World Health Organization Publication : 9241561378: Health System Decentralization ; Concepts, Issues and Country Experience

By Anne Mills

Book Id: WPLBN0000211995
Format Type: PDF eBook
File Size: 6.3 MB
Reproduction Date: 2005

Title:	World Health Organization Publication : 9241561378: Health System Decentralization ; Concepts, Issues and Country Experience
Author:	Anne Mills
Volume:
Language:	English
Subject:	Health., Public health, Wellness programs
Collections:	Medical Library Collection, World Health Collection
Historic Publication Date:
Publisher:	World Health Organization


Citation APA MLA Chicago Mills, A. (n.d.). World Health Organization Publication : 9241561378. Retrieved from http://www.self.gutenberg.org/

Description
Medical Reference Publication

Excerpt
Decentralization of health system structures and management is a key issue for many countries in the achievement of health for all by the year 2000 and in the development of primary health care. In the WHO publication entitled Formulati~lg strategies for health for all by the year 2000, it is stated that:l to achieve . . . coordination, countries may wish to review their administration system to ensure that coordination can take place at central, intermediate and local levels. As part of this review, they may wish to assess the degree to which they need to strengthen local and intermediate levels of the national administration, by means of delegation of responsibility and authority to the community and to intermediate levels as appropriate, and by the provision of sufficient manpower and resources. Discussion of delegation, decentralization and similar terms has for long been a key theme in public administration, but has been somewhat neglected in the health field. The aim of this publication is therefore to introduce the subject of decentralizing health system structures and management and to illustrate how various countries are attempting to do this. The publication is divided into three parts. Part 1 introduces the subject by referring to the historical experience of decentralization in developed and developing countries and reviews the literature on decentralization. In so doing, it clarifies the meaning of the term, and draws out a number of major issues, illustrating its points with reference to the experience of many different countries. Part 2 is made up of ten country case-studies, from Botswana, Chile, Mexico, Netherlands, New Zealand, Papua New Guinea, Senegal, Spain, Sri Lanka and Yugoslavia. The countries included are among those with recent experience of decentralization of health management and illustrate a range of different circumstances. The authors of the casestudies were asked to discuss, each in the context of their own country, the concept of decentralization, the process of implementing the decentralization policy, changes in organizational structures and management functions, the effect of decentralization on collaboration between the health sector and other sectors, groups and communities, and finally, to give an overall assessment of country experience. In Part 3, issues arising from the case-studies and from relevant literature are discussed and the lessons to be learned are examined. Part 3 also proposes some alternative approaches to decentralization that ministries of health may wish to consider.

Table of Contents
Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 PART 1 Decentralization concepts and issues: a review Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 The historical background to decentralization policiest .o .c.u.rr.e.n.t . . . . . . . . . 12 The meaning of decentralization . . . . . . . . . . . . 15 Issues in health system decentralization . . . . . . 27 Experience in practice . . . . . . . . . . . . . . . . . . . 38 References . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 PART 2 Country case-studies Decentralization of health services in Botswana . . . . . . . . . . . . . . . . . . . . . . . . . . . Decentralization and local management of the health system in Chile . . . . . . . . . . . . . . . Implementing decentralization of health services: a case-study from Mexico . . . . . . . . . . . . . . . The decentralization of the Netherlands health services . . . . . . . . . . . . . . . . . . . . . . . Decentralization of health service management: a review of the New Zealand experience . . . . Experience of decentralization in Papua New Guinea . . . . . . . . . . . . . . . . . . . . . . . . . Decentralization of health services in Senegal . Health services decentralization in Spain . . . . . Decentralization of health services in Sri Lanka Yugoslav experience of health system decentralization . . . . . . . . . . . . . . . . . . . . . . PART 3 Lessons from experience Government policies and the meaning of decentralization . . . . . . . . . . . . . . . . . . . . . . Evolution of decentralization . . . . . . . . . . . . . . . Benefits from decentralization . . . . . . . . . . . . . Implications for ministries of health . . . . . . . . . Decentralization of management functions . . . . Health financing and budgetary controls . . . . . . Health personnel issues . . . . . . . . . . . . . . . . . . Implementing decentralization . . . . . . . . . . . . .