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Low Decision Space Means No Decentralization in Fiji: Comment on "Decentralisation of Health Services in Fiji: A Decision Space Analysis"

Mohammed, North, and Ashton find that decentralization in Fiji shifted health-sector workloads from tertiary hospitals to peripheral health centres, but with little transfer of administrative authority from the centre. Decision-making in five functional areas analysed remains highly centralized. The...

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Autor principal: Faguet, Jean-Paul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Kerman University of Medical Sciences 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088726/
https://www.ncbi.nlm.nih.gov/pubmed/27801361
http://dx.doi.org/10.15171/ijhpm.2016.82
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author Faguet, Jean-Paul
author_facet Faguet, Jean-Paul
author_sort Faguet, Jean-Paul
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description Mohammed, North, and Ashton find that decentralization in Fiji shifted health-sector workloads from tertiary hospitals to peripheral health centres, but with little transfer of administrative authority from the centre. Decision-making in five functional areas analysed remains highly centralized. They surmise that the benefits of decentralization in terms of services and outcomes will be limited. This paper invokes Faguet’s (2012) model of local government responsiveness and accountability to explain why this is so – not only for Fiji, but in any country that decentralizes workloads but not the decision space of local governments. A competitive dynamic between economic and civic actors that interact to generate an open, competitive politics, which in turn produces accountable, responsive government can only occur where real power and resources have been devolved to local governments. Where local decision space is lacking, by contrast, decentralization is bound to fail because it has not really happened in the first place.
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spelling pubmed-50887262016-11-01 Low Decision Space Means No Decentralization in Fiji: Comment on "Decentralisation of Health Services in Fiji: A Decision Space Analysis" Faguet, Jean-Paul Int J Health Policy Manag Commentary Mohammed, North, and Ashton find that decentralization in Fiji shifted health-sector workloads from tertiary hospitals to peripheral health centres, but with little transfer of administrative authority from the centre. Decision-making in five functional areas analysed remains highly centralized. They surmise that the benefits of decentralization in terms of services and outcomes will be limited. This paper invokes Faguet’s (2012) model of local government responsiveness and accountability to explain why this is so – not only for Fiji, but in any country that decentralizes workloads but not the decision space of local governments. A competitive dynamic between economic and civic actors that interact to generate an open, competitive politics, which in turn produces accountable, responsive government can only occur where real power and resources have been devolved to local governments. Where local decision space is lacking, by contrast, decentralization is bound to fail because it has not really happened in the first place. Kerman University of Medical Sciences 2016-06-22 /pmc/articles/PMC5088726/ /pubmed/27801361 http://dx.doi.org/10.15171/ijhpm.2016.82 Text en © 2016 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Commentary
Faguet, Jean-Paul
Low Decision Space Means No Decentralization in Fiji: Comment on "Decentralisation of Health Services in Fiji: A Decision Space Analysis"
title Low Decision Space Means No Decentralization in Fiji: Comment on "Decentralisation of Health Services in Fiji: A Decision Space Analysis"
title_full Low Decision Space Means No Decentralization in Fiji: Comment on "Decentralisation of Health Services in Fiji: A Decision Space Analysis"
title_fullStr Low Decision Space Means No Decentralization in Fiji: Comment on "Decentralisation of Health Services in Fiji: A Decision Space Analysis"
title_full_unstemmed Low Decision Space Means No Decentralization in Fiji: Comment on "Decentralisation of Health Services in Fiji: A Decision Space Analysis"
title_short Low Decision Space Means No Decentralization in Fiji: Comment on "Decentralisation of Health Services in Fiji: A Decision Space Analysis"
title_sort low decision space means no decentralization in fiji: comment on "decentralisation of health services in fiji: a decision space analysis"
topic Commentary
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088726/
https://www.ncbi.nlm.nih.gov/pubmed/27801361
http://dx.doi.org/10.15171/ijhpm.2016.82
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