Effects of health decentralization, financing and governance in Mexico

Arredondo, Armando; Orozco, Emanuel

doi:10.1590/s0034-89102006000100023

Cited by 19 publications

(10 citation statements)

References 4 publications

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“…The introduction of family physicians charged with continuous and single-source care for most of a family's health needs has been associated with high levels of patient satisfaction in Poland and Estonia (Kalda, Polluste, Maaroos, & Lember, 2004;Polluste, Kalda, & Lember, 2000. The primary care expansions in Latin America have in some cases featured a strong element of community participation, although they are still subject to criticism for inadequate consultation of communities and top-down decision making (Arredondo & Orozco, 2006;Laurell, 2007;Lewis, Eskeland, & Traa-Valerezo, 2004).…”

Section: Responsivenessmentioning

confidence: 99%

The contribution of primary care to health and health systems in low- and middle-income countries: A critical review of major primary care initiatives

Kruk

Porignon

Rockers

et al. 2010

Social Science & Medicine

231

173

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a b s t r a c tIt has been 30 years since the Declaration of Alma Ata. During that time, primary care has been the central strategy for expanding health services in many low-and middle-income countries. The recent global calls to redouble support for primary care highlighted it as a pathway to reaching the health Millennium Development Goals. In this systematic review we described and assessed the contributions of major primary care initiatives implemented in low-and middle-income countries in the past 30 years to a broad range of health system goals. The scope of the programs reviewed was substantial, with several interventions implemented on a national scale. We found that the majority of primary care programs had multiple components from health service delivery to financing reform to building community demand for health care. Although given this integration and the variable quality of the available research it was difficult to attribute effects to the primary care component alone, we found that primary care-focused health initiatives in low-and middle-income countries have improved access to health care, including among the poor, at reasonably low cost. There is also evidence that primary care programs have reduced child mortality and, in some cases, wealth-based disparities in mortality. Lastly, primary care has proven to be an effective platform for health system strengthening in several countries. Future research should focus on understanding how to optimize the delivery of primary care to improve health and achieve other health system objectives (e.g., responsiveness, efficiency) and to what extent models of care can be exported to different settings.

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Section: Responsivenessmentioning

confidence: 99%

The contribution of primary care to health and health systems in low- and middle-income countries: A critical review of major primary care initiatives

Kruk

Porignon

Rockers

et al. 2010

Social Science & Medicine

231

173

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“…The operation of social services was delegated to "decentralized organizations", in fact structured as autonomous entities with their own legal status, governing boards, and funding sources (Mills 1990). Arredondo and Orozco (2006) found that the reform increased diversification of fi nancing sources, including of locally raised funds. This however had some negative eff ects on equity given the increase in user fees.…”

Section: Mexico and Argentinamentioning

confidence: 99%

Decentralization and Governance in the Ghana Health Sector

Couttolenc¹

2012

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Some rights reserved 1 2 3 4 15 14 13 12 World Bank Studies are published to communicate the results of the Bank's work to the development community with the least possible delay. The manuscript of this paper therefore has not been prepared in accordance with the procedures appropriate to formally edited texts. This work is a product of the staff of The World Bank with external contributions. Note that The World Bank does not necessarily own each component of the content included in the work. The World Bank therefore does not warrant that the use of the content contained in the work will not infringe on the rights of third parties. The risk of claims resulting from such infringement rests solely with you. The fi ndings, interpretations, and conclusions expressed in this work do not necessarily refl ect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Nothing herein shall constitute or be considered to be a limitation upon or waiver of the privileges and immunities of The World Bank, all of which are specifi cally reserved.

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“…Latin American countries’ experience shows decentralised governments were successful in mobilising additional household sources,8 44 which we did not see in the case of Pakistan. Decentralisation experiences in Kenya,45 46 Nigeria47 and Mexico48 report weak mechanisms for resource management in subnational governments. There is scant evidence from developing economies on post devolution planning and governance; however, literature from Sweden and UK supports the case of improved regional planning and innovations post decentralisation.…”

Section: Resultsmentioning

confidence: 99%

Health systems changes after decentralisation: progress, challenges and dynamics in Pakistan

et al. 2019

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Decentralisation is widely practised but its scrutiny tends to focus on structural and authority changes or outcomes. Politics and process of devolution implementation needs to be better understood to evaluate how national governments use the enhanced decision space for bringing improvements in the health system and the underlying challenges faced. We use the example of Pakistan’s radical, politically driven provincial devolution to analyse how national structures use decentralisation opportunities for improved health planning, spending and carrying out transformations to the health system. Our narrative draws on secondary data sources from the PRIMASYS study, supplemented with policy roundtable notes from Pakistan.Our analysis shows that in decentralised Pakistan, health became prioritised for increased government resources and achieved good budgetary use, major strides were made contextualised sector-wide health planning and legislations, and a proliferation seen in governance measures to improve and regulate healthcare delivery. Despite a disadvantaged and abrupt start to devolution, high ownership by politicians and bureaucracy in provincial governments led to resourcing, planning and innovations. However, effective translation remained impeded by weak institutional capacity, feeble federal–provincial coordination and vulnerability to interference by local elites.Building on this illustrative example, we propose (1) political management of decentralisation for effective national coordination, sustaining stable leadership and protecting from political interfere by local elites; (2) investment in stewardship capacity in the devolved structures as well as the central ministry to deliver on new roles.

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Effects of health decentralization, financing and governance in Mexico

Cited by 19 publications

References 4 publications

The contribution of primary care to health and health systems in low- and middle-income countries: A critical review of major primary care initiatives

The contribution of primary care to health and health systems in low- and middle-income countries: A critical review of major primary care initiatives

Decentralization and Governance in the Ghana Health Sector

Health systems changes after decentralisation: progress, challenges and dynamics in Pakistan

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