IBSS: Understanding the Dynamics of Local Health Systems in Developing Countries: Decentralization and Polycentric Governance Theory

这一跨学科研究项目侧重于影响发展中国家地方卫生系统绩效的体制条件。推动该项目的问题是，许多国家的卫生系统无法防止极端的健康差距和人类痛苦。在地方体制安排能够比中央政府机构提供更好的公共服务的前提下进行的权力下放改革，是对这些差距的普遍反应。问题是，关于卫生部门权力下放的理论论点不够发达，评估改革后的制度是否会产生更健康的社区的经验结果也参差不齐。该项目将重点解释为什么一些地方卫生系统的表现好于其他系统。研究人员将通过开发和测试关于治理结构如何影响当地卫生系统绩效的具体假设来解决这个问题。该项目有三个组成部分。研究人员将借鉴新制度主义和多中心治理方面的工作，开发一种将权力下放、行为模式和地方卫生系统绩效联系起来的理论。他们将收集洪都拉斯250个地方卫生系统的时间序列、横断面和社会网络数据，其中一半已下放给地方组织，其余由中央政府管理。研究人员将把现有的纵向健康数据与社会经济和机构数据结合起来，他们将与该领域的卫生系统参与者一起实施原始的社会网络地图、调查数据收集和行为实验。他们将使用这些数据来检验关于治理结构如何通过改变当地组织和个人的行为来影响卫生系统绩效的几个假设。这个项目将产生关于影响发展中国家卫生系统绩效差异的地方和制度因素的证据。所考察的问题具有理论意义，因为它们涉及公共政策如何通过人类机构以及组织和个人行为影响社会结果。通过建立理论，实施创新的研究设计，构建原始数据集，并使用定量和定性分析来测试理论，研究人员将就导致地方卫生系统绩效差异的制度条件以及卫生部门权力下放的有效性做出强有力的发现。该项目将具有直接的实用价值，因为世界各国正在努力制定有效管理卫生系统和改善社区卫生的政策。项目结果将使政策制定者、分析师和捐助者更深入地了解影响卫生系统绩效的因素、改进这一绩效的具体建议以及评估治理改革有效性的一套创新方法。这项工作的结果将与许多其他领域相关，如教育、农业和环境，在这些领域，中央政府也将决策权移交给下级政府。该项目由美国国家科学基金会跨学科行为和社会科学研究竞赛(IBSS)资助。

This interdisciplinary research project focuses on the institutional conditions that shape the performance of local health systems in developing countries. The problem motivating the project is the inability of health systems in many countries to prevent extreme health disparities and human suffering. Decentralization reforms that operate on the premise that local institutional arrangements can provide public services better than central government agencies are a ubiquitous response to these disparities. The problem is that theoretical arguments for health-sector decentralization are underdeveloped, and empirical results assessing whether reformed systems produce healthier communities are mixed. The project will focus on explaining why some local health systems perform better than others. The researchers will address this question by developing and testing specific hypotheses about the ways governance structure affects the performance of local health systems. The project has three components. The researchers will draw on work in new institutionalism and polycentric governance to develop a theory linking decentralization, behavior patterns, and the performance of local health systems. They will collect time-series, cross-sectional, and social network data for 250 local health systems in Honduras, half of which have been decentralized to local organizations and the remainder managed by the central government. The researchers will combine existing longitudinal health data with socioeconomic and institutional data, and they will implement original social network mapping, survey data collection, and behavioral experiments with health system actors in the field. They will use these data to test several hypotheses about the ways governance structure affects health-system performance through changes in the behavior of local organizations and individuals.This project will generate evidence about the local and institutional factors that affect disparities in the performance of health systems in developing countries. The questions examined are of theoretical significance, because they address how public policies affect societal outcomes through human institutions, as well as organizational and individual behavior. By building theory, implementing an innovative research design, constructing an original dataset, and employing quantitative and qualitative analyses to test theory, the researchers will contribute robust findings about the institutional conditions that drive differences in local health-system performance as well as the effectiveness of health-sector decentralization. The project will have immediate practical value as countries around the world struggle to create policies for effectively administering health systems and improving community health. Project findings will provide policy makers, analysts, and donors with a deeper understanding of the factors influencing health system performance, specific recommendations for improving that performance, and an innovative set of methods to evaluate the effectiveness of governance reforms. The results of this work will be relevant to numerous other sectors, such as education, agriculture, and the environment, where central governments have also transferred policy-making power to lower levels of government. This project is supported by the NSF Interdisciplinary Behavioral and Social Sciences Research (IBSS) competition.