IDEAS home Printed from https://ideas.repec.org/a/spr/ijphth/v62y2017i2d10.1007_s00038-016-0872-2.html
   My bibliography  Save this article

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
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s00038-016-0872-2
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s00038-016-0872-2?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Loubiere, Sandrine & Boyer, Sylvie & Protopopescu, Camélia & Bonono, Cécile Renée & Abega, Séverin-Cécile & Spire, Bruno & Moatti, Jean-Paul, 2009. "Decentralization of HIV care in Cameroon: Increased access to antiretroviral treatment and associated persistent barriers," Health Policy, Elsevier, vol. 92(2-3), pages 165-173, October.
    2. Gilson, Lucy & Mills, Anne, 1995. "Health sector reforms in sub-Saharan Africa: lessons of the last 10 years," Health Policy, Elsevier, vol. 32(1-3), pages 215-243.
    3. United Nations UN, 2015. "Transforming our World: the 2030 Agenda for Sustainable Development," Working Papers id:7559, eSocialSciences.
    4. Ciccone, Dana Karen & Vian, Taryn & Maurer, Lydia & Bradley, Elizabeth H., 2014. "Linking governance mechanisms to health outcomes: A review of the literature in low- and middle-income countries," Social Science & Medicine, Elsevier, vol. 117(C), pages 86-95.
    5. Campos-Outcalt, Doug & Kewa, Kelly & Thomason, Jane, 1995. "Decentralization of health services in Western Highlands Province, Papua New Guinea: An attempt to administer health service at the subdistrict level," Social Science & Medicine, Elsevier, vol. 40(8), pages 1091-1098, April.
    6. Katie Willis & Sorayya Khan, 2009. "Health Reform in Latin America and Africa: decentralisation, participation and inequalities," Third World Quarterly, Taylor & Francis Journals, vol. 30(5), pages 991-1005.
    7. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    8. Andrew Cassels, 1995. "Health sector reform: Key issues in less developed countries," Journal of International Development, John Wiley & Sons, Ltd., vol. 7(3), pages 329-347, May.
    9. Liu, Xiaoyun & Martineau, Tim & Chen, Lieping & Zhan, Shaokang & Tang, Shenglan, 2006. "Does decentralisation improve human resource management in the health sector? A case study from China," Social Science & Medicine, Elsevier, vol. 63(7), pages 1836-1845, October.
    10. Arrieta, Alejandro, 2011. "Health reform and cesarean sections in the private sector: The experience of Peru," Health Policy, Elsevier, vol. 99(2), pages 124-130, February.
    11. Khaleghian, Peyvand, 2004. "Decentralization and public services: the case of immunization," Social Science & Medicine, Elsevier, vol. 59(1), pages 163-183, July.
    12. Mills, A. & Antonius, R. & Daniel, J. & Gray, H. & Haqq, E. & Rutten, F., 2002. "The distribution of health planning and management responsibilities between centre and periphery: historical patterns and reform trends in four Caribbean territories," Health Policy, Elsevier, vol. 62(1), pages 65-84, October.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Abrigo, Michael Ralph M. & Ortiz, Danica Aisa P. & Tam, Zhandra C, 2017. "Decentralization and Health in the Philippines: A Systematic Review of Empirical Evidences," Discussion Papers DP 2017-58, Philippine Institute for Development Studies.
    2. 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).
    3. 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.
    4. 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).
    5. 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.
    6. 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.
    7. 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).
    8. 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.
    9. 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.
    10. Yue Dong & Dipanwita Sarkar & Jayanta Sarkar, 2021. "Decentralization and health resource allocation: Quasi-experimental evidence from China," QuBE Working Papers 060, QUT Business School.
    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.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Gonzalez Block, Miguel Angel, 1997. "Comparative research and analysis methods for shared learning from health system reforms," Health Policy, Elsevier, vol. 42(3), pages 187-209, December.
    2. Collins, Charles & Green, Andrew & Hunter, David, 1999. "Health sector reform and the interpretation of policy context," Health Policy, Elsevier, vol. 47(1), pages 69-83, April.
    3. Zain ul Abedin Janjua & Gengeswari Krishnapillai & Mobashar Rahman, 2021. "A Systematic Literature Review of Rural Homestays and Sustainability in Tourism," SAGE Open, , vol. 11(2), pages 21582440211, April.
    4. Widmer, J. & Christ, B. & Grenz, J. & Norgrove, L., 2024. "Agrivoltaics, a promising new tool for electricity and food production: A systematic review," Renewable and Sustainable Energy Reviews, Elsevier, vol. 192(C).
