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What conditions enable decentralization to improve the health system? Qualitative analysis of perspectives on decision space after 25 years of devolution in the Philippines

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  • Harvy Joy Liwanag
  • Kaspar Wyss

Abstract

Background: Decentralization is promoted as a strategy to improve health system performance by bringing decision-making closer to service delivery. Some studies have investigated if decentralization actually improves the health system. However, few have explored the conditions that enable it to be effective. To determine these conditions, we have analyzed the perspectives of decision-makers in the Philippines where devolution, one form of decentralization, was introduced 25 years ago. Methods: Drawing from the “decision space” approach, we interviewed 27 decision-makers with an average of 23.6 years of working across different levels of the Philippine government health sector and representing various local settings. Qualitative analysis followed the “Framework Method.” Conditions that either enable or hinder the effectiveness of decentralization were identified by exploring decision-making in five health sector functions. Results: These conditions include: for planning, having a multi-stakeholder approach and monitoring implementation; for financing and budget allocation, capacities to raise revenues at local levels and pooling of funds at central level; for resource management, having a central level capable of augmenting resource needs at local levels and a good working relationship between the local health officer and the elected local official; for program implementation and service delivery, promoting innovation at local levels while maintaining fidelity to national objectives; and for monitoring and data management, a central level capable of ensuring that data collection from local levels is performed in a timely and accurate manner. Conclusions: The Philippine experience suggests that decentralization is a long and complex journey and not an automatic solution for enhancing service delivery. The role of the central decision-maker (e.g. Ministry of Health) remains important to assist local levels unable to perform their functions well. It is policy-relevant to analyze the conditions that make decentralization work and the optimal combination of decentralized and centralized functions that enhance the health system.

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  • 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.
    • Handle: RePEc:plo:pone00:0206809
    DOI: 10.1371/journal.pone.0206809
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    References listed on IDEAS

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    1. Faguet, Jean-Paul & Poschl, Caroline (ed.), 2015. "Is Decentralization Good For Development?: Perspectives from Academics and Policy Makers," OUP Catalogue, Oxford University Press, number 9780198737506.
    2. Joseph J. Capuno & Orville C. Solon, 1996. "The Impact of Devolution on Local Health Expenditures: Anecdotes and Some Estimates from the Philippines," Philippine Review of Economics, University of the Philippines School of Economics and Philippine Economic Society, vol. 33(2), pages 283-318, December.
    3. Sumah, Anthony Mwinkaara & Baatiema, Leonard & Abimbola, Seye, 2016. "The impacts of decentralisation on health-related equity: A systematic review of the evidence," Health Policy, Elsevier, vol. 120(10), pages 1183-1192.
    4. Edwine W Barasa & Anthony M Manyara & Sassy Molyneux & Benjamin Tsofa, 2017. "Recentralization within decentralization: County hospital autonomy under devolution in Kenya," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-18, August.
    5. Casey, Katherine, 2018. "Radical Decentralization: Does Community Driven Development Work?," Research Papers 3629, Stanford University, Graduate School of Business.
    6. Obermann, Konrad & Jowett, Matthew R. & Alcantara, Maria Ofelia O. & Banzon, Eduardo P. & Bodart, Claude, 2006. "Social health insurance in a developing country: The case of the Philippines," Social Science & Medicine, Elsevier, vol. 62(12), pages 3177-3185, June.
    7. Bossert, Thomas, 1998. "Analyzing the decentralization of health systems in developing countries: decision space, innovation and performance," Social Science & Medicine, Elsevier, vol. 47(10), pages 1513-1527, November.
    8. Nemia Sucaldito & Enrique Tayag & Maria Roces & Michael Malison & Brian Robie & Elizabeth Howze, 2014. "The Philippines Field Management Training Program (FMTP): strengthening management capacity in a decentralized public health system," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 59(6), pages 897-903, December.
    9. 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.
    10. Konrad Obermann & Matthew Jowett & Juanito Taleon & Melinda Mercado, 2008. "Lessons for health care reform from the less developed world: the case of the Philippines," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 9(4), pages 343-349, November.
    11. Bossert, Thomas John & Mitchell, Andrew David, 2011. "Health sector decentralization and local decision-making: Decision space, institutional capacities and accountability in Pakistan," Social Science & Medicine, Elsevier, vol. 72(1), pages 39-48, January.
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    1. Anne Christine Stender Heerdegen & Moses Aikins & Samuel Amon & Samuel Agyei Agyemang & Kaspar Wyss, 2020. "Managerial capacity among district health managers and its association with district performance: A comparative descriptive study of six districts in the Eastern Region of Ghana," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-18, January.

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