The Harvard School of Public Health, has developed a unique approach to the evaluation of the decentralization of health systems. This approach, called the Decision-Space Approach, focuses on defining the range of choice (narrow to wide) over a specified series of functions (financing, service organization, human resources, targeting and governance) that is allowed to local decision-makers (see Bossert "Analyzing the Decentralization of Health Systems in Developing Countries" Social Science and Medicine 47,10). It attempts to establish a link between the range of choices available to local officials, the choices they made, in particular the innovative choices, and their effects on the performance of the decentralized system. This paper will present the final results of four country studies that have used the approach: Chile, Bolivia, Colombia and Zambia. Using this approach, local teams of researchers were chosen in Chile, Bolivia, Colombia and Zambia to implement applied research evaluations of these important experiences in decentralization. The studies have collected and analyzed nationally available data on income and expenditures, human resources data, utilization of public health services, and socio-economic conditions. Field case studies with interviews of officials and observers in selected municipalities in the countries have been implemented. Preliminary results suggest important lessons for policy making on decentralization. The LAC studies were funded by USAID through the DDM Project and the African case was funded through the PHR Project. The studies will be completed in June 2000 in time for results to be presented at the conference.
Learning Objectives: Audience should learn about new means of analyzing decentralization of health systems and its implications for equity, efficiency, and quality in four developing countries
Keywords: International Health, Health Care Restructuring
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: International Health Systems Group, Department of Population and International Health, Harvard School of Public Health
USAID Projects: Data for Decision Making and Partnerships for Health Reform
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: employment