Decentralisation of the Healthcare Systems and the Functioning of Public Health Programmes in Single‐Party States: A Systematic Review

Introduction Decentralisation is the transfer of authority from central to local governments, involving shared responsibilities in planning, management, and decision‐making. In public health, decentralisation might help improve service delivery by allowing local authorities to tailor interventions to the specific needs of diverse, geographically dispersed communities. However, no systematic review has been done on the state of knowledge regarding the capacity of local governments to influence the emergence and operation of national public health programmes in Marxist‐Leninist single‐party states. Method Following the PRISMA protocol, 859 articles from the PubMed, EMBASE and Web of Science databases were examined. To be selected, studies had to be conducted in a Marxist‐Leninist single‐party country with a centralised economy and focused on the question of the condition of power sharing between government levels in the design and implementation of specific public health programmes. Only articles in English published between 2013 and 2023 were considered, resulting in 18 studies. Their quality was assessed using the MMAT 2018 and SANRA tools. Results Limited resources and the Party's fundamental ideology may constrain the extent of power sharing influencing local government empowerment. However, factors such as the Party's local unit engagement, collaboration with external organisations, and use of digital communication platforms enhance the capacity of local government to participate in public health programmes design and execution. Conclusion Despite a politically centralising structure, one‐party countries can, under certain circumstances, share responsibilities across government levels in order to increase the adequacy of programmes to meet the health needs of the population.