Table 3 Decentralization and localization as guiding principles for health systems in LMICs
Decentralization | Localization | |
|---|---|---|
Definition | A set of policies that 1) move civil servants from central locations to sites closer to the users served; 2) increase decision-making authority of local administrators; and 3) increase decision-making authority of local users [55] | A set of processes that move production of health and input goods for health (goods, services, human resources), as well as responsibility and oversight over functioning, to more local or regional scales. |
Problems identified | - Failure to adapt interventions to local needs | - Increasing energy prices and petroleum scarcity |
- Low quality of services at the periphery | - Lack of decision-making power at local level | |
- Lack of decision-making power at local level | - Need to involve local communities as stewards of local resources | |
Potential benefits | - Improvements in equitable distribution of health care | - Adaptation to rising energy prices and mitigation of climate change |
- Accountability of decision-making | - Empowerment of local actors | |
- Financial sustainability of health systems | - Contribution to local economies | |
- Environmental sustainability of health systems | ||
Application to health systems | - Frumkin et al. 2009, Pubic Health Reports [11] | |
- World Bank [60] | - Hess et al. 2011, American Journal of Public Health [57] | |
- Bossert and Mitchell 2011, Social Science and Medicine [56] |