% of the respondents strongly agreed that the budget is drawn based on stakeholders' priorities which helps all patients to have equal access to health services, 22% agreed as Kabeneet al (2016) stated that that the budget is drawn based on stakeholders' priorities which helps all patients to have equal access to health services and both the number and cost of health service consumables (drugs, prostheses and disposable equipment) are raising astronomically, which in turn can drastically increase the costs of health service delivery and 16% were not sure. Th is implies that 84% of the respondents were in agreement with the statement that the budget is drawn based on stakeholders' priorities which helps all patients to have equal access to health 
serves. 
Table 4.5 indicated that 30% of the respondents strongly agreed that the health Centre carries out monthly cash reconciliations to ensure timely service delivery, 34% agreed as Bourgeault et al (2020) asserts that the health Centre carries out monthly cash reconciliations to ensure timely service delivery and workforce training is another important issue health service delivery. It is essential that human resources personnel consider the composition of the health 
32 

workforce in terms of both skill categories and training levels. New options for the education and in-service training of health care workers are required to ensure that the workforce is aware of and prepared to meet the health centre's present and future needs. This means that majority of the respondents 50% were in agreement with the statement that the health Centre carries out monthly cash reconciliations to ensure timely service delivery. 
Table 4.5 indicated that 60% of the respondents strongly agree, 40% agreed that political leaders can easily access information from departments which helps to identify lope holes to service delivery as Chowdhury, Sunna and Ahmed (2021) stated that political leaders can easily access information from departments which helps to identify lope holes to service delivery and human resource professionals face many obstacles in their attempt to deliver high-quality health care to citizens. Some of these constraints include budgets, lack of congruence between different stakeholders' values, absenteeism rates, high rates of turnover and low morale of health personnel. This means that majority of the respondents 100% were in agreement that political leaders can easily access information from departments which 
helps to identify lope holes to service delivery. 
Table 4.5 indicated that the study results revealed that 62% of the respondents strongly agreed that financial resources management helps to cater for infant which leads to their low rate of mortality, 22% agreed as Adhikari et al. (2022)observed that that financial resources management helps to cater for infant which leads to their low rate of mortality and funding shortages severely affected implementation of basic health services, the Australian Development Gateway noted that part of the problem limiting scaling up of health services was lack of managerial capacity at all levels of the health system especially in the area of financial management and 16% were not sure. This implies that 84% of the respondents were in agreement with the statement that financial resources management helps to cater for infant 
which leads to their low rate of mortality. 

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5.2 Conclusion 
The study findings on the influence of material resource management on health service 
delivery at Rwamahwa health center IV Rukungiri Municipality were; the health centre has adequate stock of drugs and medicines which ease service delivery, the health centre has all the basic equipment and facilities in place to ensure better service delivery, the health equipments are well maintained to use provision of services and the health centre has a budget for maintenance to ensure that service delivery is to the desired standards. 
The study findings on the influence of human resource management on health service delivery at Rwamahwa health center IV, Rukungiri Municipality were; the health centre has all staffing gaps filled which helps to ensure better service delivery, the health centre has a medical doctor in place who delivers services promptly, health staff are facilitated to perform their tasks hence better service delivery in the organization, recruitment of health staff is on merit which leads to better provision of services and deployment of health staff is on merit 
which leads to better delivery of services. 
The study findings on the relationship between financial resources management and health service delivery at Rwamahwa health center IV, Rukungiri Municipality were; the health centre has a budget in place which helps to procure the required products foe effective service delivery, the budget is drawn based on stakeholders' priorities which helps all patients to have equal access to health services, the health centre carries out monthly cash reconciliations to ensure timely service delivery, political leaders can easily access information from departments which helps to identify lope holes to service delivery and financial resources management helps to cater for infant which leads to their low rate of mortality. 
5.4 Recommendations 
Basing on study findings, the researcher made the following recommendations; 
The health centers should ensure that they procure the basic equipments and facilities to ensure that they can be able to provide better services to the intended beneficiaries. 
Health centers should always adhere and follow their budgets so that they can be able to achieve their intended goals for better service delivery to their clients. 
There is a need to ensure that the right procedures for recruitment of the employees is followed so that competent staff can be employed which can lead to improved and better 
service delivery. 
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5.5 Suggested areas for further research 
	1. 	Role of human resource management on productivity of the organization. 
	ii. 	Effect of procurement planning and service delivery in health centers 

