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Decentralization and primary health care: some negative implications in developing countries

C Collins1, A Green

  • 1Nuffield Institute for Health, Leeds, England.

International Journal of Health Services : Planning, Administration, Evaluation
|January 1, 1994
PubMed
Summary

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Decentralization in primary health care can have negative implications, particularly in developing countries. Careful consideration is needed to ensure it supports, rather than hinders, equitable health policies and avoids strengthening political domination.

Area of Science:

  • Public Health
  • Health Policy
  • Health Systems Strengthening

Background:

  • Decentralization is a prominent strategy in global Primary Health Care (PHC) policies.
  • While often beneficial, decentralization presents potential drawbacks that require careful examination.
  • The context of developing countries is particularly relevant for understanding these implications.

Purpose of the Study:

  • To analyze the negative implications of health policy decentralization.
  • To explore the relationship between decentralization and equity in health.
  • To identify conditions under which decentralization may reinforce political domination.

Main Methods:

  • Critical analysis of decentralization's impact on health policies.
  • Examination of the inherent tension between decentralization (promoting difference) and equity (promoting equivalence).
Keywords:
Community FinancingCritiqueDecentralizationDelivery Of Health CareDeveloping CountriesEconomic FactorsFinancial ActivitiesHealthHealth ServicesMacroeconomic FactorsManagementNeedsObstaclesPlanningPolitical FactorsPrimary Health CarePrivate SectorPublic Sector

Related Experiment Videos

  • Case study considerations focusing on developing countries.

    • Main Results:

    • Decentralization can be associated with limitations on state capacity.
    • A potential conflict exists between the goals of decentralization and health equity.
    • Decentralization can, in certain contexts, exacerbate political domination.

    Conclusions:

    • A checklist of critical questions and issues is proposed.
    • Ensuring decentralization genuinely supports PHC orientation is crucial.
    • Awareness of potential negative consequences is vital for effective policy implementation.