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Decentralization of health systems in low and middle income countries: a systematic review

Author

Listed:
  • Daniel Cobos Muñoz

    (Swiss Tropical and Public Health Institute
    University of Basel)

  • Paloma Merino Amador

    (Hospital Clínico San Carlos)

  • Laura Monzon Llamas

    (Swiss Tropical and Public Health Institute
    University of Basel)

  • David Martinez Hernandez

    (Complutense University)

  • Juana Maria Santos Sancho

    (Complutense University)

Abstract

Objectives A substantial number of low and middle income countries (LMICs) have implemented health sector reforms in the last 40 years, and the majority of them have included some degree of decentralization of the health system as part of the wider reform. This review will provide an updated and comprehensive assessment of the effects of decentralization in LMICs. Methods We conducted a systematic review of published and grey literature till May 2015, following standard methods. Results 54 qualitative, quantitative and mixed methods studies conducted in 26 countries were included in the review. We found positive and negative effects of decentralization of health systems in LMICs. Whereas decentralization of governance, financing and service delivery, have been shown to have positive effects on the system; decentralization of resource management has been challenging in several settings. Conclusions Overall, lessons learned from LMICs suggest that factors such as adequate mix of technical skills at the local level to perform decentralized tasks, effective decentralization of decision-making to the periphery, and political leadership are key factors for a successful decentralization.

Suggested Citation

  • 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.
    • Handle: RePEc:spr:ijphth:v:62:y:2017:i:2:d:10.1007_s00038-016-0872-2
    DOI: 10.1007/s00038-016-0872-2
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    Cited by:

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    2. 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).
    3. 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.
    4. Bukenya, Badru & Golooba-Mutebi, Frederick, 2020. "What explains sub-national variation in maternal mortality rates within developing countries? A political economy explanation," Social Science & Medicine, Elsevier, vol. 256(C).
    5. Nathaniel Mason & Charles Oyaya & Julia Boulenouar, 2020. "Reforming urban sanitation under decentralization: Cross‐country learning for Kenya and beyond," Development Policy Review, Overseas Development Institute, vol. 38(1), pages 42-63, January.
    6. Dutta, Anwesha & Fischer, Harry W., 2021. "The local governance of COVID-19: Disease prevention and social security in rural India," World Development, Elsevier, vol. 138(C).
    7. 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.
    8. 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.
    9. Yue Dong & Dipanwita Sarkar & Jayanta Sarkar, 2021. "Decentralization and health resource allocation: Quasi-experimental evidence from China," QuBE Working Papers 060, QUT Business School.
    10. Blanken, Mariëlle & Mathijssen, Jolanda & van Nieuwenhuizen, Chijs & Raab, Jörg & van Oers, Hans, 2023. "Actors’ awareness of network governance in Child Welfare and Healthcare service networks," Health Policy, Elsevier, vol. 127(C), pages 29-36.
    11. Poliana Araújo Palmeira & Ruben Araujo de Mattos & Rosana Salles-Costa, 2020. "Food security governance promoted by national government at the local level: a case study in Brazil," Food Security: The Science, Sociology and Economics of Food Production and Access to Food, Springer;The International Society for Plant Pathology, vol. 12(3), pages 591-606, June.

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