Does Decentralization Improve Health System Performance and Outcomes in Low- and Middle-Income Countries? A Systematic Review of Evidence From Quantitative Studies.

ABSTRACT: Policy Points: For more than 3 decades, international development agencies have advocated health system decentralization to improve health system performance in low- and middle-income countries. We found little rigorous evidence documenting the impact of decentralization processes on health system performance or outcomes in part due to challenges in measuring such far-reaching and multifaceted system-level changes. We propose a renewed research agenda that focuses on discrete definitions of decentralization and how institutional factors and mechanisms affect health system performance and outcomes within the general context of decentralized governance structures.

Context

Despite the widespread adoption of decentralization reforms as a means to improve public service delivery in devel

SUBMITTER: Dwicaksono A 

PROVIDER: S-EPMC5987820 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature