Decentralisation; The Question of Management Capacity: A Response to Recent Commentaries

Mohammed, Jalal; North, Nicola; Ashton, Toni

doi:10.15171/ijhpm.2016.134

Cited by 3 publications

(4 citation statements)

References 19 publications

(18 reference statements)

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“…Through a qualitative approach, we have been able to explore a number of specific policy considerations under the assumption that the synergy works. Several studies on decentralisation in other low- and middle-income countries have also concluded that decentralisation only grants the decision space, but its effective use by decision-makers at lower levels of the system will be realised only when their capacities are built, as was reported, for example, in Fiji [60] and in India [28]. Particularly for the function of planning and priority-setting, capacity-building can improve the use of decision space as noted in Tanzania [61], and enhance transparency and accountability as likewise noted in India [62] and again at district levels in Tanzania [63].…”

Section: Discussionmentioning

confidence: 99%

Optimising decentralisation for the health sector by exploring the synergy of decision space, capacity and accountability: insights from the Philippines

Liwanag

Wyss

2019

Health Res Policy Sys

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BackgroundSeveral studies on decentralisation have used the ‘decision space’ approach to assess the breadth of space made available to decision-makers at lower levels of the health system. However, in order to better understand how decentralisation becomes effective for the health sector, analysis should go beyond assessing decision space and include the dimensions of capacity and accountability. Building on Bossert’s earlier work on the synergy of these dimensions, we analysed decision-making in the Philippines where governmental health services have been devolved to local governments since 1992.MethodsUsing a qualitative research design, we interviewed 27 key decision-makers at different levels of the Philippine health system and representing various local settings. We explored their perspectives on decision space, capacities and accountability in the health sector functions of planning, financing and budget allocation, programme implementation and service delivery, management of facilities, equipment and supplies, health workforce management, and data monitoring and utilisation. Analysis followed the Framework Method.ResultsAcross all functions, decision space for local decision-makers was assessed to be moderate or narrow despite 25 years of devolution. To improve decision-making in these functions, adjustments in local capacities should include, at the individual level, skills for strategic planning, management, priority-setting, evidence-informed policy-making and innovation in service delivery. At institutional levels, these desired capacities should include having a multi-stakeholder approach, generating revenues from local sources, partnering with the private sector and facilitating cooperation between local health facilities. On the other hand, adjustments in accountability should focus on the various mechanisms that can be enforced by the central level, not only to build the desired capacities and augment the inadequacies at local levels, but also to incentivise success and regulate failure by the local governments in performing the functions transferred to them.ConclusionTo optimise decentralisation for the health sector, widening decision spaces for local decision-makers must be accompanied by the corresponding adjustments in capacities and accountability for promoting good decision-making at lower levels in the decentralised functions. Analysing the health system through the lens of this synergy is useful for exploring concrete policy adjustments in the Philippines as well as in other settings.Electronic supplementary materialThe online version of this article (10.1186/s12961-018-0402-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Optimising decentralisation for the health sector by exploring the synergy of decision space, capacity and accountability: insights from the Philippines

Liwanag

Wyss

2019

Health Res Policy Sys

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“…Turner (1999, p. 4), conceptualized "decentralization as involving transmitting authority to perform some services from an individual or an agency in central government to some other individuals or agencies that are 'closer' to the people to be served." Contemporary studies view it from the perspective of intergovernmental relations (Mohammed et al, 2017;Schneider, 2003).…”

Section: Introductionmentioning

confidence: 99%

“…Scholars averred that “to rebuild relationships between citizens and their LGs means working on both sides of the equation - that is, going beyond ‘civil society’ or ‘state-based’ approaches, to focusing on their intersection, through new forms of participation, responsiveness, and accountability” (Fung, 2006; Gaventa, 2003, p. 2). Turner (1999, p. 4), conceptualized “decentralization as involving transmitting authority to perform some services from an individual or an agency in central government to some other individuals or agencies that are ‘closer’ to the people to be served.” Contemporary studies view it from the perspective of intergovernmental relations (Mohammed et al, 2017; Schneider, 2003).…”

Section: Introductionmentioning

confidence: 99%

Decentralization of South Eastern Nigeria’s Local Governments and Achievement of Mandates Enshrined in Nigeria’s 1999 Constitution

et al. 2022

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In recent times, there has been sustained interest in how local governments in Nigeria can satisfactorily provide the critical needs of the people within their jurisdiction as stipulated in the 1999 constitution. Decentralization is enshrined in the constitution as a means of realizing these needs yet local governments have not been able to satisfactorily achieve them. This study examines the extent local governments apply the three components of decentralization; namely, political, bureaucratic, and fiscal. Relying on cross-sectional survey, the researchers obtained data, using adapted decentralization tool kit from World Bank Group. Data were analyzed using descriptive statistics and t-test. We found that the three components of decentralization are not completely applied toward achieving local government mandates.

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“…Decentralization, a concept that spans a range of disciplines including management, social policy, and geography, is variously described with no agreement on a particular definition [ 22 ]. As a health system reform mechanism, decentralization is a socio-political process that aims to improve health outcomes by redistributing service delivery from the centre to better address local healthcare needs [ 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Medical termination of pregnancy service delivery in the context of decentralization: social and structural influences

Chambers

Clune

Tomnay

2018

Int J Equity Health

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BackgroundMedical termination of pregnancy (MToP) is a safe and acceptable abortion option. Depending on country context, MToP can be administered by general practitioners and mid-level healthcare providers in the first and second trimesters of pregnancy. Like other high-income countries, a range of social and structural barriers to MToP service provision exist in Australia. To counter some of these barriers, geographic decentralization of MToP was undertaken in rural Victoria, Australia, through training service providers about MToP to increase service delivery opportunities. The aim of this study was to investigate the factors that enabled and challenged the decentralization process.MethodsFace-to-face and telephone interviews were undertaken between April and June 2016 with a purposeful sample of six training providers and 13 general practitioners (GP) and nurse training participants. Study participants were asked about their perceptions of motivations, enablers and challenges to MToP provision. A published conceptual framework of synergies between decentralization and service delivery was used to analyse the study findings.ResultsThree key themes emerged from the study findings. First, the effort to decentralize MToP was primarily supported by motivations related to making service access more equitable as well as the willingness of training providers to devolve their informal power, in the form of MToP medical expertise, to training participants. Next, the enablers for MToP decentralization included changes in the regulatory environment relating to decriminalization of abortion and availability of required medication, formation of partnerships to deliver training, provision of MToP clinical resources and local collegial support. Finally, challenges to MToP decentralization were few but significant. These included a lack of a state-wide strategy for service provision, provider concerns about coping with service demand, and provider stigma in the form of perceived negative community or collegial attitudes. These were significant enough to create caution for GPs and nurses considering service provision.ConclusionsDecentralization concepts offer an innovative way for reframing and tackling issues associated with improving MToP service delivery. There is scope for more research about MToP decentralization in other country contexts. These findings are important for informing future rural MToP service expansion efforts that improve equity in service access.

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Decentralisation; The Question of Management Capacity: A Response to Recent Commentaries

Cited by 3 publications

References 19 publications

Optimising decentralisation for the health sector by exploring the synergy of decision space, capacity and accountability: insights from the Philippines

Optimising decentralisation for the health sector by exploring the synergy of decision space, capacity and accountability: insights from the Philippines

Decentralization of South Eastern Nigeria’s Local Governments and Achievement of Mandates Enshrined in Nigeria’s 1999 Constitution

Medical termination of pregnancy service delivery in the context of decentralization: social and structural influences

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