Decentralization

Decentralization of family planning is a critical concern for policymakers as international family planning commitments and the expansion of decentralization reforms become more common. Building on the latest research, this paper presents a family planning and decentralization analytical framework that was developed by the USAID-funded Health Policy Project to help key stakeholders better understand family planning decentralization processes, identify potential challenges and opportunities, and guide decentralization reforms. [from abstract]

Indonesia is one of the countries in the world which has a decentralized model of government. The decentralization in the form of regional autonomy aims to improve the public welfare through public services. The services, especially the health service depends much on the wide area and also the geographical condition of the regional. Thus, it is necessary to do an analysis of systems towards the health service from the catchment area perspectives to solve the present and future problems. [adapted from abstract]

This paper presents the results of two field experiments on local accountability in primary health care in Uganda. Efforts to stimulate beneficiary control, coupled with the provision of report cards on staff performance, resulted in significant improvements in health care delivery and health outcomes in both the short and the longer run. Efforts to stimulate beneficiary control without providing information on performance had no impact on quality of care or health outcomes.

This paper explores the key issues associated with regulation of health markets in LMICs, and the different goals of regulation, namely quality and safety of care, value for money, social agreement over fair access and financing, and accountability. Licensing, price controls, and other traditional approaches to the regulation of markets for health products and services have played an important role, but they have been of questionable effectiveness in ensuring safety and efficacy at the point of the user in LMICs. [from abstract]

This technical highlight provides a brief overview of Pathfinder’s experience implementing the Kenyan Community Strategy through the USAID-funded APHIAplus (AIDS, Population, and Health Integrated Assistance Plus) Nairobi-Coast project (2011-2014). [from abstract]

Reflecting on service delivery in northern, rural or remote Canada, Dr. Roger Strasser (Dean of the Northern Ontario School of Medicine) and Erin Leith (Director, Collaboration for Innovation and Improvement, Canadian Foundation of Healthcare Improvement) discuss the significant momentum generated by the Canadian Recruit and Retain Conference and the influence and impact this will have on healthcare in these often under-served regions. [from introduction]

This study helps government and donors to understand how local government and service delivery work and to assess whether the return of local councils is likely to improve their functioning. [from introduction]

This paper examines three groups of innovative ideas have been institutionalized in African countries to improve maternal health: policy, institutional and experimental innovations. [adapted from abstract]

External challenges to health systems have received little attention in recent years, including the increase of prices for petroleum-based products. Health systems are significant consumers of fossil fuels in the form of petroleum-based medical supplies; transportation of goods, personnel and patients; and fuel for lighting, heating, cooling and medical equipment. Long-term increases in petroleum prices in the global market will have potentially devastating effects on health sectors who already struggle to deliver services to remote parts of their catchment areas. [adapted from abstract]

This article examines and documents the experiences facing the implementation of decentralization of health services from the perspective of national and district officials, including inadequate funding, untimely disbursement of funds from the central government, insufficient and unqualified personnel, lack of community participation in planning and political interference. [adapted from author]

The purpose of this study was to investigate the performance of health workers after decentralisation of the health services in Uganda in order to identify and suggest possible areas for improvement. [from abstract]

This presentation was part of the University of New South Wales’ short course on managing human resources for health. The presention outlines the background of decentralization in the health sector including its meaning, forms, drivers, benefits and pitfalls. It also introduces the opportunities and challenges for HRH managment in a decentralized system and the concept of recentralization. [adapted from author]

This paper assesses whether the process of decentralizing human resources for health management and organization to the level of the state and municipal health departments has involved investments in technical, political and financial resources at the national level. [from abstract]

Devolution, as other types of decentralization (e.g. deconcentration, delegation, privatization), profoundly changes governance relations in the health system. This article assesses the key advantages and dilemmas associated with devolution such as responsiveness to local needs, downward accountability and health worker retention. Challenges of politics and capacities are also addressed in relation to human resources for health at the local level. [from abstract]

This study assesses the new decentralized service provision system for people living with HIV/AIDS in rural populations in China. [from abstract]

This paper looks at the potential for decentralization to lead to better health workforce recruitment, performance and retention in rural areas through the creation of additional revenue for the health sector; better use of existing financial resources; and creation of financial incentives for health workers. [from introduction]

