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Decentralisation, Governance and Health-System Performance: 'Where You Stand Depends on Where You Sit'


  • Andrew Mitchell
  • Thomas J. Bossert


Advocates of local government often argue that when decentralisation is accompanied by adequate mechanisms of accountability, particularly those responsive to local preferences, improved service delivery will result. From the perspective of the health sector, the appropriate degree of decentralisation and the necessary mechanisms of accountability depend upon the achievement of health system goals. Drawing on evidence from six countries (Bolivia, Chile, India, Pakistan, Philippines, Uganda), this article comes to the conclusion that a balance between centralisation of some functions and decentralisation of others, along with improved mechanisms of accountability, is needed to achieve health system objectives. Copyright (c) The Authors 2010. Development Policy Review (c) 2010 Overseas Development Institute..

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  • Andrew Mitchell & Thomas J. Bossert, 2010. "Decentralisation, Governance and Health-System Performance: 'Where You Stand Depends on Where You Sit'," Development Policy Review, Overseas Development Institute, vol. 28(6), pages 669-691, November.
  • Handle: RePEc:bla:devpol:v:28:y:2010:i:6:p:669-691

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    Cited by:

    1. Solveig Danielsen & Frank B. Matsiko, 2016. "Using a plant health system framework to assess plant clinic performance in Uganda," Food Security: The Science, Sociology and Economics of Food Production and Access to Food, Springer;The International Society for Plant Pathology, vol. 8(2), pages 345-359, April.

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