The 130th Annual Meeting of APHA

Abstract #38723

Antonio Ugalde, PhD, Department of Sociology, University of Texas-Austin, 1802 Westridge, Austin, TX 78704, 512-471-1122, augalde@mail.la.utexas.edu and Nuria Homedes, MD, DrPH, School of Public Health, University of Texas Houston, Health Science Center, 1100 North Stanton, Suite # 110, El Paso, TX 79902.

In this paper we examine the process of decentralization and the effects from data collected in the field and interviews with policy makers, health administrators and providers in the two states in 2001. Additionally, authors gathered quantitative data about transfers of funds to the district levels, organizational charts, and health reports.

Data are still being analyzed but preliminary findings suggest that decentralization to the district level is marred with constrains including lack of qualified personnel, and poorly defined administrative procedures.

State legislators and municipal presidents did not have an input in the design of the decentralization, in the appropriation and disbursement of funds, and in general in the process of decentralization. Their knowledge of public health is very limited and legislatures and municipal councils do not have personnel that can assist them in prioritizing health needs and interventions. Their role is limited to exercise some political influence to satisfy the needs of some of their constituents, i.e. political patronage.

It was also found that decentralizing does not reduce administrative costs; on the contrary it tends to increase them. Districts are authorized to levy fees as part of decentralization. We were able to obtain solid financial data and found that most of the locally generated funds do not benefit users but providers. Some authors have suggested that recovery fees are a barrier to health services utilization and this may also be the case in Mexico.

Learning Objectives:

Participants will
• learn to identify conditions required for a success decentralization to the district and municipal levels.
• learn to identify the administrative functions that can be decentralized according to characteristics of the health system and socio-economic uniqueness of each setting.
• become aware of the costs of decentralizing different administrative functions.

Keywords: Financing, Developing Countries

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.