TOPIC EIGHT
HEALTH SYSTEM DECENTRALIZATION
The topic introduces the student to the health sector reforms and more specifically to
decentralization. Overtime, health sector has undergone various reforms driven by various
motives which could be political, economic, international ideologies and so on. Kenya has
not been left behind. The Kenyan health system has undergone different reforms including
the recent devolvement of the health services. This topic will look at the decentralization and
its various categories and the objectives for each.
8.1 TOPIC OBJECTIVES
At the end of this lecture, you should be able to:
Understand the meaning and basis health sector decentralization
Explain definitions of decentralization
Discuss objectives of health sector decentralization
Differentiate different types of decentralization
8.2 BACKGROUND
In this sub-topic, we define decentralization; discuss the objectives and various types
ofdecentralization.
1
, - Decentralization is regarded as the transfer of public authority, resources, and personnel from
the national level to sub-national jurisdictions.
- Decentralization is based on the simple concept of getting resources to where they areneeded.
- It is rooted in administrative science; it has been promoted widely because of its perceived
technical, political and fiscal benefits in the development.
- Decentralization is also perceived as part of the democratization process, thus the
characterization as an administrative and political tool for reform
- The most and commonly used definition of decentralization is the transfer of decision-making
power and administrative responsibility from the central government to the periphery.
- Though there are different definitions of decentralization the widely accepted on is:
o “The transfer of responsibility for planning, management and the raising and
allocation of resources from central government and its agencies to field units or
levels of government, semi-autonomous public authorities or corporations, area-
wide, regional or functional authorities, or non-governmental private or voluntary
organizations”
8.2.1 Dimensions of decentralization
- Scholars have identified four typologies of decentralization as described below.
1) Political decentralization involves horizontal sharing of political power between the three
arms of government as well as vertical sharing of power between the national and sub-
national governments.
2) Fiscal decentralization involves the transfer of financial resources from the central
government to autonomous local agencies. This entails direct transfers from the national
level to the local agencies or assignment of taxation powers to the sub-national units.
3) Administrative decentralization refers to the transfer of responsibility for the planning,
financing and management of certain public functions.
4) Divestment or Economic/Market decentralization is where the national or sub-national
government assigns responsibilities to private entities which offer the services and levy
user charges for the same. In this regard the private entity works for and on behalf of the
government. However the government still bears the legal responsibility to ensure that
2
HEALTH SYSTEM DECENTRALIZATION
The topic introduces the student to the health sector reforms and more specifically to
decentralization. Overtime, health sector has undergone various reforms driven by various
motives which could be political, economic, international ideologies and so on. Kenya has
not been left behind. The Kenyan health system has undergone different reforms including
the recent devolvement of the health services. This topic will look at the decentralization and
its various categories and the objectives for each.
8.1 TOPIC OBJECTIVES
At the end of this lecture, you should be able to:
Understand the meaning and basis health sector decentralization
Explain definitions of decentralization
Discuss objectives of health sector decentralization
Differentiate different types of decentralization
8.2 BACKGROUND
In this sub-topic, we define decentralization; discuss the objectives and various types
ofdecentralization.
1
, - Decentralization is regarded as the transfer of public authority, resources, and personnel from
the national level to sub-national jurisdictions.
- Decentralization is based on the simple concept of getting resources to where they areneeded.
- It is rooted in administrative science; it has been promoted widely because of its perceived
technical, political and fiscal benefits in the development.
- Decentralization is also perceived as part of the democratization process, thus the
characterization as an administrative and political tool for reform
- The most and commonly used definition of decentralization is the transfer of decision-making
power and administrative responsibility from the central government to the periphery.
- Though there are different definitions of decentralization the widely accepted on is:
o “The transfer of responsibility for planning, management and the raising and
allocation of resources from central government and its agencies to field units or
levels of government, semi-autonomous public authorities or corporations, area-
wide, regional or functional authorities, or non-governmental private or voluntary
organizations”
8.2.1 Dimensions of decentralization
- Scholars have identified four typologies of decentralization as described below.
1) Political decentralization involves horizontal sharing of political power between the three
arms of government as well as vertical sharing of power between the national and sub-
national governments.
2) Fiscal decentralization involves the transfer of financial resources from the central
government to autonomous local agencies. This entails direct transfers from the national
level to the local agencies or assignment of taxation powers to the sub-national units.
3) Administrative decentralization refers to the transfer of responsibility for the planning,
financing and management of certain public functions.
4) Divestment or Economic/Market decentralization is where the national or sub-national
government assigns responsibilities to private entities which offer the services and levy
user charges for the same. In this regard the private entity works for and on behalf of the
government. However the government still bears the legal responsibility to ensure that
2
