SynthesisBMJ global health2023
The impact of decentralisation on health systems: a systematic review of reviews.
Synthesis in BMJ global health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
31 citing papers in PubMed, 33 citations in OpenAlex.
- Article
- Catheter-Associated Urinary Tract Infection Prevention Practices in US Hospitals.JAMA network open · 2026Article
- Social Participation for Health and Health Care Workers' Self-Management: Lessons from Socialist Yugoslavia for Contemporary Health Systems-A Systematic Review.Healthcare (Basel, Switzerland) · 2026Review
- Having and eating the cake? The centralisation paradox in decentralised healthcare governance: a scoping review.BMC health services research · 2026Article
- Review
- Assessment of community health workforce governance in federal Nepal.Health policy and planning · 2026Article
- Evaluating fifteen years of national policy in Israel to overcome socio-geographic health disparities in Israel's Northern District: a mixed-methods study.International journal for equity in health · 2026Article
- Family and health professional perspectives of the CHD LIFE cardiac developmental long-term care pathway: a qualitative evaluation.Pediatric research · 2026Article
- Estimating and Ranking of Common Cancers in South Africa's Eastern Cape and Mpumalanga Provinces: A Patient Survey in Three Referral Hospitals.International journal of environmental research and public health · 2026Article
- Development and Real-World Evaluation of a Statewide Mainstream Model of Germline Genetic Testing for BRCA1/2 and Mismatch Repair Gene Variants (Lynch Syndrome).Asia-Pacific journal of clinical oncology · 2026Article
- Fragmentation in health system financing: a major challenge for improving effectiveness, efficiency, equity and choice within health systems.BMJ public health · 2026Review
- Analysis of the implementation of nutritional care in the context of Primary Health Care.Revista de saude publica · 2026Article
- "The system is a bit broken…" a qualitative exploration of barriers in the pathway for diagnosing Developmental Coordination Disorder.PloS one · 2026Article
- Impact of The Challenge Initiative on Public-Sector Family Planning Service Provision in Pakistan: Evidence from a Difference-in-Differences Analysis.Open access journal of contraception · 2026Article
- Challenges and coping practices of frontline health workers in newly created districts in Uganda: an exploratory qualitative study.BMJ open · 2025Article
- Health impact assessment of decentralization of Emergency Medical Services: a case study in Chonburi Province, Thailand.Scientific reports · 2025Article
- Improving oral health service delivery: the patient perspective.Primary health care research & development · 2025Article
- The determinants of evidence use by Australian clinical networks as agents and stewards of safety and quality: a conceptual framework.Health research policy and systems · 2025Article
- Neurodevelopmental follow-up care pathways and processes for children with congenital heart disease in Australia.Pediatric research · 2025Article
- A laboratory-focussed desk review of health systems in Uganda, Kenya, and the UK to respond to current and future pandemics.Journal of global health · 2025Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundDecentralisation is a common mechanism for health system reform; yet, evidence of how it impacts health systems remains fragmented. Despite published findings from primary and secondary research illustrating range of impacts, a comprehensive and clear understanding is currently lacking. This review synthesised the existing evidence to assess how decentralisation (by devolution) impacts each of the six WHO building blocks, and the health system.
methodWe systematically searched five electronic databases for reviews exploring impact of decentralisation on health systems, globally. Reviews, both systematic and non-systematic, published in the English language from January 1990 to February 2022 were included. Data were synthesised across each of six building blocks. Quality assessment of the reviews was conducted using Critical Appraisal Skills Program for systematic and Scale for Assessment of Narrative Review Articles for non-systematic reviews.
resultsNine reviews, each addressing somewhat different questions, contexts and issues, were included. A range of positive and negative impacts of decentralisation on health system building blocks were identified; yet, overall, the impacts were more negative. Although inconclusive, evidence suggested that the impacts on leadership and governance and financing components in particular shape the impact on overall health system. Assessment of how the impact on building blocks translates to the broader impact on health systems is challenged by the dynamic complexities related to contexts, process and the health system itself.
conclusionsDecentralisation, even if well intentioned, can have unintended consequences. Despite the difficulty of reaching universally applicable conclusions about the pros and cons of decentralisation, this review highlights some of the common potential issues to consider in advance. PROSPERO REGISTRATION NUMBER: CRD42022302013.
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What OpenQuestion holds
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.