The impacts of decentralization on health system equity, efficiency and resilience: a realist synthesis of the evidence.

ABSTRACT: One constant refrain in evaluations and reviews of decentralization is that the results are mixed. But given that decentralization is a complex intervention or phenomenon, what is more important is to generate evidence to inform implementation strategies. We therefore synthesized evidence from the literature to understand why, how and under what circumstances decentralization influences health system equity, efficiency and resilience. In doing this, we adopted the realist approach to evidence synthesis and included quantitative and qualitative studies in high-, low- and middle-income countries that assessed the the impact of decentralization on health systems. We searched the Medline and Embase databases via Ovid, and the Cochrane library of systematic reviews and included 51 studies with

SUBMITTER: Abimbola S 

PROVIDER: S-EPMC6794566 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature