Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #111913

Paul Hutchinson, PhD, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, 504 988-6078, phutchin@tulane.edu and Anne K. LaFond, MS, MEASURE Evaluation Project, John Snow, Inc., 1616 North Fort Myer Drive, 11th floor, Arlington, VA 22209.

The decentralization of responsibilities from the central government to lower levels of government or semi-autonomous institutions has become an increasingly common strategy for improving the performance of health systems in developing countries and ultimately for improving the health status of developing country populations. However, efforts to monitor and evaluate the implementation and functioning of decentralization programs are often hampered by poor or incompatible data, by the absence of sound research designs, and by the sheer scope of the reform. This work presents a conceptual framework for identifying key areas for evaluation of decentralization programs and the pathways – and potential barriers – by which decentralization can affect health systems. It also identifies ways to evaluate the impact of decentralization in achieving key objectives – improved efficiency, accessibility, equity, community participation and health status. The monitoring and evaluation framework is then applied to the country of Tanzania, where considerable fiscal decentralization and needs-based planning has been occurring in recent years. Measures of fiscal and administrative decentralization are collected from a 1999 survey of District Health Management Teams (DHMTs). These measures are then linked to both objective measures of health behaviors and outcomes from the 1999 Tanzania Reproductive and Child Health Survey and from DHMT reports of decentralization's outcomes. The results indicate that the effectiveness of decentralization is sensitive to the measures of decentralization that are used.

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