The distribution of health planning and management responsibilities between centre and periphery: historical patterns and reform trends in four Caribbean territories

Mills, Anne; Antonius, Rachad; Daniel, Jacquelyn; Gray, Harold F.; Haqq, E.; Rutten, Frans

doi:10.1016/s0168-8510(01)00230-5

Cited by 12 publications

(20 citation statements)

References 4 publications

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“…10 According to Mills et al, “health systems can be described in terms of the relative roles and responsibilities given to the different levels of the health system, from the national government at the top, down to the individual facility level.” 16 The roles assumed by the various institutions at different levels of the system are determined by the degree of decentralization and the distribution of authority. Thus, within each organizational system, the responsibilities assumed and the associated decision space available, are unique, and fall anywhere across a wide spectrum of options.…”

Section: Resultsmentioning

confidence: 99%

“…20 Yet a recurring concern identified in the literature is that of unclear boundaries between central and local authorities and lack of clarity regarding who gives instructions, who has jurisdiction and who is responsible for implementation. 16,21-25 Having unclear responsibilities and multiple authorities could lead to confusion regarding the available decision space. …”

Section: Resultsmentioning

confidence: 99%

“…10,16 Therefore, in defining the decision space, there is a need to consider not just the formal policies and legislation mandating authority but also the various processes and relationships which may influence the actual range of choice afforded to local authorities and, thus, how the organization actually functions. 1,8,16,25 …”

Section: Resultsmentioning

confidence: 99%

“…The literature does not always acknowledge the interdependence between the availability of resource capacities and their management 16,23,31,32 ; nor does it always differentiate between the influences of the different forms of capacity. 14,21,36-38 …”

Section: Resultsmentioning

confidence: 99%

“…Insights into the latter were derived from studies on governance and decentralization reforms. 16,20,21,41-43 These articles suggest that the introduction of decentralization policies that were not sufficiently explicit in defining and respecting the lines of reporting and responsibility, led to weakened accountability within the system. 21,23,28,32,33,71,72 …”

Section: Resultsmentioning

confidence: 99%

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Exploring the Functioning of Decision Space: A Review of the Available Health Systems Literature

Roman

Cleary

McIntyre

2017

Int J Health Policy Manag

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Background: The concept of decision space holds appeal as an approach to disaggregating the elements that may influence decision-making in decentralized systems. This narrative review aims to explore the functioning of decision space and the factors that influence decision space. Methods: A narrative review of the literature was conducted with searches of online databases and academic journals including PubMed Central, Emerald, Wiley, Science Direct, JSTOR, and Sage. The articles were included in the review based on the criteria that they provided insight into the functioning of decision space either through the explicit application of or reference to decision space, or implicitly through discussion of decision-making related to organizational capacity or accountability mechanisms. Results: The articles included in the review encompass literature related to decentralisation, management and decision space. The majority of the studies utilise qualitative methodologies to assess accountability mechanisms, organisational capacities such as finance, human resources and management, and the extent of decision space. Of the 138 articles retrieved, 76 articles were included in the final review. Conclusion: The literature supports Bossert’s conceptualization of decision space as being related to organizational capacities and accountability mechanisms. These functions influence the decision space available within decentralized systems. The exact relationship between decision space and financial and human resource capacities needs to be explored in greater detail to determine the potential influence on system functioning.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Exploring the Functioning of Decision Space: A Review of the Available Health Systems Literature

Roman

Cleary

McIntyre

2017

Int J Health Policy Manag

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Management of human resources for health in health districts in Uganda: A decision space analysis

Mansour

Aryaija-Karemani

Martineau

et al. 2021

Health Planning & Management

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Background Decentralisation has been adopted by many governments to strengthen national systems, including the health system. Decision space is used to describe the decision‐making power devolved to local government. Human resource Management (HRM) is a challenging area that District Health Management Teams (DHMT) need some control over its functions to develop innovative ways of improving health services. The study aims to examine the use of DHMTs' reported decision space for HRM functions in Uganda. Methods Mixed methods approach was used to examine the DHMTs' reported decision space for HRM functions in three districts in Uganda, which included self‐assessment questionnaires and focus group discussions (FGDs). Results The decision space available for the DHMTs varied across districts, with Bunyangabu and Ntoroko DHMTs reporting having more control than Kabarole. All DHMTs reported full control over the functions of performance management, monitoring policy implementation, forecasting staffing needs, staff deployment, and identifying capacity needs. However, they reported narrow decision space for developing job descriptions, resources mobilisation, and organising training; and no control over modifying staffing norms, setting salaries and developing an HR information system (HRIS). Nevertheless, DHMTs tried to overcome their limitations by adjusting HR policies locally, better utilising available resources and adapting the HRIS to local needs. Conclusions Decentralisation provides a critical opportunity to strengthen HRM in low‐and‐middle‐income countries. Examining decision space for HRM functions can help identify areas where district health managers can change or improve their actions. In Uganda, decentralisation helped the DHMTs be more responsive to the local workforce needs and analysing decision space helped identify areas for improvement in HRM. There are some limitations and more power over HRM functions and strong management competencies would help them become more resourceful.

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Decentralization of health systems in low and middle income countries: a systematic review

Muñoz

Amador

Llamas

et al. 2016

Int J Public Health

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The distribution of health planning and management responsibilities between centre and periphery: historical patterns and reform trends in four Caribbean territories

Cited by 12 publications

References 4 publications

Exploring the Functioning of Decision Space: A Review of the Available Health Systems Literature

Exploring the Functioning of Decision Space: A Review of the Available Health Systems Literature

Management of human resources for health in health districts in Uganda: A decision space analysis

Decentralization of health systems in low and middle income countries: a systematic review

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