Decentralization in Africa: Local Government and Health Care in Ghana, Malawi and Tanzania

Improving Access to Maternal Health Care through Devolution in Western Kenya

“…Part of this success was the fact that in all three cases, the state remained a relatively weak central authority, that could not support public health services in the early 1980s. More recently, Inkoom and Gyapong (2016) highlight that despite advances in the implementation of more ambitious health-care decentralisation plans in Ghana, Malawi and Tanzania, in all three countries policymaking is still based at the centre and local governments report a high dependence on central government for funds (usually earmarked), allowing for central government interference.…”

The Influence of Balanced Processing Construct Among Health Leaders on the Governance of County Referral Hospitals in Kenya

“…This success was partly due to the fact since in all three cases, throughout the 1980s, central governments remained a largely weak authority that devolved units of government could not depend on for effective delivery of healthcare; hence the need for self-reliance. Inkoom and Gyapong (2016) further concluded that where the central government is still in control of the health services at the local level, lower-level government units have limited influence over the administration and governance of healthcare services that affect the needy population. They further indicate that despite advances in the implementation of more ambitious healthcare decentralization plans in Tanzania, Malawi, and Ghana, in all three countries, most policymaking is still done at the centre and local governments are highly dependent on the central government for financial resources, which are often earmarked (Inkoom & Gyapong, 2016).…”

“…Inkoom and Gyapong (2016) further concluded that where the central government is still in control of the health services at the local level, lower-level government units have limited influence over the administration and governance of healthcare services that affect the needy population. They further indicate that despite advances in the implementation of more ambitious healthcare decentralization plans in Tanzania, Malawi, and Ghana, in all three countries, most policymaking is still done at the centre and local governments are highly dependent on the central government for financial resources, which are often earmarked (Inkoom & Gyapong, 2016). In all this, one undercurrent persists: central governments' reluctance to truly devolve political and economic power.…”

Institutional reproduction, contradiction and legitimacy crisis: The politics of policy design and practice in Malawi's Ministry of Health

“…In an attempt to prepare the health sector for decentralisation as per the policy design, the Regional Health Offices were abolished in the year 2000 with the aim of allowing district hospitals to make autonomous decisions and become more efficient and effective in-service delivery. The understanding was that the District Health Offices would report directly to the Ministry of Health headquarters and thereby reduce the bureaucratic red-tape that was created by the Regional Health Offices in the spirit of decentralisation (Hussein, 2005;Tambulasi & Kayuni, 2007;Inkoom & Gyapong, 2016). However, the practical policy realities were that no sooner had the Regional Health Offices been abolished than the Ministry of Health with support from international donor organisations created Zonal Offices, which was a reproduction of the Regional Officean entity that faced a major legitimacy crisis as it contradicted with the initial institutional transformation design.…”