Decentralization of Health Services: Opportunities and Challenges: A Scoping Review of Identified Low and Middle Income Countries
Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
Background: Decentralization has been defined as the transfer of authority and responsibility for public functions from the central government to peripheral departments within the same agency, intermediate and local government or quasi-independent government organizations. In its various forms; whether deconcentration, delegation, devolution or privatization, decentralization has been a common feature of reforms in both developed and developing nations. Accompanying decentralization are profound changes in the resourcing of publicly funded services such as health, the management of human, financial and material resources. In decentralization of health services, the extent to which front-runners in health participate in the design and planning of how and to whom responsibility and authority will be transferred varies. Experience at country level shows that technical health expertise has not been adequately utilized in these reforms, especially in the many countries where the motivation to transfer power away from the center stemmed from political, as opposed to health sector concerns. This review gives the experience of decentralization of health services in some low and middle income countries; describing the challenges and opportunities emerging from the process.
Aim: The main objective of the study is to describe the opportunities and challenges experienced as a result of decentralization of health systems in low and middle income countries.
Methods: The study is a scoping review, with a qualitative approach that involved mapping of existing literature on decentralization of health services. Articles used in the review were searched in Web of science, with access through Umeå University’s library web page. The search involved use of phrases that led to the identification of articles that were relevant to decentralization of health systems from the years 1945 - 2016. A total of 1318 articles were first identified and further refining led to 48 articles. Further filtering of the 48 articles led to 8 articles that were relevant to decentralization of health services in low and middle income countries. 2 more articles were obtained from reference lists. A total of 10 articles were finally used in the review. Data analysis was done using a thematic analytic approach; which involved identifying emerging themes of the various impacts of decentralization of health systems in the various contexts.
Results: Findings from the articles were summarized in the form of 6 main cross-cutting themes that came up as results of decentralization of health services. The identified themes included responsiveness to community needs, accountability mechanisms, level of capacity, retention of health care workers, political interference and financing and financial incentives. Each country’s decentralization experience was reviewed on the basis of these themes; whether they had positive or negative impacts and the accompanying challenges and opportunities.
Conclusion: In order for the envisioned objectives of decentralization to be realized; that is equity, efficiency and effectiveness in the health sector, the decentralization policies should incorporate all the factors identified in the themes and address them so as to avoid emerging challenges during the process of implementation.
Place, publisher, year, edition, pages
2016. , 51 p.
Centre for Public Health Report Series, ISSN 1651-341x ; 2016:27
Decentralization of Health Services, Low ans Middle Income Countries
Public Health, Global Health, Social Medicine and Epidemiology
IdentifiersURN: urn:nbn:se:umu:diva-131582OAI: oai:DiVA.org:umu-131582DiVA: diva2:1075010
Master's Programme in Public Health
2016-05-23, Umeå Universitet, Umeå, 14:30 (English)
Coe, Anna-Britt, Associate Professor
Goicolea, Isabel, Associate Professor