How district health decision-making is shaped within decentralised contexts: A qualitative research in Malawi, Uganda and Ghana

Bulthius, Susan, Kok, Maryse, Amon, Samuel, Agyei Agyemang, Samuel, Nsabagasani, Xavier, Sanudi, Lifah, Raven, Joanna ORCID: https://orcid.org/0000-0002-4112-6959, Finn, Mairead, Gerold, Jana, Tulloch, Olivia and Dieleman, Marjolein (2021) 'How district health decision-making is shaped within decentralised contexts: A qualitative research in Malawi, Uganda and Ghana'. Global Public Health, Vol 16, Issue 1, pp. 120-135.

Text RGPH-2020-0342-Health-system-decision-making-Bulthuis-for-author-approval.docx - Accepted Version Download (240kB)

Abstract

District Health Management Teams (DHMTs) are often entry points for the implementation of health interventions. Insight into decision-making and power relationships at district level could assist DHMTs to make better use of their decision space. This study explored how district-level health system decision-making is shaped by power dynamics in different decentralised contexts in Ghana, Malawi and Uganda. In-depth interviews took place with national- and district-level stakeholders. To unravel how power dynamics influence decision-making, the Arts and Van Tatenhove (2004) framework was applied. In Ghana and Malawi, the national-level Ministry of Health substantially influenced district-level decision-making, because of dispositional power based on financial resources and hierarchy. In Uganda and Malawi, devolution led to decision-making being strongly influenced by relational power, in the form of politics, particularly by district-level political bodies. Structural power based on societal structures was less visible, however, the origin, ethnicity or gender of decision-makers could make them more or less credible, thereby influencing distribution of power. As a result of these different power dynamics, DHMTs experienced a narrow decision space and expressed feelings of disempowerment. DHMTs’ decision-making power can be expanded through using their unique insights into the health realities of their districts and through joint collaborations with political bodies.

Item Type:	Article
Subjects:	WA Public Health > WA 20.5 Research (General) WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WA Public Health > Health Administration and Organization > WA 540 National and state health administration WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1080/17441692.2020.1791213
Depositing User:	Jan Randles
Date Deposited:	03 Aug 2020 11:27
Last Modified:	13 Jul 2021 01:02
URI:	https://archive.lstmed.ac.uk/id/eprint/15177

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