THE DECENTRALIZATION OF HEALTH-CARE IN DEVELOPING-COUNTRIES - ORGANIZATIONAL OPTIONS

The complex ways in which decentralization is practised in the field o f government health services are examined. Organizationally, decentral ization means a choice between different types of public institution, which vary in terms of: the areas over which they have jurisdiction, t he functions delegated to local institutions; and the way decision-mak ers are recruited, so producing institutions. There is little agreemen t about the optimum size of areas, either in terms of population or te rritory. Areas cannot be delimited without consideration being given t o the powers to be exercised at each level. The specification of funct ions always assumes certain things about who will exercise the delegat ed powers. The two issues cannot be separated. Five structures of dece ntralization are distinguished, each of which could in principle be cr eated at regional, district and village/community level: the multi-pur pose local authority, the single-purpose council, the hybrid council, the single purpose executive agency, the management board, field admin istration, health teams, and interdepartmental committees. Whatever th e institutions used for decentralization, the choice of structures and the ensuing process of decision-making will be highly charged politic ally. (C) 1997 by John Wiley & Sons, Ltd.