Health Care Organization Centralized And Decentralized

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Health Care Organization Centralized And Decentralized

Health Care Organization Centralized and Decentralized


The implementation of decentralisation reforms in the health sector of started in the 1980s. These reforms were intended to relinquish substantial powers and resources to districts to improve the development of the health sector. Little is known about the impact of decentralisation on recruitment and distribution of health workers at the district level. Reported difficulties in recruiting health workers to remote districts led the Government to partly re-instate central recruitment of health workers. The effects of this policy change are not yet documented. This study highlights the experiences and challenges associated with decentralisation and the partial re-centralisation in relation to the recruitment and distribution of health workers.


There have been a number of studies from both high and low income countries that attempt to analyse the most central factors for effective recruitment of health workers to remote places. Most of these studies have focused on the attributes of particular locations where the challenge is greatest. Personal attributes of the prospective job-seekers or those who are already employed, such as rural origin, socio-economic, demographic and family background etc., have also been addressed. However, little emphasis has been placed on the potential role of the health sector organisation in recruitment. We shall argue that the hindrances and/or opportunities inherent in the health sector organisation (centralised or decentralised) may have substantial implications on recruitment, distribution and retention of health workers (Werlin, 1992).

Decentralisation has been defined as a process that involves one or all of the following aspects: i) the shifting of workload from centrally located officials to staff or offices outside the national capital (deconcentration), ii) the transfer of management from the centre to semi-autonomous organisations and agencies within the public service structure (delegation), iii) the transfer of political and decision-making powers and authority for managing public services to independently elected local governments (devolution), and iv) the transfer of management and financing functions to a private organisation (privatisation) (Wang et al, 2002).

The concept of decentralisation has become a catch word not only within health sector reform strategies but also in the overall policy and theoretical debates underpinning the development literature. However, it is by no means a new concept. Decentralisation reforms gained a special status during the earliest primary health care reforms initiated by the World Health Organization (WHO) following the Alma-Ata Declaration of 1978. This declaration emphasised that community participation is a crucial ingredient for the development of responsive health-care systems both in high and low income countries. Community participation was seen as being achieved if more political powers and resources were relinquished from the centre to the local government authorities through a decentralisation process. Conceived in the framework of the primary health-care philosophy, decentralisation was supposed to ensure efficiency, effectiveness and accountability in the management of health-care services and resources (Mills, 1994).

There is a substantial body of literature on the decentralisation reforms in the health sector both from middle and low income ...
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