ArticleConflict and health2023
The impact of decentralisation on health systems in fragile and post-conflict countries: a narrative synthesis of six case studies in the Indo-Pacific.
Article in Conflict and health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 26 citations in OpenAlex.
- The impact of decentralisation on health systems: a systematic review of reviews.BMJ global health · 2023Pooled it
- Assessment of community health workforce governance in federal Nepal.Health policy and planning · 2026Article
- Job satisfaction among local-level health workers following decentralization in Nepal.BMC health services research · 2026Article
- Strengthening Health Systems to Overcome Respiratory Infectious Diseases in Indonesia: A Comprehensive Review.Risk management and healthcare policy · 2026Review
- Fiscal federalism, inter-governmental transfers and public health- The case of Urban Local Bodies in India.SSM - health systems · 2025Article
- Measuring what matters: key indicators for performance and resilience in fragile, low-income contexts. A scoping review.Health research policy and systems · 2025Article
- Sweden's public health response to COVID-19: a qualitative study building on a realist approach.BMC health services research · 2025Article
- Investing in the Advanced Practice Nursing Workforce to Improve Health System Responses to Armed Conflict.International nursing review · 2025Review
- The Lack of Impact of Primary Care Units on Screening Services in Thailand and the Transition to Local Administrative Organization Policy.Healthcare (Basel, Switzerland) · 2025Article
- Power dynamics and intersectoral collaboration for health in low- and middle-income countries: a realist review.Health policy and planning · 2025Article
- Charting the path to the implementation of universal health coverage policy in Nigeria through the lens of Delphi methodology.BMC health services research · 2025Article
- Barriers and Facilitators to International Universal Health Coverage Reforms: A Realist Review.International journal of health policy and management · 2025Review
- Stakeholders' Perspectives on Child Healthcare Services under Rural Health Reform in Thailand: A Qualitative Study.International journal of community based nursing and midwifery · 2025Article
- Support Vector Machine-Based Prediction Model for Healthcare Workforce Transition Success Under Decentralization.F1000Research · 2025Article
- A conceptual learning analysis of paired after action and intra action reviews for health emergencies.Learning health systems · 2024Article
- An anthropological history of Nepal's Female Community Health Volunteer program: gender, policy, and social change.International journal for equity in health · 2024Article
- Understanding health system resilience in responding to COVID-19 pandemic: experiences and lessons from an evolving context of federalization in Nepal.BMC health services research · 2024Article
Corrections and comments
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Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
A health system has three key stakeholders, the State-at national and subnational levels-the health service providers and the citizens. In most settings and especially in peacetime, these stakeholders are typically well-defined. In contrast, during conflict and crisis as well as during ceasefire and post-conflict peacebuilding, stakeholders in the health system are often more diverse and contested. Health systems in such settings tend to be more decentralised, de facto-often in addition to de jure decentralisation. Despite much debate on the potential benefits of decentralisation, assessing its impact on health system performance remains difficult and its effect is open to dispute in the literature. This narrative synthesis aims to support efforts to assess and make sense of how decentralisation impacts health system performance in fragile and post-conflict countries-by synthesising evidence on the impact of decentralisation on health system performance from six country case studies: Papua New Guinea, the Philippines, Indonesia, Pakistan, Myanmar and Nepal. The impact of decentralisation on health system performance is optimised when combining centralisation (e.g., the benefits of central coordination in improving efficiency) with decentralisation (e.g., the benefits of local decision making in improving equity and resilience). The findings may inform efforts to think through what to centralise or decentralise, the impacts of those choices, and how the impact may change over time as countries go through and emerge from conflict-and as they go through and recover from the Covid-19 pandemic and prepare for future pandemics.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.