Decentralization of health systems in low and middle income countries: a systematic review

Daniel Cobos Muñoz (), Paloma Merino Amador (), Laura Monzon Llamas (), David Martinez Hernandez () and Juana Maria Santos Sancho ()
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Daniel Cobos Muñoz: Swiss Tropical and Public Health Institute
Paloma Merino Amador: Hospital Clínico San Carlos
Laura Monzon Llamas: Swiss Tropical and Public Health Institute
David Martinez Hernandez: Complutense University
Juana Maria Santos Sancho: Complutense University

International Journal of Public Health, 2017, vol. 62, issue 2, No 6, 219-229

Abstract: 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.

Keywords: Systematic review; Decentralization; District health system; Universal health coverage; Health sector reform; UHC; Governance; LMIC (search for similar items in EconPapers)
Date: 2017
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Citations: View citations in EconPapers (12)

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DOI: 10.1007/s00038-016-0872-2

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