Decentralization Without Capacity: The Human Cost of Rapid District Creation in Uganda

For nearly three decades, Uganda has pursued an ambitious decentralization agenda,devolving public service delivery to local district governments while simultaneously creatingnew districts at a rapid pace. Utilizing a difference-in-differences design, this paper examineshow Uganda’s 2009–10 wave of district creation, which expanded the number of districts by 42percent, affected individual-level health outcomes and, more tentatively, education outcomes.Health Survey data from 2000-2016 shows that in newly created districts, women were 5.8percentage points less likely to receive skilled birth attendance after the splits relative todistricts that experienced no administrative boundary changes. Children in new districtswere 2.5 percentage points less likely to attend school, though this estimate is sensitiveto control group composition and should be interpreted with caution. Both effects areabsent in 2011 but grow substantially by 2016, consistent with worsening capacity constraintsover time. These findings build on Cohen (2024), which reported decreased administrativecapacity and service quality in new districts after the 2009–10 wave, and support conditioningfuture district creation on demonstrated capacity.