Insights for Implementers Decentralization and Health System Reform

D is pursued for a variety of reasons: technical, political, and financial. On the technical side, it is frequently recommended as a means to improve administrative and service delivery effectiveness. Politically, decentralization usually seeks to increase local participation and autonomy, redistribute power, and reduce ethnic and/or regional tensions. On the financial side, decentralization is invoked as a means of increasing cost efficiency, giving local units greater control over resources and revenues, and sharpening accountability. However, it can also be employed (overtly or covertly) to offload financial responsibility from resource-poor central governments to regional and/or local entities.