    5. Olivia Magwood & Victoire Kpadé & Kednapa Thavorn & Sandy Oliver & Alain D Mayhew & Kevin Pottie, 2019. "Effectiveness of home-based records on maternal, newborn and child health outcomes: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 14(1), pages 1-17, January.
    6. Khaleghian, Peyvand & Gupta, Monica Das, 2005. "Public management and the essential public health functions," World Development, Elsevier, vol. 33(7), pages 1083-1099, July.
    7. Arelys López‐Concepción & Ana I. Gil‐Lacruz & Isabel Saz‐Gil, 2022. "Stakeholder engagement, Csr development and Sdgs compliance: A systematic review from 2015 to 2021," Corporate Social Responsibility and Environmental Management, John Wiley & Sons, vol. 29(1), pages 19-31, January.
    8. Buse, Kent & Walt, Gill, 1996. "Aid coordination for health sector reform: a conceptual framework for analysis and assessment," Health Policy, Elsevier, vol. 38(3), pages 173-187, December.
    9. Khaleghian, Peyvand, 2003. "Decentralization and public services : the case of immunization," Policy Research Working Paper Series 2989, The World Bank.
    10. Gioconda Riofrío-Calderón & María-Soledad Ramírez-Montoya, 2022. "Mediation and Online Learning: Systematic Literature Mapping (2015–2020)," Sustainability, MDPI, vol. 14(5), pages 1-21, March.
    11. Nathalia Suchek & João J. Ferreira & Paula O. Fernandes, 2022. "A review of entrepreneurship and circular economy research: State of the art and future directions," Business Strategy and the Environment, Wiley Blackwell, vol. 31(5), pages 2256-2283, July.
    12. Joseph Crawford & Javier Cifuentes-Faura, 2022. "Sustainability in Higher Education during the COVID-19 Pandemic: A Systematic Review," Sustainability, MDPI, vol. 14(3), pages 1-11, February.
    13. Takondwa Mwase, 2021. "Health financing policy reforms for universal health coverage in eastern, central and southern Africa (ECSA)-health community region," Working Papers 179cherp, Centre for Health Economics, University of York.
    14. Ahmad Farhan Roslan & Terrence Fernando & Sara Biscaya & Noralfishah Sulaiman, 2021. "Transformation towards Risk-Sensitive Urban Development: A Systematic Review of the Issues and Challenges," Sustainability, MDPI, vol. 13(19), pages 1-24, September.
    15. Joana Gonçalves & Ricardo Mateus & José Dinis Silvestre & Ana Pereira Roders, 2020. "Going beyond Good Intentions for the Sustainable Conservation of Built Heritage: A Systematic Literature Review," Sustainability, MDPI, vol. 12(22), pages 1-28, November.
    16. Giulia Borghesi & Piergiuseppe Morone, 2023. "A review of the effects of COVID-19 on food waste," Food Security: The Science, Sociology and Economics of Food Production and Access to Food, Springer;The International Society for Plant Pathology, vol. 15(1), pages 261-280, February.
    17. José Sánchez-Santamaría & Brenda Imelda Boroel-Cervantes & Fátima-María López-Garrido & David Hortigüela-Alcalá, 2021. "Motivation and Evaluation in Education from the Sustainability Perspective: A Review of the Scientific Literature," Sustainability, MDPI, vol. 13(7), pages 1-19, April.
    18. Md Nuruzzaman Khan & Melissa L. Harris & Desalegn Markos Shifti & Alexander Suuk Laar & Deborah Loxton, 2019. "Effects of unintended pregnancy on maternal healthcare services utilization in low- and lower-middle-income countries: systematic review and meta-analysis," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 64(5), pages 743-754, June.
    19. Sarah Shair-Rosenfield, 2022. "Decentralization, intergovernmental coordination, and emergency response in East and Southeast Asia: lessons from combatting the COVID-19 pandemic," Working Papers. Collection A: Public economics, governance and decentralization 2209, Universidade de Vigo, GEN - Governance and Economics research Network.
    20. Diego Sánchez-González & Fermina Rojo-Pérez & Vicente Rodríguez-Rodríguez & Gloria Fernández-Mayoralas, 2020. "Environmental and Psychosocial Interventions in Age-Friendly Communities and Active Ageing: A Systematic Review," IJERPH, MDPI, vol. 17(22), pages 1-34, November.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:ijphth:v:62:y:2017:i:2:d:10.1007_s00038-016-0872-2. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.