International Journal of Health Policy and Management

International Journal of Health Policy and Management

Low Decision Space Means No Decentralization in Fiji; Comment on “Decentralisation of Health Services in Fiji: A Decision Space Analysis”

Document Type : Commentary

Author
Jean-Paul Faguet
Department of International Development & STICERD, London School of Economics, London, UK
10.15171/ijhpm.2016.82
Abstract
Mohammed, North, and Ashton find that decentralization in Fiji shifted health-sector workloads from tertiary hospitals to peripheral health centres, but with little transfer of administrative authority from the centre. Decisionmaking in five functional areas analysed remains highly centralized. They surmise that the benefits of decentralization in terms of services and outcomes will be limited. This paper invokes Faguet’s (2012) model of local government responsiveness and accountability to explain why this is so – not only for Fiji, but in any country that decentralizes workloads but not the decision space of local governments. A competitive dynamic between economic and civic actors that interact to generate an open, competitive politics, which in turn produces accountable, responsive government can only occur where real power and resources have been devolved to local governments. Where local decision space is lacking, by contrast, decentralization is bound to fail because it has not really happened in the first place.
Keywords
Decentralization
Democracy
Local Government
Good Governance
Civil Society
Fiji
Subjects
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International Journal of Health Policy and Management
Volume 5, Issue 11
2016
Pages 663-665

  • Received Date 20 April 2016
  • Revised Date 22 June 2016
  • Accepted Date 14 June 2016
  • First Published Date 01 November 2016
  • Published Date 01 November 2016