Decentralization of Health Services

1. Decentralization of Health Services

2. Definition Rationale Types of Decentralization Administrative Decentralization Major key QUESTIONS of decentralization Framework for analyzing decentralization Country case studies WHO role Outline

3. WHO Decentralization is transfer of authority or dispersal of public planning, management and decision making from the national level to sub-national levels [1990] Promotion of primary health care was seen as incompatible with centralized systems of health care Basic Concepts �definitions Political: Aims to give citizens or their elected representatives more power in public decision-making. Advocates of political decentralization assume that decisions made with greater participation will be better informed and more relevant to diverse interests in society than those made only by national political authorities. Financial: Responsibility is a core component of decentralization. If local governments and private organizations are to carry out decentralized functions effectively, they must have an adequate level of revenues �either raised locally or transferred from the central government +The authority to make decisions about expenditures. 3-Economic or Market Decentralization According to IMF & WB it is considered to be the most complete form of decentralization from a government's perspective: i.e. privatization and deregulation because they shift responsibility for functions from the public to the private sector . Privatization and deregulation are usually, but not always, accompanied by economic liberalization and market development policies.Political: Aims to give citizens or their elected representatives more power in public decision-making. Advocates of political decentralization assume that decisions made with greater participation will be better informed and more relevant to diverse interests in society than those made only by national political authorities. Financial: Responsibility is a core component of decentralization. If local governments and private organizations are to carry out decentralized functions effectively, they must have an adequate level of revenues �either raised locally or transferred from the central government +The authority to make decisions about expenditures. 3-Economic or Market Decentralization According to IMF & WB it is considered to be the most complete form of decentralization from a government's perspective: i.e. privatization and deregulation because they shift responsibility for functions from the public to the private sector . Privatization and deregulation are usually, but not always, accompanied by economic liberalization and market development policies.

4. Political: Aims to give citizens or their elected representatives more power in public decision-making. Advocates of political decentralization assume that decisions made with greater participation will be better informed and more relevant to diverse interests in society than those made only by national political authorities. Financial: Responsibility is a core component of decentralization. If local governments and private organizations are to carry out decentralized functions effectively, they must have an adequate level of revenues �either raised locally or transferred from the central government +The authority to make decisions about expenditures. 3-Economic or Market Decentralization According to IMF & WB it is considered to be the most complete form of decentralization from a government's perspective: i.e. privatization and deregulation because they shift responsibility for functions from the public to the private sector . Privatization and deregulation are usually, but not always, accompanied by economic liberalization and market development policies.Political: Aims to give citizens or their elected representatives more power in public decision-making. Advocates of political decentralization assume that decisions made with greater participation will be better informed and more relevant to diverse interests in society than those made only by national political authorities. Financial: Responsibility is a core component of decentralization. If local governments and private organizations are to carry out decentralized functions effectively, they must have an adequate level of revenues �either raised locally or transferred from the central government +The authority to make decisions about expenditures. 3-Economic or Market Decentralization According to IMF & WB it is considered to be the most complete form of decentralization from a government's perspective: i.e. privatization and deregulation because they shift responsibility for functions from the public to the private sector . Privatization and deregulation are usually, but not always, accompanied by economic liberalization and market development policies.

5. Rationale Improve efficiency? allocative and production efficiency Improve equity? Improve quality of care? Improve financial soundness? Improve local accountability Political: Aims to give citizens or their elected representatives more power in public decision-making. Advocates of political decentralization assume that decisions made with greater participation will be better informed and more relevant to diverse interests in society than those made only by national political authorities. Financial: Responsibility is a core component of decentralization. If local governments and private organizations are to carry out decentralized functions effectively, they must have an adequate level of revenues �either raised locally or transferred from the central government +The authority to make decisions about expenditures. 3-Economic or Market Decentralization According to IMF & WB it is considered to be the most complete form of decentralization from a government's perspective: i.e. privatization and deregulation because they shift responsibility for functions from the public to the private sector . Privatization and deregulation are usually, but not always, accompanied by economic liberalization and market development policies.Political: Aims to give citizens or their elected representatives more power in public decision-making. Advocates of political decentralization assume that decisions made with greater participation will be better informed and more relevant to diverse interests in society than those made only by national political authorities. Financial: Responsibility is a core component of decentralization. If local governments and private organizations are to carry out decentralized functions effectively, they must have an adequate level of revenues �either raised locally or transferred from the central government +The authority to make decisions about expenditures. 3-Economic or Market Decentralization According to IMF & WB it is considered to be the most complete form of decentralization from a government's perspective: i.e. privatization and deregulation because they shift responsibility for functions from the public to the private sector . Privatization and deregulation are usually, but not always, accompanied by economic liberalization and market development policies.