This article describes the Public Health Resource Network, an innovative distance-learning course in training, motivating, empowering and building a network of health personnel from government and civil society groups. Its aim is to build human resource capacity for strengthening decentralized health planning, especially at the district level. [from abstract]

This study highlights the experiences and challenges associated with decentralisation and the partial re-centralisation in relation to the recruitment and distribution of health workers. [from abstract]

The objective of this article is to determine the stock of human resources for health in 15 districts, their service status and primary place of work. It also assesses the effect of decentralization on management of human resources and the implications for the future. [from abstract]

In developing countries, postabortion care (PAC) programs are frequently available only in urban or regional health facilities, placing rural women at greater risk for mortality and morbidity from complications because they lack access to services. This technical brief evaluates efforts to decentralize PAC activities in Senegal and Tanzania that show PAC can be safely and successfully decentralized with services capably provided by mid-level personnel in health centers, dispensaries, and some health posts when providers are trained and supervised and equipment and supplies are available.

This paper presents some of the basic governance issues related to decentralization and some examples of how projects and donor policies have contributed to more effective decentralization processes. [from author]

Most Central American hospitals that provide decentralized HIV services struggle with issues such as weak infection prevention practices, poor nutritional care and persistent discriminatory practices. The Capacity Project is helping national HIV programs in Belize, Costa Rica, El Salvador, Guatemala, Nicaragua and Panama to improve performance and supervision systems that will help address these issues. [from author]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It reviews a study of how Rwanda, faced with constrained fiscal conditions, has implemented innovative reforms to create fiscal space for human resources and to make these resources more responsive to needs through an analysis of budget documents and policy and regulation changes and key informant interviews. [adapted from author]

The development of the delivery of reproductive health services is continually confronted by challenges from a changing environment, an important element of which is health sector reform, in particular decentralization, which is being undertaken by most governments in Africa. The general objective of this research is to make health sector decentralisation more effective in the development of appropriate reproductive health services. In Chapter 8 human resource management and development as it has been affected by decentralization is discussed. [adapted from introduction]

As part of the United Republic of Tanzania, Zanzibar maintains its own government and an independent Ministry of Health and Social Welfare. To improve the quality of health care, the Ministry created a Human Resources for Health 5-Year Development Plan. A key strategy is the development of Mnazi Mmoja Hospital (MMH) into a semi-autonomous organization. [author’s description]

This issue of The Manager shows how health managers, though faced with multiple challenges of decentralization, can redefine their roles and responsibilities to better support both the people they serve and the staff at management levels closest to the population. It shows how health managers can adopt leadership practices to carry out their new roles and ultimately make decentralization work. [editor’s description]

This issue of The Manager will help managers at all levels understand the principles of local-level performance assessment and improvement. It also presents the concept of essential public health functions as a useful policy framework for decentalizing service management while maintaining and improving the coverage and quality of services. [editor’s description]

In 1993, Uganda began decentralization of its health care sector to the district and subdistrict levels. Its objectives were to increase local revenue for health service provision, in part through user fees; involve the consumers in the management of their health care services; and integrate all providers, including non-governmental organizations, missions, and non-traditional providers, into the care delivery system. The increased revenues and consumer participation was expected to improve quality and increase utilization of services. With a focus on maternal and child health (MCH) services, this study used statistical data and interviews with local health administrators and physicians to assess how the reform policies have been implemented and how they have impacted MCH service provision and utilization.

Dissatisfied with centralized approaches to delivering local public services, a large number of countries are decentralizing responsibility for these services to lower- level, locally elected governments. The results have been mixed. This chapter provides a framework for evaluating the benefits and costs, in terms of service delivery, of different approaches to decentralization, based on relationships of accountability between different actors in the delivery chain. Moving from a model of central provision to that of decentralization to local governments introduces a new relationship of accountability—between national and local policymakers—while altering existing relationships, such as that between citizens and elected politicians.

The article analyzes the practice of physicians and nurses working on the Family Health Program. A questionnaire was used to assess the evidences of assimilation of the new values and care principles proposed by the programme. The results showed that a great number of professionals seem to have incorporated the practice of home visits, health education actions and planning of the teams’ work agenda to their routine labour activities. [abstract]