Poorly designed decentralization
programmes indirectly increase the gap between people and health
systems. These programmes have reduced access to services, reduced
equity in health systems or reduced the coverage of public health
& Munga, 1997; Gilson
et al., 1994).
Decentralization is an explicit
policy measure to shift authority, to devolve legal powers and
controls, such as the hiring and firing of personnel, to a lower
level of the health system. Despite this, there is weak evidence
of the promised benefits in accountability or increased public
et al., 1994; Gaventa
& Robinson, 1998).