Decentralization of health systems in Ghana, Zambia, Uganda and the Philippines: a comparative analysis of decision space
Decentralization of health systems in Ghana, Zambia, Uganda and the Philippines: a comparative analysis of decision space
复制标题
DOI：
10.1093/heapol/17.1.14
复制
发表时间：
2002-03-01
影响因子：
3.2
通讯作者：
Beauvais, JC
中科院分区：
文献类型：
--
作者：
Bossert, TJ;Beauvais, JC
本研究报告审查了加纳、乌干达、赞比亚和菲律宾这四个发展中国家权力下放的经验。它使用两个分析框架来描述和比较每个国家权力下放的类型和程度。第一个框架规定了三种类型的权力下放：权力下放、授权和权力下放。第二个框架使用了一个主要的代理人的方法和创新的地图的“决策空间”，以确定范围的选择不同的功能，从中心转移到外围的系统。分析发现，权力下放的类型和程度各不相同，菲律宾在下放给地方政府单位的许多职能方面的选择范围最广。最少的选择通过授权转移到加纳的一个自治医疗服务机构。乌干达和赞比亚的情况介于这两个极端之间。没有足够的证据表明权力下放的影响，以评估这些差异的“决策空间”如何影响每个卫生系统的业绩。作者认为这是未来研究的一个主要领域。
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 is transferred from the centre to the periphery of the system. The analysis finds a variety of different types and degrees of decentralization, 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. There was insufficient evidence of the impact of decentralization to assess how these differences in 'decision space' influenced the performance of each health system. The authors suggest that this is a major area for future research.