Exercising Leadership to Make Decentralization Work
The main purpose of decentralizing a health system is to improve access to health services and, ultimately, the health of the population. Under a decentralized system, local health managers can better address deficiencies in cost-effectiveness, efficiency, and performance that are not solved by a centralized system. The local level receives responsibility for primary health services while the central level focuses on policies and standards. Yet the lengthy transition toward a decentralized health system can fracture parts of a health system that previously functioned adequately, without immediately solving pre-existing problems.
In places where decentralized management systems function well, managers at the central and decentralized levels come together to define new management responsibilities and to create supportive management structures, systems, resource flows, and activity plans. To make such changes, health managers at all levels need to become leaders who can mobilize people inside and outside their organizations to create new paths toward improved health.
This issue of The Manager shows how health managers, though faced with multiple challenges of decentralization, can redefine their roles and responsibilities to better support both the people they serve and the staff at management levels closest to the population. It shows how health managers can adopt leadership practices to carry out their new roles and ultimately make decentralization work.