Decentralisation, Governance and Health‐System Performance: ‘Where You Stand Depends on Where You Sit’

Abstract

Advocates of local government often argue that when decentralisation is accompanied by adequate mechanisms of accountability, particularly those responsive to local preferences, improved service delivery will result. From the perspective of the health sector, the appropriate degree of decentralisation and the necessary mechanisms of accountability depend upon the achievement of health system goals. Drawing on evidence from six countries (Bolivia, Chile, India, Pakistan, Philippines, Uganda), this article comes to the conclusion that a balance between centralisation of some functions and decentralisation of others, along with improved mechanisms of accountability, is needed to achieve health system objectives.

Decentralization and Governance in Health Care

“…Mitchell and Bossert ( 2010 ) found that both fi scal and nonfi nancial resources, especially skilled and confi dent staff, are a constraint on the exercise of local discretion: '… some health-sector functions…require technical capacities that can far exceed what is possible at the local level, even for health-sector administrators' (p. 681).…”

Enhancing Public Service Quality Trough Building Coordinated Policy: An Analytical Study of Jamkesmas And Jamkesda Implementation

“…In the case of various health financing schemes in Indonesia, both public (Jamkesmas, Jamkesda, Jamsostek, Askes, ASABRI etc) and private insurances, they must be synchronised within good guidelines of comprehensive policy in order to avoid cross-purposes. This is reasonable because health is one of the most complex social-sector goods (Mitchell and Bossert, 2010), since it involves several institutions (health clinics, hospitals, pharmacies) and produces multiple products (outpatient/inpatient consultations and procedures, pharmaceuticals, public health measures).With multiple institutions of health insurance, policy coordination can facilitate different aims of various health insurance providers working together. As Ney points out, the common problem in most middle-income countries is lack of basic regulatory competences with regard to a coherent health insurance scheme.…”

Implementing plant clinics in the maelstrom of policy reform in Uganda

“…This, however, would require a change in NAADS' current focus on a few crops and input supply, as well as clarity about roles and authority at the different governance levels. Drawing a parallel to human health, Mitchell and Bossert (2010) argue that a balance is needed between centralisation of some health system functions (e.g. handling disease outbreaks, administration of health information management system) and decentralisation of others (e.g.…”