Public sector decentralization

Silverman, Jerry

doi:10.1596/0-8213-2279-6

Cited by 36 publications

(3 citation statements)

References 50 publications

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“…Decentralization was a mechanism adopted in many developing countries to strengthen their health systems [ 11 ]. Health sector decentralization involved mainly deconcentration (transfer of responsibilities) and devolution (transfer of authority) [ 12 - 14 ] in a process aimed at increasing governance capacity to meet local health needs, increase the efficiency and quality of health services and court the participation of the community in making decision about their health [ 5 , 15 - 19 ]. Basically, decentralization and the broader health sector reforms were done with the purpose of improving health system performance [ 20 - 22 ].…”

Section: Introductionmentioning

confidence: 99%

Governing the implementation of Emergency Obstetric Care: experiences of Rural District Health Managers, Tanzania

Mkoka

Kiwara

Goicolea

et al. 2014

BMC Health Serv Res

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BackgroundMany health policies developed internationally often become adopted at the national level and are implemented locally at the district level. A decentralized district health system led by a district health management team becomes responsible for implementing such policies. This study aimed at exploring the experiences of a district health management team in implementing Emergency Obstetric Care (EmOC) related policies and identifying emerging governance aspects.MethodsThe study used a qualitative approach in which data was obtained from thirteen individual interviews and one focus group discussion (FGD). Interviews were conducted with members of the district health management team, district health service boards and NGO representatives. The FGD included key informants who were directly involved in the work of implementing EmOC services in the district. Documentary reviews and observation were done to supplement the data. All the materials were analysed using a qualitative content analysis approach.ResultsImplementation of EmOC was considered to be a process accompanied by achievements and challenges. Achievements included increased institutional delivery, increased number of ambulances, training service providers in emergency obstetric care and building a new rural health centre that provides comprehensive emergency obstetric care. These achievements were associated with good leadership skills of the team together with partnerships that existed between different actors such as the Non-Governmental Organization (NGO), development partners, local politicians and Traditional Birth Attendants (TBAs). Most challenges faced during the implementation of EmOC were related to governance issues at different levels and included delays in disbursement of funds from the central government, shortages of health workers, unclear mechanisms for accountability, lack of incentives to motivate overburdened staffs and lack of guidelines for partnership development.ConclusionThe study revealed that implementing EmOC is a process accompanied by challenges that require an approach with multiple partners to address them and that, for effective partnership, the roles and responsibilities of each partner should be well stipulated in a clear working framework within the district health system. Partnerships strengthen health system governance and therefore ensure effective implementation of health policies at a local level.

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Section: Introductionmentioning

confidence: 99%

Governing the implementation of Emergency Obstetric Care: experiences of Rural District Health Managers, Tanzania

Mkoka

Kiwara

Goicolea

et al. 2014

BMC Health Serv Res

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“…In regard to the impact of fiscal decentralization on IMR reduction, several studies argue that fiscal decentralization could lead to increased local governments' responsiveness and accountability by providing preference-matching local public goods such as particular vaccination initiatives (Alesina & Spolaore, 1997;Faguet, 2004;Lockwood, 2002;Oates, 1972;Silverman, 1992). This effect is known as -allocative efficiency.‖ Seabright (1996), Persson and Tabellini (2000), and Hindriks and Lockwood (2005) contend that fiscal decentralization could also reduce the incumbents' rent diversion out of tax revenues.…”

Section: Literature Reviewmentioning

confidence: 99%

Does Fiscal Decentralization Improve Healthcare Outcomes? Empirical Evidence from China

Jin,

Sun

2011

Public Finance and Management

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Since the late 1970s, China has adopted a variety of economic reforms that have led to its overall economic success. The Tax Sharing System (TSS) reform, as part of the gradual fiscal decentralization policy, was initiated in 1994. The conventional theory claims that fiscal decentralization could result in various potential benefits including increased responsiveness of local governments to deliver public goods. However, very little empirical work has examined the impact of fiscal decentralization on health outcomes in China. In this study, we use the infant mortality rate (IMR) as an indicator of healthcare outcomes and provide a quantitative measurement of the impact of fiscal decentralization on infant mortality at the provincial government level. We measure fiscal decentralization as both a dummy and a ratio and estimate the infant mortality rate production function using both Ordinary Least Squares (OLS) and Panel Feasible Generalized Least Squares (FGLS) approaches. We find that, contradictory to the predictions made by the conventional theories, fiscal decentralization has generated an overall adverse impact on the IMR in China.

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“…La definición del Observatorio Europeo contiene la dimensión de privatización ya que incluye a las ONG. Para Silverman (27) y Bossert (28) la delegación también se da cuando la responsabilidad o autoridad se transfiere a instituciones semi-autónomas.…”

Section: Medición De La Descentralizaciónunclassified

La descentralización de los servicios de salud: de la teoría a la práctica

Ugalde

Homedes

2008

Salud Colectiva

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mas de salud, y al mismo tiempo incrementará la satisfacción de los usuarios. Además, quienes abogan por la descentralización piensan que la descentralización facilitará la participación de las comunidades en la toma de decisiones relacionadas con la salud, y en consecuencia la democracia. En este trabajo se discute primero la falta de consenso que existe sobre el significado del concepto de descentralización y la dificultad de medir el nivel de descentralización de un sistema de salud. También se identifica a los actores que formularon estas hipótesis, se examinan las razones detrás de su formulación, y si los resultados alcanzados tras la descentralización de los servicios de salud en América Latina las confirman.

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Public sector decentralization

Cited by 36 publications

References 50 publications

Governing the implementation of Emergency Obstetric Care: experiences of Rural District Health Managers, Tanzania

Governing the implementation of Emergency Obstetric Care: experiences of Rural District Health Managers, Tanzania

Does Fiscal Decentralization Improve Healthcare Outcomes? Empirical Evidence from China

La descentralización de los servicios de salud: de la teoría a la práctica

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