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Municipal health services provision by local governments: a systematic review of experiences in decentralized Sub-Saharan African countries.
Health Policy Plan 2017; 32(9):1327-1336HP

Abstract

'Four' types of decentralization are distinguished in health care: deconcentration when the shift in authority is to regional or district offices; devolution when the shift is to state, provincial or municipal governments; delegation when semi-autonomous agencies are granted new powers; and privatization when ownership is granted to private entities. This article systematically reviews the experiences of local governments of Sub-Saharan African countries with the provision of health services during and after decentralization reforms. The article highlights the achievements, challenges and issues associated with decentralization. The review shows that most countries have mainly focused on the process by enacting numerous policies, regulations and standards with mixed outcomes for health services delivery. Decentralization in general, and resource transfer from the central to local governments in particular, are a highly political issue that influences the health reform strategy on decentralization. The literature shows the complexity of implementing decentralization schemes which strongly impact the health service organization and delivery. The theory of decision space applied in a comparative analysis found that some functions, particularly financing, remain under the control of the central state. Despite the numerous challenges, this review identifies some good practices in resources transfer, key determinants being the type of decentralization and the government's will to make legislative and administrative changes required for the effectiveness of decentralization. The literature search, even though systematic, resulted in a limited number of relevant publications with evidence on the link between decentralization and health services delivery. This is a largely unexplored research area, especially the use of financial resources by local governments, the factors that drive local decision-making processes and the effects of decentralization on health care sector performance.

Authors+Show Affiliations

National Laboratory of Public Health, Ministry of Health, Ouagadougou, Burkina Faso. Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.Institut de Recherche en Sciences de la Santé, CNRST, Ministère de la Recherche Scientifique et des Innovations, Ouagadougou, Burkina Faso.Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands.

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

28981661

Citation

Zon, Hilaire, et al. "Municipal Health Services Provision By Local Governments: a Systematic Review of Experiences in Decentralized Sub-Saharan African Countries." Health Policy and Planning, vol. 32, no. 9, 2017, pp. 1327-1336.
Zon H, Pavlova M, Drabo KM, et al. Municipal health services provision by local governments: a systematic review of experiences in decentralized Sub-Saharan African countries. Health Policy Plan. 2017;32(9):1327-1336.
Zon, H., Pavlova, M., Drabo, K. M., & Groot, W. (2017). Municipal health services provision by local governments: a systematic review of experiences in decentralized Sub-Saharan African countries. Health Policy and Planning, 32(9), pp. 1327-1336. doi:10.1093/heapol/czx082.
Zon H, et al. Municipal Health Services Provision By Local Governments: a Systematic Review of Experiences in Decentralized Sub-Saharan African Countries. Health Policy Plan. 2017 Nov 1;32(9):1327-1336. PubMed PMID: 28981661.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Municipal health services provision by local governments: a systematic review of experiences in decentralized Sub-Saharan African countries. AU - Zon,Hilaire, AU - Pavlova,Milena, AU - Drabo,Koiné Maxime, AU - Groot,Wim, PY - 2017/06/07/accepted PY - 2017/10/6/entrez PY - 2017/10/6/pubmed PY - 2018/5/23/medline KW - Decentralization KW - Sub-Saharan Africa KW - decision space theory KW - health care KW - systematic review SP - 1327 EP - 1336 JF - Health policy and planning JO - Health Policy Plan VL - 32 IS - 9 N2 - 'Four' types of decentralization are distinguished in health care: deconcentration when the shift in authority is to regional or district offices; devolution when the shift is to state, provincial or municipal governments; delegation when semi-autonomous agencies are granted new powers; and privatization when ownership is granted to private entities. This article systematically reviews the experiences of local governments of Sub-Saharan African countries with the provision of health services during and after decentralization reforms. The article highlights the achievements, challenges and issues associated with decentralization. The review shows that most countries have mainly focused on the process by enacting numerous policies, regulations and standards with mixed outcomes for health services delivery. Decentralization in general, and resource transfer from the central to local governments in particular, are a highly political issue that influences the health reform strategy on decentralization. The literature shows the complexity of implementing decentralization schemes which strongly impact the health service organization and delivery. The theory of decision space applied in a comparative analysis found that some functions, particularly financing, remain under the control of the central state. Despite the numerous challenges, this review identifies some good practices in resources transfer, key determinants being the type of decentralization and the government's will to make legislative and administrative changes required for the effectiveness of decentralization. The literature search, even though systematic, resulted in a limited number of relevant publications with evidence on the link between decentralization and health services delivery. This is a largely unexplored research area, especially the use of financial resources by local governments, the factors that drive local decision-making processes and the effects of decentralization on health care sector performance. SN - 1460-2237 UR - https://www.unboundmedicine.com/medline/citation/28981661/Municipal_health_services_provision_by_local_governments:_a_systematic_review_of_experiences_in_decentralized_Sub_Saharan_African_countries_ L2 - https://academic.oup.com/heapol/article-lookup/doi/10.1093/heapol/czx082 DB - PRIME DP - Unbound Medicine ER -