Objectives of Decentralization

Health reformers pursue decentralization largely to increase health sector performance, but in many cases governance and political objectives also figure importantly. The following list enumerates frequently cited objectives.

  1. Increase service delivery effectiveness through adaptation to local conditions and targeting to local needs.
  2. Improve efficiency of resource utilization by incorporating local preferences into determination of service mix and expenditures.
  3. Increase cost-consciousness and efficiency of service production through closer links between resource allocation and utilization.
  4. Increase health worker motivation through local supervision and involvement of service users in oversight, performance assessment, etc.
  5. Improve accountability, transparency, and legitimacy by embedding health service delivery in local administrative systems.
  6. Increase citizen participation in health service delivery by creating systems and procedures for involvement in planning, allocation, oversight, and evaluation.
  7. Increase equity of service delivery by enabling marginalized and poor groups to access health care providers and to influence decisions on service mix and expenditures.
  8. Increase the role of the private sector in health service delivery by separating financing of health care from service provision.

References: IS1

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