ArticlePloS one2018
What conditions enable decentralization to improve the health system? Qualitative analysis of perspectives on decision space after 25 years of devolution in the Philippines.
Article in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 1 of them a synthesis that pooled it.
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Who cites it
32 citing papers in PubMed, 1 synthesis or guideline pooled it.
- A review and analysis of accountability in global health funding, research collaborations and training: towards conceptual clarity and better practice.BMJ global health · 2023Pooled it
- Fortifying essential medicines supply chains in Sub-Saharan Africa - the curious cases of Kenya and Uganda.Global health action · 2026Review
- Strengthening district health systems to achieve Malawi's decentralisation objectives: lessons learnt from Malawi's Blantyre Prevention Strategy.BMJ global health · 2026Review
- Frontline decision autonomy under decentralization: Evidence from health sector reform.PloS one · 2026Article
- A biopsychosocial & culturally-anchored suicide postvention model for the Philippines.Frontiers in psychiatry · 2026Article
- The Analysis of the Provider, Payer, and Regulator Stakeholders' Understanding and Acceptance of the Universal Healthcare Law in Three Provinces in the Philippines: A Qualitative Study Using a Content Analysis Approach.Acta medica Philippina · 2026Article
- Healthcare Leadership in Resource-Limited Settings: Reimagining Public Hospital Governance in Somalia.Journal of healthcare leadership · 2026Article
- A Multi-Sector Mixed Methods Study of Stroke Services in the Philippines: Insights From Government Officials and Organisational Leaders.The International journal of health planning and management · 2025Article
- Experiences and Perceptions About Death Reporting and Notification Among Rural Communities on the Islands of Lake Victoria, Uganda: Qualitative Study.JMIR public health and surveillance · 2025Article
- Implementing Electronic Health Records in Philippine Primary Care Settings: Mixed-Methods Pilot Study.JMIR medical informatics · 2025Article
- Health workforce issues and recommended practices in the implementation of Universal Health Coverage in the Philippines: a qualitative study.Human resources for health · 2025Article
- Decentralized Management of Home Care Services for Seniors: Protocol for a Participatory Action Research.JMIR research protocols · 2025Article
- Pragmatic Application of Implementation Science in Filipino Healthcare Environments.International forum for nursing and healthcare · 2025Article
- Article
- One health in the Philippines: A review and situational analysis.One health (Amsterdam, Netherlands) · 2024Review
- Evaluating the decentralisation of the Spanish healthcare system: a data envelopment analysis approach.BMJ open · 2024Article
- National Rural Health Mission reforms in light of decentralised planning in Kerala, India: a realist analysis of data from three witness seminars.BMC public health · 2024Article
- Decentralisation of the Health System Derailed by Organisational Inertia in Machinga, Malawi.International journal of health policy and management · 2024Article
- How does Public Financial Management (PFM) influence health system efficiency: A scoping review.Wellcome open research · 2024Article
- Overcoming the challenges facing Nepal's health system during federalisation: an analysis of health system building blocks.Health research policy and systems · 2023Article
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDecentralization is promoted as a strategy to improve health system performance by bringing decision-making closer to service delivery. Some studies have investigated if decentralization actually improves the health system. However, few have explored the conditions that enable it to be effective. To determine these conditions, we have analyzed the perspectives of decision-makers in the Philippines where devolution, one form of decentralization, was introduced 25 years ago.
methodsDrawing from the "decision space" approach, we interviewed 27 decision-makers with an average of 23.6 years of working across different levels of the Philippine government health sector and representing various local settings. Qualitative analysis followed the "Framework Method." Conditions that either enable or hinder the effectiveness of decentralization were identified by exploring decision-making in five health sector functions.
resultsThese conditions include: for planning, having a multi-stakeholder approach and monitoring implementation; for financing and budget allocation, capacities to raise revenues at local levels and pooling of funds at central level; for resource management, having a central level capable of augmenting resource needs at local levels and a good working relationship between the local health officer and the elected local official; for program implementation and service delivery, promoting innovation at local levels while maintaining fidelity to national objectives; and for monitoring and data management, a central level capable of ensuring that data collection from local levels is performed in a timely and accurate manner.
conclusionsThe Philippine experience suggests that decentralization is a long and complex journey and not an automatic solution for enhancing service delivery. The role of the central decision-maker (e.g. Ministry of Health) remains important to assist local levels unable to perform their functions well. It is policy-relevant to analyze the conditions that make decentralization work and the optimal combination of decentralized and centralized functions that enhance the health system.
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