6. Not mutually exclusive, considerable overlap Implemented in different forms and combinations across countries, within countries and within sectors Political: Aims to give citizens or their elected representatives more power in public decision-making. Advocates of political decentralization assume that decisions made with greater participation will be better informed and more relevant to diverse interests in society than those made only by national political authorities. Financial: Responsibility is a core component of decentralization. If local governments and private organizations are to carry out decentralized functions effectively, they must have an adequate level of revenues �either raised locally or transferred from the central government +The authority to make decisions about expenditures. 3-Economic or Market Decentralization According to IMF & WB it is considered to be the most complete form of decentralization from a government's perspective: i.e. privatization and deregulation because they shift responsibility for functions from the public to the private sector . Privatization and deregulation are usually, but not always, accompanied by economic liberalization and market development policies.Political: Aims to give citizens or their elected representatives more power in public decision-making. Advocates of political decentralization assume that decisions made with greater participation will be better informed and more relevant to diverse interests in society than those made only by national political authorities. Financial: Responsibility is a core component of decentralization. If local governments and private organizations are to carry out decentralized functions effectively, they must have an adequate level of revenues �either raised locally or transferred from the central government +The authority to make decisions about expenditures. 3-Economic or Market Decentralization According to IMF & WB it is considered to be the most complete form of decentralization from a government's perspective: i.e. privatization and deregulation because they shift responsibility for functions from the public to the private sector . Privatization and deregulation are usually, but not always, accompanied by economic liberalization and market development policies.

7. �is the transfer of responsibility for planning, financing, and managing certain public functions from the central government to lower levels� (Rondinelli 1999). Political: Aims to give citizens or their elected representatives more power in public decision-making. Advocates of political decentralization assume that decisions made with greater participation will be better informed and more relevant to diverse interests in society than those made only by national political authorities. Financial: Responsibility is a core component of decentralization. If local governments and private organizations are to carry out decentralized functions effectively, they must have an adequate level of revenues �either raised locally or transferred from the central government +The authority to make decisions about expenditures. 3-Economic or Market Decentralization According to IMF & WB it is considered to be the most complete form of decentralization from a government's perspective: i.e. privatization and deregulation because they shift responsibility for functions from the public to the private sector . Privatization and deregulation are usually, but not always, accompanied by economic liberalization and market development policies.Political: Aims to give citizens or their elected representatives more power in public decision-making. Advocates of political decentralization assume that decisions made with greater participation will be better informed and more relevant to diverse interests in society than those made only by national political authorities. Financial: Responsibility is a core component of decentralization. If local governments and private organizations are to carry out decentralized functions effectively, they must have an adequate level of revenues �either raised locally or transferred from the central government +The authority to make decisions about expenditures. 3-Economic or Market Decentralization According to IMF & WB it is considered to be the most complete form of decentralization from a government's perspective: i.e. privatization and deregulation because they shift responsibility for functions from the public to the private sector . Privatization and deregulation are usually, but not always, accompanied by economic liberalization and market development policies.

8. 2-Administrative Decentralization Deconcentration - shifting power from the central offices to peripheral offices of the same administrative structure e.g. provincial department of health and its district offices Functional: field officers are directly linked and controlled from centre; Prefectoral: there is a layer [PREFECT] in between � commissioner or governor; Salient features Shifting of power from the same structure; Semi-autonomy to field officers in routine decision making; Some planning functions according to central guidelines; Political: Aims to give citizens or their elected representatives more power in public decision-making. Advocates of political decentralization assume that decisions made with greater participation will be better informed and more relevant to diverse interests in society than those made only by national political authorities. Financial: Responsibility is a core component of decentralization. If local governments and private organizations are to carry out decentralized functions effectively, they must have an adequate level of revenues �either raised locally or transferred from the central government +The authority to make decisions about expenditures. 3-Economic or Market Decentralization According to IMF & WB it is considered to be the most complete form of decentralization from a government's perspective: i.e. privatization and deregulation because they shift responsibility for functions from the public to the private sector . Privatization and deregulation are usually, but not always, accompanied by economic liberalization and market development policies.Political: Aims to give citizens or their elected representatives more power in public decision-making. Advocates of political decentralization assume that decisions made with greater participation will be better informed and more relevant to diverse interests in society than those made only by national political authorities. Financial: Responsibility is a core component of decentralization. If local governments and private organizations are to carry out decentralized functions effectively, they must have an adequate level of revenues �either raised locally or transferred from the central government +The authority to make decisions about expenditures. 3-Economic or Market Decentralization According to IMF & WB it is considered to be the most complete form of decentralization from a government's perspective: i.e. privatization and deregulation because they shift responsibility for functions from the public to the private sector . Privatization and deregulation are usually, but not always, accompanied by economic liberalization and market development policies.

