Going down to the local: incorporating social organisation and political culture into assessments of decentralised health care

Influence of organisational culture on the implementation of health sector reforms in low- and middle-income countries: a qualitative interpretive review

“…Three kinds of management styles were described in the reviewed articles: authoritarian, participative and consultative [37–39,41–44]. These management styles had different influences on the implementation of health sector reforms, as seen below.…”

“…Atkinson et al [44] examined public health system decentralisation in three districts (one rural, one urban and one metropolitan) in Brazil. They observed that decision-making power in the rural district was centralised to the district prefect – a political figure – who never consulted health staff or members of the health council.…”

“…They observed that decision-making power in the rural district was centralised to the district prefect – a political figure – who never consulted health staff or members of the health council. As a result, the health secretariat and staff lacked autonomy and voice in decision-making, which led to the poor implementation of the reform policy [44]. …”

“…However, the secretary did not engage the district health council because of the assumption that the district health council (made up of both health workers and lay members of the community) was a bureaucratic intervention. As a result, the council no longer convened, which slowed the implementation of the decentralisation policy [44]. In Nigeria, hospital managers encouraged team work and participation of the staff in planning for the health sector reforms.…”

“…As a result, the decentralisation policy was judged as better implemented in the urban district than in the rural and metropolitan districts [44]. …”