Journal of Poverty, Investment and Development www.iiste.org ISSN 2422-846X An International Peer-reviewed Journal Vol.13, 2015 128 The Status of District level of Government in Amhara State, Ethiopia: From the perspective of primary health care service delivery Alene Agegnehu 1 , Worku Dibu 1 and Ayele Behaylu 2 1, Department of Civic and Ethical studies, Adigrat University- Ethiopia, 2, Department of Geography and Environmental studies, Adigrat University, Ethiopia Abstract The existence of district level government was constitutionally recognized at regional level with legislative, executive and judicial power so as to make law centered on in its particular jurisdiction, enforce and adjudicate local cases with first instance court level respectively. They are also empowered to rendered important social services such as education, health, road and water etc for their electorate. Practically speaking, however, the kind of law they make need strict observance of the law of the upper levels of government and the quality and quantity of services they render are largely determined by the available funds they received from the above. Since they have limited resource availability, they could not provide and meet the intended objectives of decentralization in Ethiopia. Regardless of this fact, district level of government have entrusted health care service delivery related powers and responsibilities for instance, Undertake Building of HCs and health posts, health workers recruitment, provide in-service training and promotion to the health workers, management and Supervision of health institutions, and collect user fee and finance health institutions are given to the district government in Amhara state. Keywords: District Government, Health Center, Health post, Health Care Service Introduction A dejure decentralization process was held since 1991 following the adoption of federal state structure and implementation of first wave of decentralization which is commonly recognized as ‘regional level decentralization’. During this historic event, nine self-administered regional governments were established by taking settlement pattern, consent of the people concerned, language and identity criteria in to consideration (FDRE Constitution, Art. 46 (2)). Accordingly, significant political, fiscal and administrative powers were devolved from the centre to the regions with the objectives to keep the country from disintegration via addressing a long standing nationalities question (Negalegn, 2010; Tegegne, 1998). The 1995 FDRE constitution also grant to each nation, nationalities and people of Ethiopia unconditional rights to self-determination including the right to secession under Art.39. Moreover, each regional government has the power to form their government, make constitution, organize court system and to use their language, preserve their history and develop their culture. Under Art 52 of FDRE constitution, regional governments are entrusted power to formulate and execute economic, social and development policies, strategies and plans of the State; to establish and administer a state police force, and to maintain public order and peace within the State; to administer land and other natural resources. Though social service provision is supposed to be rendered concurrently, but the lion share of such tasks are lay on the shoulder of the regional tiers of government. Financially, regional governments also has power to levy and collect taxes and duties on those revenue sources that are reserved to the States and are empowered to prepare and administer the State budget. After a decade, another decentralization phase “district level decentralization” was practiced since 2000s (Hashim, 2010; Alemu, 2011). Although the existence of district government federal constitutional lack an explicit provision in it, but there is an implied provision that allowed regional government to devolve part of their power and established district and local level of government under Article 54 which read as: The State government shall be established other administrative levels if they find necessary and adequate power shall be granted to them to enable the People to participate directly in the administration of such units‟ (Federal constitution Art.50/4). Based on this constitutional provision, the regional governments have established local governments in a way that fits their specific circumstances. Accordingly, Heterogeneous states have formed Zones or special Districts on ethnic bases whereas relatively homogenous states established District governments (Tesfay, 2007). The powers and functions of Local Governments (includes Zonal, District and kebele) therefore, derive from the states’ functions and powers. Accordingly, the revised constitutions of Amhara regional state has been arranged its administration sphere in to nationality administrations, District and Kebele level. The Awi, Himra, and Oromo people are recognized as nationality Zonal administrations (Amhara proc. No 59/2001, Art. 45 (2)). Hence, there are 11 functional zonal administrations in the region. The purpose of District level decentralization was to improve social service delivery, to have more