It would appear that decentralization has often taken place in a poorly defined legal framework, with inadequate resources, qualified personnel, transport and other inputs for planning and monitoring health activities. Under-resourced health workers in this situation are likely to regard public demands for accountability and greater control as a burden rather than an asset.

Where can I find out more? The 'Decentralization Planning Tool' by Management Sciences for Health, USA, is a useful tool to map roles and functions in decentralization and is found at http://erc.msh.org in the electronic resource centre. Further web resources on decentralization can, for example, be found at http://www1.worldbank.org/publicsector/decentralization/