Decentralization and Socio-Economic Development: Assessing Primary Health Care Service Delivery in Bo District

Abstract

This study examines the impact of decentralization on socio-economic developmentin the chiefdoms of Bo District, Sierra Leone, with particular attention to primary health careservices. Following the reintroduction of decentralization in 2004 after the civil war, localcouncils and chiefdom administrations were expected to improve service delivery and strengthencommunity participation in governance.A mixed-method approach was adopted, combining quantitative survey data and structuredinterviews. A total of 414 respondents were selected across sixteen chiefdoms using stratifiedsampling techniques. Data were analyzed using SPSS, employing descriptive statistics andPearson’s chi-square tests to assess associations between decentralization and selected healthindicators, including malaria, enteric fever, labour pain-related deaths, HIV/AIDS, and anaemia.The findings reveal mixed outcomes regarding the impact of decentralization on health servicedelivery and socio-economic development. While decentralization has improved localparticipation and awareness of health-related issues, significant challenges persist in theprovision, accessibility, and effectiveness of primary health care services. Inferential statisticalresults indicate varying degrees of association between decentralized governance structures andhealth outcomes within the district. The study concludes that although decentralization hascreated opportunities for local involvement in governance and development, institutional,financial, and administrative constraints continue to limit its full potential in enhancing socioeconomic development in the chiefdoms of Bo District.