Improving maternal health is a Millennium Development Goal adopted at the 2000 Millennium Summit of the United Nations. As part of the improving maternal health in Tanzania, it has been recommended that skilled birth attendants be present at all births to help reduce the high maternal mortality ratio. However, utilization of these attendants varies across socio-economic groups. The government o...

Origin of this Collection Over the past four years the Ontario Ministry of Health and Long-Term Care (MOHLTC) has been engaged in transforming the province’s health system, a process that includes decentralizing decisions pertaining to the delivery of services. This decentralization is occurring through the devolution of decisionmaking to the newly created Local Health Integration Networks (LHI...

Background Indonesia comprises 17,000 islands and 495 districts. Decentralization mandates district health services, but ensuring proper supply chain management (SCM) capacity at the district level is a challenge. The ministry of health developed and implemented SCM training modules and guidelines; however, weaknesses in the system remain, particularly related to human resources. The ministry i...

This study examines the impact of political decentralization on an essential public service provided in almost all countries: childhood immunization. The relationship is examined empirically using a time-series data set of 140 low- and middle-income countries from 1980 to 1997. The study finds that decentralization has different effects in low- and middle-income countries. In the low-income gro...

BACKGROUND The Brazilian health reform process, following the establishment of the Unified Health System (SUS), has had a strong emphasis on decentralization, with a special focus on financing, management and inter-managerial agreements. Brazil is a federal country and the Ministry of Health (MoH), through the Secretary of Labour Management and Health Education, is responsible for establishing ...

OBJECTIVE To assess the effect of decentralization (DC) of antiretroviral therapy (ART) provision in a rural district of Malawi using an integrated primary care model. METHODS Between October 2004 and December 2008, 8093 patients (63% women) were registered for ART. Of these, 3440 (43%) were decentralized to health centres for follow-up ART care. We applied multivariate regression analysis th...

This article focuses on the development of public health in Brazil, with the aim of analyzing the present process of decentralization of health care. The authors argue that the neoliberal or conservative position is unable to offer a reasonable solution to problems in the health care system. On the other hand, the reformist position concentrates its attention on the health system and its admini...

OBJECTIVE To describe how district-wide access to HIV/AIDS care was achieved and maintained in Thyolo District, Malawi. METHOD In mid-2003, the Ministry of Health and Médecins Sans Frontières developed a model of care for Thyolo district (population 587, 455) based on decentralization of care to health centres and community sites and task shifting. RESULTS After delegating HIV testing and c...

HIV/AIDS remains the second most common cause of death in low and middle-income countries (LMICs), and only 34% of eligible patients in Africa received antiretroviral therapy (ART) in 2013. This study investigated the impact of ART decentralization on patient enrollment and retention in rural Malawi. We reviewed electronic medical records of patients registered in the Neno District ART program ...