Decentralisation – A Portmanteau Concept That Promises Much but Fails to Deliver?; Comment on “Decentralisation of Health Services in Fiji: A Decision Space Analysis”
نویسنده
چکیده مقاله:
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.
منابع مشابه
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 conceptu...
متن کاملDecentralisation – A Portmanteau Concept That Promises Much but Fails to Deliver?
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 conceptu...
متن کاملDecentralisation of Health Services in Fiji: A Decision Space Analysis
Background Decentralisation aims to bring services closer to the community and has been advocated in the health sector to improve quality, access and equity, and to empower local agencies, increase innovation and efficiency and bring healthcare and decision-making as close as possible to where people live and work. Fiji has attempted two approaches to decentralisation. The current approach refl...
متن کاملDecentralisation, Decision Space and Directions for Future Research; Comment on “Decentralisation of Health Services in Fiji: A Decision Space Analysis”
Decentralisation continues to re-appear in health system reform across the world. Evaluation of these reforms reveals how research on decentralisation continues to evolve. In this paper, we examine the theoretical foundations and empirical references which underpin current approaches to studying decentralisation in health systems.
متن کاملLow Decision Space Means No Decentralization in Fiji; Comment on “Decentralisation of Health Services in Fiji: A Decision Space Analysis”
Mohammed, North, and Ashton find that decentralization in Fiji shifted health-sector workloads from tertiary hospitals to peripheral health centres, but with little transfer of administrative authority from the centre. Decisionmaking in five functional areas analysed remains highly centralized. They surmise that the benefits of decentralization in terms of services and outcomes will be limited....
متن کاملDecision Space and Capacities in the Decentralization of Health Services in Fiji; Comment on “Decentralisation of Health Services in Fiji: A Decision Space Analysis”
The study of decentralization in Fiji shows that increasing capacities is not necessarily related to increasing decision space of local officials, which is in contrast with earlier studies in Pakistan. Future studies should address the relationship among decision space, capacities, and health system performance.
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عنوان ژورنال
دوره 5 شماره 12
صفحات 729- 732
تاریخ انتشار 2016-12-01
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