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REFERENCES 
Abreu, M. H. N. G. de, Amaral, J. H.L. do, Guimaraes Zina, L., Vasconcelos, M., da Silveira Pinto, R., & Werneck, M.A. F. (2022). Role of management and human resource factors on matrix support in secondary oral health care in Brazil. Community Dentistry and Oral 
Epidemiology, 50(1 ), 19-26. 
Adhikari, B., Mishra, S. R.. & Schwarz, R. (2022). Transforming Nepal's primary health care 
delivery system in global health era: addressing historical and current implementation 
challenges. Globalization and Health, 18( 1 ), 1- 12. 
Ahmad, J. (2005). Decentralization and service delivery (Vol. 3603). World Bank 
Publications. 
Aranda, Z., Binde, T., Tashman, K., Tadikonda, A., Mawindo, B., Maweu, D.. Boley, E. J., 
Mphande, I., Dumbuya, I., & Montano, M. (2022). Disruptions in maternal health service use during the COVID-I9 pandemic in 2020: experiences from 37 health facilities in low-income and middle-income countries. BMJ Global Health, 7( I), 
e007247. 
Campbell, S., Greenwood, M., Prior, S., Shearer, T., Walkem, K., Young, S., Bywaters, D.. 
& Walker, K. (2020). Purposive sampling: complex or simple? Research case examples. 
Journal of Research in Nursing, 25(8), 652-661. 
Chrisostom, 0., & Ruth Komunda, T. (2020). Supportive Leadership Style and Staff 
Motivation in Private Universities in Uganda: Case of Kampala International 
University. 
Cohen, L. (2007). Experiments, quasi-experiments, single-case research and meta-anal» 
(Cohen, L., Manion, L., & Morrison, K. in Eds) Research methods in education.(6th 
eds.). London: Routledge Fahner. 
Creswell, J. W ., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and 
mixed methods approaches. Sage publications. 
Deussom, R., Mwarey, D., Bayu, M.. Abdullah, S. S., & Marcus, R. (2022). Systematic 
review of performance-enhancing health worker supervision approaches in low-and middle-income countries. Human Resources for Health, 201) l-12. 
Goryakin, Y., Revill, P., Mirelman, A., Sweeney, R., Ochalek, J. M., & Suhrcke, M. E. (2017). Public financial management and health service delivery: a literature review. 
Griffee, D. T. (2005). Research Tips: Interview Data Collection. Journal of Developmental 
Education, 28(3), 36-37. 
36 

Harrell, M. C., & Bradley, M. A. (2009). Data collection methods. Semi-structured interviews and focus groups. Rand National Defense Research Inst santa monica ca. 

Jawale, K. V. (2012). Methods of sampling design in the legal research: Advantages and disadvantages. Online International Interdisciplinary Research Journal, 2(6), 183-190. 
Kiiza, K. A. (2019). Pull-push factors and international student experiences in Uganda: a case study of two universities. University of Pretoria. 
Korstjens, I., & Moser, A. (2017). Series: Practical guidance to qualitative research. Part 2: 
Context, research questions and designs. European Journal of General Practice, 23( I), 
274-279. 
Koschinsky, J., Marwell, N., & Mansour, R. (2021). Does Health Service Funding Go Where 
the Need Is? A Prototype Spatial Access Analysis for New Urban Contracts Data. 
Kothari, C. R. (2004). Research methodology: Methods and techniques. New Age 
International. 
Luu, K., Brubacher, L. J., Lau, L. L., Liu, J. A., & Dodd, W. (2022). Exploring the role of 
social networks in facilitating health service access among low-income women in the Philippines: a qualitative study. Health Services Insights, 15, 11786329211068916. 
Madura, J. (2020). International financial management. Cengage Learning. 
Mahapatro, B. B. (2022). Human resource management. PG Department of Business 
Management. 
Malela-Majika, J.-C., Shongwe, S. C., Aslam, M., & Abbasi, S. A. (2021 ). Robust 

Distribution-Free Hybrid Exponentially Weighted Moving Average Schemes Based on Simple Random Sampling and Ranked Set Sampling Techniques. Mathematical 
Problems in Engineering, 2021. 
Mukumbang, F. C., Marchal, B., Van Belle, S., & van Wyk, B. (2020). Using the realist 
interview approach to maintain theoretical awareness in realist studies. Qualitative 
Research, 20(4), 485-515. 
Odaga, J., & Lochoro, P. (2006). Budget ceilings and health in Uganda. Caritas, Uganda. 
Oketch, C., & Komunda, T. R. (2021 ). Supportive Leadership Style and Staff Motivation in Private Universities In Uganda: Case of Kampala International University. Global Journal of Management And Business Research. 
Pace, D. S. (2021 ). Probability and Non-Probability Sampling-An Entry Point for Undergraduate Researchers. International Journal of Quantitative and Qualitative 
Research Methods, 9(2), 1-15. 
Paramasivan, C. (2016). Financial management. 37 
13.	
11.	

Riffin, C., Griffin, J.M., Brody, L., Wolff, J. L., Pillemer, K. A., Adelman, R. D., Bangerter, L. R., Starks, S. M., Falzarano, F., & Villanigro-Santiago, M. (2022). Engaging and Supporting Care Partners of Persons With Dementia in Health-Care Delivery: Results From a National Consensus Conference. Public Policy & Aging Report, 322). 58 65. 
Sheiman, I., & Shevsky, V. (2019). Concentration of health care providers: does it contribute to integration of service delivery? Risk Management and Healthcare Policy, 12, 153. 
Sugiura, L., Wiles, R., & Pope, C. (2017). Ethical challenges in online research: 
Public/private perceptions. Research Ethics, 13(3-4), 184-199. 
Yip, W., Fu, H., Chen, A. T., Zhai, T., Jian, W., Xu, R., Pan, J., Hu, M., Zhou, Z.. & Chen, Q. (2019). 10 years of health-care reform in China: progress and gaps in universal health 
coverage. The Lancet, 394(10204), 1192-1204. 

