'Four' types of decentralization are distinguished in health care: deconcentration when the shift in authority is to regional or district offices; devolution when the shift is to state, provincial or municipal governments; delegation when semi-autonomous agencies are granted new powers; and privatization when ownership is granted to private entities. This article systematically reviews the experiences of local governments of Sub-Saharan African countries with the provision of health services during and after decentralization reforms. The article highlights the achievements, challenges and issues associated with decentralization. The review shows that most countries have mainly focused on the process by enacting numerous policies, regulations and standards with mixed outcomes for health services delivery. Decentralization in general, and resource transfer from the central to local governments in particular, are a highly political issue that influences the health reform strategy on decentralization. The literature shows the complexity of implementing decentralization schemes which strongly impact the health service organization and delivery. The theory of decision space applied in a comparative analysis found that some functions, particularly financing, remain under the control of the central state. Despite the numerous challenges, this review identifies some good practices in resources transfer, key determinants being the type of decentralization and the government's will to make legislative and administrative changes required for the effectiveness of decentralization. The literature search, even though systematic, resulted in a limited number of relevant publications with evidence on the link between decentralization and health services delivery. This is a largely unexplored research area, especially the use of financial resources by local governments, the factors that drive local decision-making processes and the effects of decentralization on health care sector performance.
Background Burkina Faso has undertaken major reforms, the cornerstone of which has been the decentralization of the health system to increase access to primary healthcare and to increase the effectiveness, efficiency, financial viability and equity of health services. This study aims to analyze the socio-demographic determinants of households’ access to healthcare in Burkina Faso. Methods We used data from a national household survey conducted in 2014 in Burkina Faso. We carried out binary logistic and linear regression analysis using data from a national household survey. The statistical analysis explored the associations between socio-demographic characteristics on the one side, and the use of health services, satisfaction with health services and expenditures on health services, on the other side. Results The findings indicate an association between age, education, income and use of services (p < 0.0005). The results show that healthcare users’ satisfaction is influenced by age, the association is stronger with the age group under 24 (p < 0.0005) than the age group of 25–39 (p < 0.005). An association was found between the age group under 15 (p < 0.005), the type of health facility used (p < 0.0005), the distance traveled to health facilities (p < 0.005) and households’ individuals’ health expenditure. Conclusion Specific policies are needed to enhance geographical access to healthcare, financial access to and satisfaction with healthcare in moving towards universal health coverage (UHC).
Summary Background Burkina Faso has undertaken decentralization reforms in the health care sector to improve the performance of the health system. This study aimed to analyze the differences in health outcomes by health district's demographic and economic status, and the distribution of health resources during the period of health care decentralization. Methods A bivariate correlation analysis was conducted using data at the health districts and regions level. Data from the health management information system (HMIS) and national households' surveys were used. Results The results indicate a strong correlation between district's population size and the availability of health resources ( P ≤ .05). The health visits per capita and skilled birth attendance are correlated with the economic status of the health district ( P ≤ .05). Malnutrition among under‐five and maternal mortality was associated with the availability of health personnel and health infrastructures ( P ≤ .05). No correlation was found between financial resources and health outcomes. Conclusion The results indicated disparities in health among the health districts in Burkina Faso. The ways to address this inequality include more transparent resource allocation, as well as policies to address the socio‐economic disparities and financial barriers to health services. Further research is needed to collect relevant data and investigate the effects of decentralization, which was not possible in our study.
Background and Aims In line with the decentralization policy, in 2009, the central government of Burkina Faso issued a decree to transfer health resources to local governments for fulfilling their new responsibilities in health care provision. The first stage of this health care decentralization process involved the basic health care facilities, composed of primary health care facilities, maternities, dispensaries, maternal and child health centers, and essential drugs depots. This study seeks to explore the strengths, weaknesses, opportunities, and threats (SWOT) associated with the health resources transfer in Burkina Faso, from the perspective of decision makers. Methods We used a qualitative research approach. We conducted 17 semistructured interviews with 17 representatives of key decision‐making groups, in August to December 2017 in Burkina Faso. The participants included mayors of municipalities, health district managers, policy decision makers, and donors/partners. The data collected were subjected to a directed qualitative content analysis, and the SWOT framework was used to select themes and codes for the analysis. Results The most cited strength was the improvement of local governance, which also creates the opportunity for an enhanced partnership and decentralized cooperation. As expected, however, the limited financial capacity of local governments is an important weakness. Furthermore, misuse of financial resources threatens the resources transfer. Recommendations to improve decentralization and health resources transfer included effective enforcement of decentralization's laws and policies, strengthening local governments' capacities, adequate funding, and evaluation of the resources transfer process. Conclusions An analysis of the preconditions for a successful resources transfer is needed to provide guidance to policy.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.