Resource allocation and budgetary mechanisms for decentralized health systems: experiences from Balochistan, Pakistan

This paper identifies key political and technical issues involved in the de velopment of an appropriate resource allocation and budgetary system for th e public health sector, using experience gained in the Province of Balochis tan, Pakistan. The resource allocation and budgetary system is a critical, yet often neglected, component of any decentralization policy. Current syst ems are often based on historical incrementalism that is neither efficient nor equitable. This article describes technical work carried out in Balochi stan to develop a system of resource allocation and budgeting that is needs -based, in line with policies of decentralization, and implementable within existing technical constraints. However, the development of technical syst ems, while necessary, is not a sufficient condition for the implementation of a resource allocation and decentralized budgeting system. This is illust rated by analysing the constraints that have been encountered in the develo pment of such a system in Balochistan.