es ▁at ▁public ▁health ▁facilities , ▁which ▁triggered ▁a ▁sur ge ▁in ▁out pat ient ▁attend ances ▁across ▁the ▁country . ▁ ▁Dec ent ral ization ▁of ▁health ▁services ▁began ▁in ▁the ▁mid - 1 9 9 0 s ▁alongside ▁wider ▁de volution ▁of ▁all ▁public ▁administration , ▁and ▁was ▁se aled ▁in ▁ 1 9 9 8 ▁with ▁the ▁definition ▁of ▁the ▁health ▁sub - d istrict . ▁Im plementation ▁of ▁the ▁health ▁sub ▁district ▁concept ▁extended ▁into ▁the ▁early ▁ 2 0 0 0 s . ▁ ▁To ▁improve ▁medic ines ▁management ▁and ▁avail ability , ▁the ▁government ▁of ▁U g anda ▁made ▁medic ines ▁available ▁to ▁private - not - for - pro fit ▁( PN FP ) ▁prov iders . ▁With ▁decent ral ization ▁of ▁health ▁services , ▁a ▁" pull " ▁system ▁was ▁instit uted ▁in ▁which ▁district ▁and ▁health ▁facility ▁man agers ▁were ▁granted ▁aut onomy ▁to ▁proc ure ▁medic ines ▁they ▁needed ▁in ▁the ▁required ▁quantities ▁from ▁the ▁national ▁medical ▁stores , ▁within ▁pre - set ▁financial ▁ear marks . ▁The ▁result ▁was ▁better ▁avail ability ▁of ▁medic ines . ▁ ▁Health ▁system ▁performance ▁ ▁A ▁compreh ensive ▁review ▁of ▁U g anda ' s ▁Health ▁System ▁conducted ▁in ▁ 2 0 1 1 ▁by ▁USA ID ▁un cover ed ▁strength s ▁and ▁weak ness es ▁of ▁the ▁health ▁system , ▁organized ▁around ▁the ▁six ▁technical ▁building ▁blocks ▁of ▁health ▁system ▁that ▁were ▁defined ▁by ▁the ▁W HO . ▁In ▁summary , ▁the ▁assess ment ▁found