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

Document Type : Commentary

Author

Department of International Development & STICERD, London School of Economics, London, UK

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.

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References

Bossert T. Analyzing the decentralization of health in developing countries: decision space, innovation and performance. Soc Sci Med 1998;47:1513-1527. doi:10.1016/S0277-9536(98)00234-2
Bossert T. Empirical Studies of an Approach to Decentralization: "Decision Space" in Decentralized Health Systems. In: Faguet JP, Pöschl C, eds. Is Decentralization Good for Development? Perspectives from Academics and Policy Makers. Oxford: Oxford University Press; 2015.
Faguet JP. Decentralization and Popular Democracy: Governance from Below in Bolivia. Ann Arbor: University of Michigan Press; 2012.
Mohammed J, North N, Ashton T. Decentralisation of health services in Fiji: a decision space analysis. Int J Health Policy Manag. 2015;5(3):173-181. doi:10.15171/ijhpm.2015.199.
Faguet JP, Pöschl C, eds. Is Decentralization Good for Development? Perspectives from Academics and Policy Makers. Oxford: Oxford University Press; 2015.
Channa A, Faguet JP. 2016. Decentralization of Health and Education in Developing Countries: A Quality-Adjusted Review of the Empirical Literature.” World Bank Research Observer. 2016. doi: 10.1093/wbro/lkw001
Faguet JP. Transformation from Below in Bangladesh: Decentralization, Local Governance, and Systemic Change. Modern Asian Studies. Forthcoming.
Faguet JP. Building Democracy in Quicksand: Altruism, Empire and the United States. Challenge: The Magazine of Economic Affairs. 2004;47:73-93.
 
International Journal of Health Policy and Management
Volume 5, Issue 11
November 2016
Pages 663-665

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