Health Citizenship in the "Forgotten District": Non-Profit Governance in the Ugandan Welfare State

The increasing presence of non-profit and non-governmental organizations as healthcare providers in Uganda has altered the role of the nation state in providing health services. This alteration is especially salient in Bududa district, located in a region of Uganda that has been labeled as “the forgotten district,” where traditional modes of the government oftentimes do not reach. Through three months of ethnographic fieldwork conducted in Bududa, this thesis attempts to address the ways in which individuals understand their relationship to the government vis à vis the health welfare system, and the ways in which the presence of the non-profit alters this understanding. I argue that the non-profit clinic changes the citizen-state relationship through its ability to provide the health services that the state cannot. Within this argument, I first establish that political forms of the state do not directly reach the rural district of Bududa. Rather, healthcare becomes the primary way through which individuals interact with the Ugandan government. I then argue that individuals measure the efficacy of this government service through the pharmaceuticals that they do or do not receive, as well as through their characterization of healthcare workers who distribute the pharmaceuticals as corrupt. Lastly, I demonstrate that these logics of pharmaceuticals as a measurement of adequate treatment qualify the non-profit as a more desirable site to receive care. In this process, the non-profit creates a form of governance that functions as an alternative to the state. I end by thinking through the implications of these multiple forms of governance on the current and future role of the Ugandan state in development of the country.