9. 3-Administrative Decentralization Delegation - shifts responsibility and authority to semi-autonomous organizations; Salient features Functions are shifted to regions or functional bodies or special project units; Independent from central government rules and regulations in personnel, recruitment, budgeting and procurement; Examples: Social security institutions, separate regulatory commission or accreditation commissions; Political: Aims to give citizens or their elected representatives more power in public decision-making. Advocates of political decentralization assume that decisions made with greater participation will be better informed and more relevant to diverse interests in society than those made only by national political authorities. Financial: Responsibility is a core component of decentralization. If local governments and private organizations are to carry out decentralized functions effectively, they must have an adequate level of revenues �either raised locally or transferred from the central government +The authority to make decisions about expenditures. 3-Economic or Market Decentralization According to IMF & WB it is considered to be the most complete form of decentralization from a government's perspective: i.e. privatization and deregulation because they shift responsibility for functions from the public to the private sector . Privatization and deregulation are usually, but not always, accompanied by economic liberalization and market development policies.Political: Aims to give citizens or their elected representatives more power in public decision-making. Advocates of political decentralization assume that decisions made with greater participation will be better informed and more relevant to diverse interests in society than those made only by national political authorities. Financial: Responsibility is a core component of decentralization. If local governments and private organizations are to carry out decentralized functions effectively, they must have an adequate level of revenues �either raised locally or transferred from the central government +The authority to make decisions about expenditures. 3-Economic or Market Decentralization According to IMF & WB it is considered to be the most complete form of decentralization from a government's perspective: i.e. privatization and deregulation because they shift responsibility for functions from the public to the private sector . Privatization and deregulation are usually, but not always, accompanied by economic liberalization and market development policies.

10. 4-Administrative Decentralization Devolution � transfer of functions or decsion making authority to legally incorporated local governments such as states, provinces..etc ( Collins 1994); Shifts responsibility and authority from the central offices (MoH) to separate administrative structures still within public administration ( Bossert 1995) Responsibilities for services to local government Local governments elect their own representatives Raise their own revenues and Independent authority to make investment decisions Political: Aims to give citizens or their elected representatives more power in public decision-making. Advocates of political decentralization assume that decisions made with greater participation will be better informed and more relevant to diverse interests in society than those made only by national political authorities. Financial: Responsibility is a core component of decentralization. If local governments and private organizations are to carry out decentralized functions effectively, they must have an adequate level of revenues �either raised locally or transferred from the central government +The authority to make decisions about expenditures. 3-Economic or Market Decentralization According to IMF & WB it is considered to be the most complete form of decentralization from a government's perspective: i.e. privatization and deregulation because they shift responsibility for functions from the public to the private sector . Privatization and deregulation are usually, but not always, accompanied by economic liberalization and market development policies.Political: Aims to give citizens or their elected representatives more power in public decision-making. Advocates of political decentralization assume that decisions made with greater participation will be better informed and more relevant to diverse interests in society than those made only by national political authorities. Financial: Responsibility is a core component of decentralization. If local governments and private organizations are to carry out decentralized functions effectively, they must have an adequate level of revenues �either raised locally or transferred from the central government +The authority to make decisions about expenditures. 3-Economic or Market Decentralization According to IMF & WB it is considered to be the most complete form of decentralization from a government's perspective: i.e. privatization and deregulation because they shift responsibility for functions from the public to the private sector . Privatization and deregulation are usually, but not always, accompanied by economic liberalization and market development policies.

12. What functions can be decentralized to local choice? Financing Service Delivery Human Resources Governance How much choice may be different for each function Political: Aims to give citizens or their elected representatives more power in public decision-making. Advocates of political decentralization assume that decisions made with greater participation will be better informed and more relevant to diverse interests in society than those made only by national political authorities. Financial: Responsibility is a core component of decentralization. If local governments and private organizations are to carry out decentralized functions effectively, they must have an adequate level of revenues �either raised locally or transferred from the central government +The authority to make decisions about expenditures. 3-Economic or Market Decentralization According to IMF & WB it is considered to be the most complete form of decentralization from a government's perspective: i.e. privatization and deregulation because they shift responsibility for functions from the public to the private sector . Privatization and deregulation are usually, but not always, accompanied by economic liberalization and market development policies.Political: Aims to give citizens or their elected representatives more power in public decision-making. Advocates of political decentralization assume that decisions made with greater participation will be better informed and more relevant to diverse interests in society than those made only by national political authorities. Financial: Responsibility is a core component of decentralization. If local governments and private organizations are to carry out decentralized functions effectively, they must have an adequate level of revenues �either raised locally or transferred from the central government +The authority to make decisions about expenditures. 3-Economic or Market Decentralization According to IMF & WB it is considered to be the most complete form of decentralization from a government's perspective: i.e. privatization and deregulation because they shift responsibility for functions from the public to the private sector . Privatization and deregulation are usually, but not always, accompanied by economic liberalization and market development policies.

21. WHO ROLE