Is decentralisation the real solution?

Mosca, Ilaria

doi:10.1016/j.healthpol.2005.07.011

Cited by 50 publications

(43 citation statements)

References 7 publications

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“…As Mosca concluded, based on the lessons learned from three European countries, "decentralization per se cannot be seen as a means to revamp the state and to automatically improve efficiency of services delivered". [12] Our findings corroborate this conclusion. Capacity building at a subnational level is a long and painful process and we, as members of public health academia, appreciate having an active role in designing it.…”

Section: Resultssupporting

confidence: 87%

“…[1] Opinions in the academic community are divided, and so is the evidence. [12,26] The present study did not attempt to resolve the dilemma which approach to health planning and resource governing is more efficient, the central or regional one. As Mosca concluded, based on the lessons learned from three European countries, "decentralization per se cannot be seen as a means to revamp the state and to automatically improve efficiency of services delivered".…”

Section: Resultsmentioning

confidence: 97%

“…Policy development is a political process, thus jeopardized by national and local political changes. [1,12] This limitation was predicted and counteracted by two "anchoring mechanisms", concentric (project) widening and legitimacy building, which helped local projects survive the political change in 6 (Dubrovnik-Neretva, Osijek-Baranja, SisakMoslavina, Vara din, Virovitica-Podravina, and Brod-Posavina) of 7 counties.…”

Section: Resultsmentioning

confidence: 99%

“…[10,11] The assumption was that only through an active involvement of all key players, the process of development and implementation of county health policies could be improved (as prerequisite for a successful decentralization). [12] Although the Program aimed to include all 21 counties, it had involved 15 counties and the city of Zagreb until February 2006. We present the impact of the Program on the development of the local public health policies and practice in these 15 counties.…”

mentioning

confidence: 99%

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Evaluation of Croatian model of polycentric health planning and decision making

et al. 2009

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Section: Resultssupporting

confidence: 87%

Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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Evaluation of Croatian model of polycentric health planning and decision making

et al. 2009

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“…5 Whilst decentralisation of health services has been widely promoted since the 1970s, how the concept is defined lacks conceptual clarity. 6,7 There is, however, an emerging consensus that decentralisation broadly refers to the transfer of authority to manage, plan and make decisions, from the central government to agencies and actors at lower levels. 1,[7][8][9][10][11] Decentralisation, in its many forms, seeks to promote a more effective and efficient system aimed at rectifying a topdown bureaucratic structure and improving government responsiveness to the public.…”

Section: Approaches To Decentralisationmentioning

confidence: 99%

Decentralisation of Health Services in Fiji: A Decision Space Analysis

Mohammed¹,

North²,

Ashton³

2015

Int J Health Policy Manag

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Background: Decentralisation aims to bring services closer to the community and has been advocated in the health sector to improve quality, access and equity, and to empower local agencies, increase innovation and efficiency and bring healthcare and decision-making as close as possible to where people live and work. Fiji has attempted two approaches to decentralisation. The current approach reflects a model of deconcentration of outpatient services from the tertiary level hospital to the peripheral health centres in the Suva subdivision. Methods: Using a modified decision space approach developed by Bossert, this study measures decision space created in five broad categories (finance, service organisation, human resources, access rules, and governance rules) within the decentralised services. Results: Fiji's centrally managed historical-based allocation of financial resources and management of human resources resulted in no decision space for decentralised agents. Narrow decision space was created in the service organisation category where, with limited decision space created over access rules, Fiji has seen greater usage of its decentralised health centres. There remains limited decision space in governance. Conclusion:The current wave of decentralisation reveals that, whilst the workload has shifted from the tertiary hospital to the peripheral health centres, it has been accompanied by limited transfer of administrative authority, suggesting that Fiji's deconcentration reflects the transfer of workload only with decision-making in the five functional areas remaining largely centralised. As such, the benefits of decentralisation for users and providers are likely to be limited.

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Recentralization and vertical alignment in the French health‐care system

Simonet

2017

Journal of Public Affairs

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In foreign exemplars, key new public management (NPM) features such as decentralization and devolution of health-care responsibilities had outcomes below expectations. Other NPM traits such as the patient as overseer of reforms or the empowerment of patient remained elusive. In France, the integration of public values such as greater participation of patients and local actors (NGOs and elected officials) and NPM-driven private values such as performance evaluation has yet to be seen. Taking advantage of NPM's failings and austerity agenda, a French welfare elite regained control over health-care policy decisions at the expense of regions and other local actors. NPM outcomes were below expectations. Austerity cures led to weakening of the regional decision spaces, which can be explained under the principal-agent relationship. Accountability shifted to managerial (the professionalization of hospital managers) and legal (governance via regulations) forms in a bid to restore central government control. A democratic recess results from the lack of public engagement in recent health reforms.

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Is decentralisation the real solution?

Cited by 50 publications

References 7 publications

Evaluation of Croatian model of polycentric health planning and decision making

Evaluation of Croatian model of polycentric health planning and decision making

Decentralisation of Health Services in Fiji: A Decision Space Analysis

Recentralization and vertical alignment in the French health‐care system

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