IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0206809.html
   My bibliography  Save this article

What conditions enable decentralization to improve the health system? Qualitative analysis of perspectives on decision space after 25 years of devolution in the Philippines

Author

Listed:
  • Harvy Joy Liwanag
  • Kaspar Wyss

Abstract

Background: Decentralization is promoted as a strategy to improve health system performance by bringing decision-making closer to service delivery. Some studies have investigated if decentralization actually improves the health system. However, few have explored the conditions that enable it to be effective. To determine these conditions, we have analyzed the perspectives of decision-makers in the Philippines where devolution, one form of decentralization, was introduced 25 years ago. Methods: Drawing from the “decision space” approach, we interviewed 27 decision-makers with an average of 23.6 years of working across different levels of the Philippine government health sector and representing various local settings. Qualitative analysis followed the “Framework Method.” Conditions that either enable or hinder the effectiveness of decentralization were identified by exploring decision-making in five health sector functions. Results: These conditions include: for planning, having a multi-stakeholder approach and monitoring implementation; for financing and budget allocation, capacities to raise revenues at local levels and pooling of funds at central level; for resource management, having a central level capable of augmenting resource needs at local levels and a good working relationship between the local health officer and the elected local official; for program implementation and service delivery, promoting innovation at local levels while maintaining fidelity to national objectives; and for monitoring and data management, a central level capable of ensuring that data collection from local levels is performed in a timely and accurate manner. Conclusions: The Philippine experience suggests that decentralization is a long and complex journey and not an automatic solution for enhancing service delivery. The role of the central decision-maker (e.g. Ministry of Health) remains important to assist local levels unable to perform their functions well. It is policy-relevant to analyze the conditions that make decentralization work and the optimal combination of decentralized and centralized functions that enhance the health system.

