Decentralization of Health Systems: Preliminary Review of Four Country Case Studies

摘要

This study reviews the experience of decentralization in four developing countries: Ghana, Uganda, Zambia, and the Philippines. It uses two analytical frameworks to describe and compare the types and degrees of decentralization in each country. The first framework specifies three types of decentralization: deconcentration, delegation, and devolution. The second framework uses a principal agent approach and innovative maps of decision space to define the range of choice for different functions that are transferred from the center to the periphery of the system. The analysis finds a variety of types and degrees of decentralization among the four countries, with the Philippines demonstrating the widest range of choice over many functions that were devolved to local government units. The least choice was transferred through delegation to an autonomous Health Service in Ghana. Uganda and Zambia display variations between these extremes.