Decentralisation

What issues arise when considering human resources and health sector decentralisation programmes in developing countries? Evidence about the impact of decentralisation on efficiency, equity and quality of health services is based primarily on theoretical and anecdotal evidence, rather than on systematic empirical studies. The impact of decentralisation on HRH decisions made at the local level is well illustrated in a case study about Ghana, Zambia, Uganda and the Philippines. The paper outlines how decentralisation impacts upon human resources in four ways: payment of health workers; health systems governance; the political nature of HRH management; and balancing equity and efficiency between the local and national health systems. The authors argue that little information is available on this complex issue and propose a new research agenda

The paper Decentralization and human resources: implications and impact, aimed at health leaders considering decentralisation or implementing reforms, analyses the impact of decentralisation on sound human resource development. Two major human resource issues are considered, those that emerge as a part of the process of transferring power to lower management levels and identification of the most important areas of HR where problems arise as a result of the way in which decentralised management systems are structured.