HEALTH SECTOR DECENTRALISATION IN DEVELOPING COUNTRIES: Unique

and Nepal for repeated short assignments and has coordinated a global evaluation of the Joint Nutrition Support Programme (JNSP) on behalf of the Government of Italy, WHO and UNICEF in 1989. Dr. Omar's areas of work cover (a) teaching: human resources planning and training, decentralised planning and management and district management strengthening; (b) Providing technical support through consultancy work to a number of overseas health systems development projects; and (c) researching in decentralisation and health sector reforms in developing countries. Abstract Experiments with decentralisation began in the late 1970s and continued throughout the 1980s. Decentralisation 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 decentralisation works in developed countries, it will also work in the developing world often pursue decentralisation. 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 decentralisation. Without doubt, the most serious mistake any reformer can make is to assume decentralisation to be a managerial exercise devoid of political cause and consequences. Introduction and Background Globally, during 1950s and 1960s the state played a strong central development role and health policies had largely been decided under the influence of a medical elite (Walt & Gilson 1994). In the 1980s, however, as neo-liberal ideas began to dominate, health policies moved into different arena. Debates about health policy were increasingly characterised by conflict, making them, relative to previous decades, high politics agenda items (Wuyts et al 1992).