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Decentralization of health systems in low and middle income countries: a systematic review.
Int J Public Health 2017; 62(2):219-229IJ

Abstract

OBJECTIVES

A substantial number of low and middle income countries (LMICs) have implemented health sector reforms in the last 40 years, and the majority of them have included some degree of decentralization of the health system as part of the wider reform. This review will provide an updated and comprehensive assessment of the effects of decentralization in LMICs.

METHODS

We conducted a systematic review of published and grey literature till May 2015, following standard methods.

RESULTS

54 qualitative, quantitative and mixed methods studies conducted in 26 countries were included in the review. We found positive and negative effects of decentralization of health systems in LMICs. Whereas decentralization of governance, financing and service delivery, have been shown to have positive effects on the system; decentralization of resource management has been challenging in several settings.

CONCLUSIONS

Overall, lessons learned from LMICs suggest that factors such as adequate mix of technical skills at the local level to perform decentralized tasks, effective decentralization of decision-making to the periphery, and political leadership are key factors for a successful decentralization.

Authors+Show Affiliations

Swiss Tropical and Public Health Institute, Socinstrasse 57, PO Box 4002, Basel, Switzerland. daniel.cobos@unibas.ch. University of Basel, Basel, Switzerland. daniel.cobos@unibas.ch.Department of Microbiology, Hospital Clínico San Carlos, Madrid, Spain.Swiss Tropical and Public Health Institute, Socinstrasse 57, PO Box 4002, Basel, Switzerland. University of Basel, Basel, Switzerland.Department of Public Health and Preventive Medicine, Complutense University, Madrid, Spain.Department of Public Health and Preventive Medicine, Complutense University, Madrid, Spain.

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

27572495

Citation

Cobos Muñoz, Daniel, et al. "Decentralization of Health Systems in Low and Middle Income Countries: a Systematic Review." International Journal of Public Health, vol. 62, no. 2, 2017, pp. 219-229.
Cobos Muñoz D, Merino Amador P, Monzon Llamas L, et al. Decentralization of health systems in low and middle income countries: a systematic review. Int J Public Health. 2017;62(2):219-229.
Cobos Muñoz, D., Merino Amador, P., Monzon Llamas, L., Martinez Hernandez, D., & Santos Sancho, J. M. (2017). Decentralization of health systems in low and middle income countries: a systematic review. International Journal of Public Health, 62(2), pp. 219-229. doi:10.1007/s00038-016-0872-2.
Cobos Muñoz D, et al. Decentralization of Health Systems in Low and Middle Income Countries: a Systematic Review. Int J Public Health. 2017;62(2):219-229. PubMed PMID: 27572495.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Decentralization of health systems in low and middle income countries: a systematic review. AU - Cobos Muñoz,Daniel, AU - Merino Amador,Paloma, AU - Monzon Llamas,Laura, AU - Martinez Hernandez,David, AU - Santos Sancho,Juana Maria, Y1 - 2016/08/29/ PY - 2016/03/02/received PY - 2016/07/26/accepted PY - 2016/07/22/revised PY - 2016/8/31/pubmed PY - 2018/7/26/medline PY - 2016/8/31/entrez KW - Decentralization KW - District health system KW - Governance KW - Health sector reform KW - LMIC KW - Systematic review KW - UHC KW - Universal health coverage SP - 219 EP - 229 JF - International journal of public health JO - Int J Public Health VL - 62 IS - 2 N2 - OBJECTIVES: A substantial number of low and middle income countries (LMICs) have implemented health sector reforms in the last 40 years, and the majority of them have included some degree of decentralization of the health system as part of the wider reform. This review will provide an updated and comprehensive assessment of the effects of decentralization in LMICs. METHODS: We conducted a systematic review of published and grey literature till May 2015, following standard methods. RESULTS: 54 qualitative, quantitative and mixed methods studies conducted in 26 countries were included in the review. We found positive and negative effects of decentralization of health systems in LMICs. Whereas decentralization of governance, financing and service delivery, have been shown to have positive effects on the system; decentralization of resource management has been challenging in several settings. CONCLUSIONS: Overall, lessons learned from LMICs suggest that factors such as adequate mix of technical skills at the local level to perform decentralized tasks, effective decentralization of decision-making to the periphery, and political leadership are key factors for a successful decentralization. SN - 1661-8564 UR - https://www.unboundmedicine.com/medline/citation/27572495/Decentralization_of_health_systems_in_low_and_middle_income_countries:_a_systematic_review_ L2 - https://dx.doi.org/10.1007/s00038-016-0872-2 DB - PRIME DP - Unbound Medicine ER -