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Appendices 
Appendix I: Survey Questionnaire 
Dear, Respondents 
I am Ndyamuhaki Faith, an Under-Graduate student of Kabale University. I am undertaking Research as part of the requirements for the Award of a Bachelor's Degree of Business Administration of Kabale University. The questions presented to you in this questionnaire are only intended to help me undertake my research and will be used for any other purpose. Your answers given will be treated with utmost confidentiality. 
Yours sincerely, 
···································· 
SECTION A: BIO-DATA. (Tick the right option or fill the right answer in the spaces provided). 
SECTION A: BIO DATA OF RESPONDENTS 
	l. 	Age 
202s b) 26-30 
	2. 	Sex 
Female 
3. Marital Status 
a)	Single 
b)	Married 

c)31-40 d)41-50 
b) Male 
c)	Separated 
d)	Widow 
e)51> 

e) Divorced 
4. 	Highest level of Education attained 	
b) 	Non formal Education 		
c) 	Primary 		
d) 	Secondary 		
e) 	University 		
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SECTION: B 

5. Influence of material resource management on health service delivery at Rwamahwa health center IV Rukungiri Municipality 
Please respond to the following statements on the scale provided Tick appropriately using 
SA- Strongly agree, A- Agree, N- Not sure, D- Disagree and SD- Strongly disagree the boxes 
that most closely fit your opinion 
Influence of material resource management on health service delivery at 	SA 	A 	N 	D 	SD 	
Rwamahwa health center IV Rukungiri Municipality 						
The health centre has adequate stock of drugs and medicines which ease service 						
delivery 						
The health centre has all the basic equipment and facilities in place to ensure 						
better service delivery 						
The health equipments are well maintained to use provision of services 						
	-- 	--~- 			
The health centre has a budget for maintenance to ensure that service delivery is 						
to the desired standards 						

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SECTION: C 
6. Influence of human resource management on health service delivery at Rwamahwa health center IV, Rukungiri Municipality 
Please respond to the following statements on the scale provided Tick appropriately using 
SA- Strongly agree, A- Agree, N- Not sure, D- Disagree and SD- Strongly disagree the boxes 
that most closely fit your opinion 
Influence of human 	resource management on 	health 	SA 	A 	N 	D 	SD 	
service 	delivery 	at 	Rwamahwa 	health 	center 	IV, 						
Rukungiri Municipality 										
The Health Centre has all staffing gaps filled which helps to 						
ensure better service delivery 										
The Health Centre has a medical doctor in place who 								
delivers services promptly 										
Health staff are facilitated to perform their tasks hence better 						
service delivery in the organization 										
Recruitment of health staff is on merit which leads to better 						
provision of services 											
Deployment of health staff is on merit which leads to better 						
delivery of services 												
14.	
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SECTION: D 
7. Relationship between financial resources management and health service delivery at Rwamahwa health center IV, Rukungiri Municipality 
Please respond to the following statements on the scale provided Tick appropriately using SA- Strongly agree, A- Agree, N- Not sure, D- Disagree and SD- Strongly disagree the boxes 
that most closely fit your opinion 

Relationship 	between 	financial 	resources 	management 	SA 	A 	N 	D 	SD 	
and health service delivery at Rwamahwa health center 						
IV, Rukungiri Municipality 								
The Health Centre has a budget in place which helps to 						
procure the required products foe effective service delivery 						
The budget is drawn based on stakeholders' priorities which 						
helps all patients to have equal access to health services 						
The health Centre carries out monthly cash reconciliations to 						
ensure timely service delivery 								
Political leaders can easily access information from 						
departments which helps to identify lope holes to service 						
delivery 										
Financial resources management helps to cater for infant 						
which leads to their low rate of mortality. 							
THANKS FOR YOUR COOPERATION 

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Appendix II Interview Guide for Key Informants 
a) How have the contribution of lower local governments to resource management and health service delivery in Eastern Division Rukungiri Municipality, Rwamahwa health center IV? 
•	Human resources for health 
•	Health infrastructure 
•	Healthcare consumables 
b)	What could be the other factors that are not mentioned above but affect health service delivery in lower local governments in Rwamahwa health center lV, Rukungiri Municipality? 
c)How are drugs and equipment procured in the Health Centre? 
d) What is the influence of materials resource management on health service delivery at Rwamahwa health center IV, Eastern Division Rukungiri Municipality. 
e) What is the influence of human resource management on health service delivery al Rwamahwa health center 1V, Eastern Division Rukungiri Municipality. 
f) What is the relationship between financial resources management and health service delivery at Rwamahwa health center IV, Eastern Division Rukungiri Municipality. 
g)	Are procurement procedures followed in acquisition of equipment and supplies? 
h)	Does the health facility possess a store for its supplies and equipment? 
i)	Do you think patients receive health services in time? 
j)	Are you satisfied with the behavior of health staff when attending to patients? k) Are members given breakdown of expenditure on quarterly basis? 

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