Health sector decentralization in developing countries: unique or universal!

Abstract

Experiments with decentralization began in the late 1970s and continued throughout the 1980s. decentralization was regarded as a key element of the primary health care approach. It was seen initially as having important political value that can be used as a means to enhance health service policy. However, in many instances, western donors who believe that because one form of decentralization works in developed countries, it will also work in the developing world often pursue decentralization. This paper identifies key political, managerial, technical and structural issues underpinning each individual country which vary enormously from one country to another. The relevance of experience of transfer will need to be considered with these variations in mind. The paper draws lessons from the experiences of various countries and highlights the need to approach formulation and implementation strategies for health sector reforms systematically, rather than importing, uncritically, structural models developed abroad. Political considerations are inherent in any decision made, and a political environment limits the extent of decentralization. Without doubt, the most serious mistake any reformer can make is to assume decentralization to be a managerial exercise devoid of political cause and consequences.