The decentralization of health care in developing countries: organizational options

Smith, Bruce L. R.

doi:10.1002/(sici)1099-162x(199710)17:4<399::aid-pad976>3.0.co;2-p

Cited by 35 publications

(24 citation statements)

References 25 publications

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“…At subnational (regional/local) levels, the incidence and characteristics of poverty result from the interaction between macro-or meso-processes and policies and the particular circumstances of regional/local economies, settlements and households. Local policies are constrained both by the effects of these policies and by the allocation of responsibilities for social and infrastructure expenditure (see, for example, Dillinger, 1993;Smith, 1997). The potential for action depends on the extent of local autonomy, which is limited in most countries, so that, although there may be scope for local decisionmaking on expenditure priorities and pricing/subsidy policies, the design of social policies and safety nets, and measures to support economic activities, the impact of local policies is likely to be outweighed by the effects of national policies.…”

Section: Policy Implications Of Capital Assets Frameworkmentioning

confidence: 99%

A Capital Assets Framework for Analysing Household Livelihood Strategies: Implications for Policy

Rakodi

1999

Development Policy Review

305

151

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Section: Policy Implications Of Capital Assets Frameworkmentioning

confidence: 99%

A Capital Assets Framework for Analysing Household Livelihood Strategies: Implications for Policy

Rakodi

1999

Development Policy Review

305

151

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“…The establishment of VHCs represents one form of decentralisation of healthcare services. As local institutions at the village level, the VHCs plan and implement activities to address broader issues pressing to the local population (Smith, 1997: 402–403). In this way, community participation is seen ‘as part of wider community development programs’ rather than engagement ‘in health services alone’ (Rifkin, 2009: 33).…”

Section: Introductionmentioning

confidence: 99%

Mutual learning on the local level: The Swiss Red Cross and the Village Health Committees in the Kyrgyz Republic

Isabekova

2020

Global Social Policy

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The importance of mutual learning between providers and recipients of development assistance has been emphasised for decades. Nevertheless, its practical implementation remains limited, primarily due to organisational issues and unequal power relations in development aid. Using the ‘design-thinking’ approach, this study demonstrates the possibility of mutual learning utilising the example of the Swiss Red Cross and the Village Health Committees in the Kyrgyz Republic. Based on the related project documentation and interviews with relevant partners, this article provides an insight into the factors enabling mutual learning in practice. It suggests that decentralisation of the organisation, its leadership and response to failures, continuous contact between provider and recipient of development assistance, and emphasis on local expertise contribute to learning. Although context-specific, these findings are essential to understanding the mutual learning in general and taking this phenomenon from theory to practice.

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“…Global health partnerships can benefit health services development, improve retention and attrition rates, and impact service sustainability through health services implementation research. 8,15,[31][32][33][34] US universities commonly collaborate with LMIC universities for health services research. However, these partnerships often entail challenges.…”

Section: Introductionmentioning

confidence: 99%

Peace Corps Partnered Health Services Implementation Research in Global Health: Opportunity for Impact

Dykens

Hedrick²,

Ndiaye³

et al. 2014

Glob Adv Health Med

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Background:There is abundant evidence of the affordable, life-saving interventions effective at the local primary health care level in low- and middle-income countries (LMICs). However, the understanding of how to deliver those interventions in diverse settings is limited. Primary healthcare services implementation research is needed to elucidate the contextual factors that can influence the outcomes of interventions, especially at the local level. US universities commonly collaborate with LMIC universities, communities, and health system partners for health services research but common barriers exist. Current challenges include the capacity to establish an ongoing presence in local settings in order to facilitate close collaboration and communication. The Peace Corps is an established development organization currently aligned with local health services in many LMICs and is well-positioned to facilitate research partnerships. This article explores the potential of a community–Peace Corps–academic partnership approach to conduct local primary healthcare services implementation research.Discussion:The Peace Corps is well positioned to offer insights into local contextual factors because volunteers work closely with local leaders, have extensive trust within local communities, and have an ongoing, constant, well-integrated presence. However, the Peace Corps does not routinely conduct primary healthcare services implementation research. Universities, within the United States and locally, could benefit from the established resources and trust of the Peace Corps to conduct health services implementation research to advance access to local health services and further the knowledge of real world application of local health services in a diversity of settings. The proposed partnership would consist of (1) a local community advisory board and local health system leaders, (2) Peace Corps volunteers, and (3) a US-LMIC academic institutional collaboration. Within the proposed partnership approach, the contributions of each partner are as follows: the local community and health system leadership guides the work in consideration of local priorities and context; the Peace Corps provides logistical support, community expertise, and local trust; and the academic institutions offer professional technical and public health educational and training resources and research support.Conclusion:The Peace Corps offers the opportunity to enhance a community-academic partnership in LMICs through community-level guidance, logistical assistance, and research support for community based participatory primary health-care services implementation research that addresses local primary healthcare priorities.

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The decentralization of health care in developing countries: organizational options

Cited by 35 publications

References 25 publications

A Capital Assets Framework for Analysing Household Livelihood Strategies: Implications for Policy

A Capital Assets Framework for Analysing Household Livelihood Strategies: Implications for Policy

Mutual learning on the local level: The Swiss Red Cross and the Village Health Committees in the Kyrgyz Republic

Peace Corps Partnered Health Services Implementation Research in Global Health: Opportunity for Impact

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