decentralisation – a portmanteau concept that promises much but fails to deliver?; comment on “decentralisation of health services in fiji: a decision space analysis”

decentralisation has been described as an empty concept that lacks clarity. yet there is an enduring interest in the process of decentralisation within health systems and public services more generally. many claims about the benefits of decentralisation are not supported by evidence. it may be useful as an organising framework for analysis of health systems but in this context it lacks conceptual clarity and particularly often ignores level context issues given the focus on a principal-agent/vertical centre/local axis or other aspects of limits on autonomy such as standards for professional practice. both these aspects are relevant in discussing the establishment of “decentralised” health centres in fiji. in the end decentralisation may be nothing more than a useful descriptive label that can be used in an increasingly wide range of ways but actually have little meaning in practice as an analytical concept.