Through Mintzberg's glasses: a fresh look at the organization of ministries of health

In 1987, district health care policies were officially adopted by a majorit y of developing countries. Many operational problems constraining implement ation of such policies have subsequently been identified, most of which are attributable to well-known characteristics of less developed countries. Ho wever, the policy of operational and administrative decentralization has of ten been critically obstructed by inappropriate organizational structures i n ministries of health. By applying Mintzberg's analytical framework to sev eral ministries of health, we identify structural deficiencies that make sy stems unfit to match their policy environment and yield the expected outcom es of functional and decentralized services. We propose a typology likely t o elicit strategies for decentralizing health care administration. Our anal ysis is based on the following steps: a description of Mintzberg's concepts of organizational structure, generic components (strategic apex, technostructure, supporting structure, middle l ine, operational core) and functions (horizontal and vertical integration, liaison devices, vertical and horizontal decentralization) applied to healt h systems; a discussion of divisionalized adhocracy as a suitable configuration for he alth organizations with a need for a high degree of regional autonomy, comm unity participation, medical staff initiative, action research and operatio nal research, and continuous evaluation; a discussion of the organizational features of a number of health ministry systems and a consideration of strategies for transforming configurations t owards divisionalized adhocracy.