Back to basics: does decentralization improve health system performance? Evidence from Ceara in north-east Brazil.

Atkinson, S. and Haran, David (2004) 'Back to basics: does decentralization improve health system performance? Evidence from Ceara in north-east Brazil.'. Bulletin of the World Health Organization, Vol 82, Issue 11, pp. 822-827.

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Abstract

Objective To examine whether decentralization has improved health system performance in the State of Ceara, north-east Brazil.
Methods Ceara is strongly committed to decentralization. A survey across 45 local (municipio) health systems collected data on performance and formal organization, including decentralization, informal management and local political culture. The indicators for informal management and local political culture were based on prior ethnographic research. Data were analysed using analysis of variance, Duncan's post-hoc test and multiple regression.
Findings Decentralization was associated with improved performance, but only for 5 of our 22 performance indicators. Moreover, in the multiple regression, decentralization explained the variance in only one performance indicator; indicators for informal management and political culture appeared to be more important influences. However, some indicators for informal management were themselves associated with decentralization but not any of the political culture indicators.
Conclusion Good management practices in the study led to decentralized local health systems rather than vice versa. Any apparent association between decentralization and performance seems to be an artefact of the informal management, and the wider political culture in which a local health system is embedded strongly influences the performance of local health systems.

Item Type:	Article
Uncontrolled Keywords:	delivery of health care/organization and administration community health services/organization and administration quality indicators, health care efficiency, organizational informal sector politics regression analysis brazil care
Subjects:	W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care WA Public Health > WA 20.5 Research (General) WA Public Health > Health Administration and Organization > WA 525 General works
Faculty: Department:	Groups (2002 - 2012) > Disease Control Strategy Group
Depositing User:	Martin Chapman
Date Deposited:	20 Mar 2012 13:23
Last Modified:	06 Feb 2018 13:03
URI:	https://archive.lstmed.ac.uk/id/eprint/2136

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