Suggested Citation

  • Harvy Joy Liwanag & Kaspar Wyss, 2018. "What conditions enable decentralization to improve the health system? Qualitative analysis of perspectives on decision space after 25 years of devolution in the Philippines," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-20, November.
    • Handle: RePEc:plo:pone00:0206809
    DOI: 10.1371/journal.pone.0206809
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206809
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0206809&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0206809?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Faguet, Jean-Paul & Poschl, Caroline (ed.), 2015. "Is Decentralization Good For Development?: Perspectives from Academics and Policy Makers," OUP Catalogue, Oxford University Press, number 9780198737506.
    2. Sumah, Anthony Mwinkaara & Baatiema, Leonard & Abimbola, Seye, 2016. "The impacts of decentralisation on health-related equity: A systematic review of the evidence," Health Policy, Elsevier, vol. 120(10), pages 1183-1192.
    3. Edwine W Barasa & Anthony M Manyara & Sassy Molyneux & Benjamin Tsofa, 2017. "Recentralization within decentralization: County hospital autonomy under devolution in Kenya," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-18, August.
    4. Daniel Cobos Muñoz & Paloma Merino Amador & Laura Monzon Llamas & David Martinez Hernandez & Juana Maria Santos Sancho, 2017. "Decentralization of health systems in low and middle income countries: a systematic review," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 62(2), pages 219-229, March.
    5. Konrad Obermann & Matthew Jowett & Juanito Taleon & Melinda Mercado, 2008. "Lessons for health care reform from the less developed world: the case of the Philippines," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 9(4), pages 343-349, November.
    6. Joseph J. Capuno & Orville C. Solon, 1996. "The Impact of Devolution on Local Health Expenditures: Anecdotes and Some Estimates from the Philippines," Philippine Review of Economics, University of the Philippines School of Economics and Philippine Economic Society, vol. 33(2), pages 283-318, December.
    7. Casey, Katherine, 2018. "Radical Decentralization: Does Community Driven Development Work?," Research Papers 3629, Stanford University, Graduate School of Business.
    8. Obermann, Konrad & Jowett, Matthew R. & Alcantara, Maria Ofelia O. & Banzon, Eduardo P. & Bodart, Claude, 2006. "Social health insurance in a developing country: The case of the Philippines," Social Science & Medicine, Elsevier, vol. 62(12), pages 3177-3185, June.
    9. Bossert, Thomas, 1998. "Analyzing the decentralization of health systems in developing countries: decision space, innovation and performance," Social Science & Medicine, Elsevier, vol. 47(10), pages 1513-1527, November.
    10. Nemia Sucaldito & Enrique Tayag & Maria Roces & Michael Malison & Brian Robie & Elizabeth Howze, 2014. "The Philippines Field Management Training Program (FMTP): strengthening management capacity in a decentralized public health system," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 59(6), pages 897-903, December.
    11. Bossert, Thomas John & Mitchell, Andrew David, 2011. "Health sector decentralization and local decision-making: Decision space, institutional capacities and accountability in Pakistan," Social Science & Medicine, Elsevier, vol. 72(1), pages 39-48, January.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Anne Christine Stender Heerdegen & Moses Aikins & Samuel Amon & Samuel Agyei Agyemang & Kaspar Wyss, 2020. "Managerial capacity among district health managers and its association with district performance: A comparative descriptive study of six districts in the Eastern Region of Ghana," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-18, January.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Yue Dong & Dipanwita Sarkar & Jayanta Sarkar, 2021. "Decentralization and health resource allocation: Quasi-experimental evidence from China," QuBE Working Papers 060, QUT Business School.
    2. Niccol? Persiani & Martina Giusti & Maria Jose Caldes & Afef Hagi, 2022. "Il contributo del management alla definizione della strategia di decentramento del Servizio Sanitario: il caso del Servizio Sanitario Tunisino," MECOSAN, FrancoAngeli Editore, vol. 2022(122), pages 85-103.
    3. Abrigo, Michael Ralph M. & Ortiz, Danica Aisa P. & Tam, Zhandra C, 2017. "Decentralization and Health in the Philippines: A Systematic Review of Empirical Evidences," Discussion Papers DP 2017-58, Philippine Institute for Development Studies.
    4. Feldhaus, Isabelle & Chatterjee, Susmita & Clarke-Deelder, Emma & Brenzel, Logan & Resch, Stephen & Bossert, Thomas J., 2023. "Examining decentralization and managerial decision making for child immunization program performance in India," Social Science & Medicine, Elsevier, vol. 317(C).
    5. Mikael Ohrling & John Øvretveit & Mats Brommels, 2021. "Can management decentralisation resolve challenges faced by healthcare service delivery organisations? Findings for managers and researchers from a scoping review," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(1), pages 30-41, January.
    6. Makokha, Racheal Omukhulu, 2017. "Does Decentralization Improve Provision of Health Services? Evidence from Kisumu and Makueni Counties in Kenya," Thesis Commons xef7a, Center for Open Science.
    7. London, Jonathan D., 2013. "The promises and perils of hospital autonomy," Social Science & Medicine, Elsevier, vol. 96(C), pages 232-240.
    8. Smith, Stephanie L., 2014. "Political contexts and maternal health policy: Insights from a comparison of south Indian states," Social Science & Medicine, Elsevier, vol. 100(C), pages 46-53.
    9. Ramadhani Kigume & Stephen Maluka, 2019. "Health sector decentralisation in Tanzania: Analysis of decision space in human resources for health management," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1265-1276, October.
    10. Katherine Casey & Rachel Glennerster & Edward Miguel & Maarten Voors, 2023. "Skill Versus Voice in Local Development," The Review of Economics and Statistics, MIT Press, vol. 105(2), pages 311-326, March.
    11. Ramiro Guerrero & Sergio I. Prada & Dov Chernichovsky, 2014. "La doble descentralización en el sector salud: evaluación y alternativas de política pública," Cuadernos de Fedesarrollo 12019, Fedesarrollo.
    12. Hilaire Zon & Milena Pavlova & Wim Groot, 2020. "Regional health disparities in Burkina Faso during the period of health care decentralization. Results of a macro‐level analysis," International Journal of Health Planning and Management, Wiley Blackwell, vol. 35(4), pages 939-959, July.
    13. Taiwo Obembe & Sharon Fonn, 2020. "Affording unavoidable emergency surgical care – The lived experiences and payment coping strategies of households in Ibadan metropolis, Southwestern Nigeria," PLOS ONE, Public Library of Science, vol. 15(5), pages 1-18, May.
    14. Ardanaz, Martin & Otálvaro-Ramírez, Susana & Scartascini, Carlos, 2023. "Does information about citizen participation initiatives increase political trust?," World Development, Elsevier, vol. 162(C).
    15. Hakiman, Kamran & Sheely, Ryan, 2023. "Unlocking the Potential of Participatory Planning: How Flexible and Adaptive Governance Interventions Can Work in Practice," OSF Preprints kucjs, Center for Open Science.
    16. Seregious Be-ere, 2022. "Decentralization Reforms in Developing Countries Designed to Champion the Interests of Central Politicians and not Grassroots Development," Journal of Developing Societies, , vol. 38(1), pages 27-49, March.
    17. Wesam Mansour & Adelaine Aryaija‐Karemani & Tim Martineau & Justine Namakula & Paul Mubiri & Freddie Ssengooba & Joanna Raven, 2022. "Management of human resources for health in health districts in Uganda: A decision space analysis," International Journal of Health Planning and Management, Wiley Blackwell, vol. 37(2), pages 770-789, March.
    18. Fumagalli, Laura & Martin, Thomas, 2023. "Child labor among farm households in Mozambique and the role of reciprocal adult labor," World Development, Elsevier, vol. 161(C).
    19. Omar Galárraga & Sandra Sosa-Rubí & Aarón Salinas-Rodríguez & Sergio Sesma-Vázquez, 2010. "Health insurance for the poor: impact on catastrophic and out-of-pocket health expenditures in Mexico," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(5), pages 437-447, October.
    20. Pushkar Maitra & Sandip Mitra & Dilip Mookherjee & Sujata Visaria, 2020. "Decentralized Targeting of Agricultural Credit Programs: Private versus Political Intermediaries," HKUST IEMS Working Paper Series 2020-70, HKUST Institute for Emerging Market Studies, revised Jan 2020.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0206809. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.