Define decentralisation. Decentralisation synonyms, decentralisation pronunciation, decentralisation translation, English dictionary definition of decentralisation. Decentralisation - the spread of power away from the center to local branches or governments decentralization spreading, spread - act of extending.
Health systems decentralization involves moving decision making away from centralised control and closer to the users of health services. Many countries have embarked on a process to decentralize their health systems as a means to improve their responsiveness and performance.
In practice, decentralization involves the transfer of authority and power from:
- Higher to lower levels of government or from national to subnational levels of government.
- Government to legally independent autonomous state organisations.
- Government to the private sector (whether “for profit” or “not for profit”).
Types of decentralisation
There are four main types of decentralisation: political, administrative, fiscal, and market decentralisation.
1. Political decentralisation
Political decentralisation aims to give citizens or their elected representatives more power in public decision-making. Its goal is to introduce more participatory forms of governance by giving citizens, or their representatives, more influence in the formulation and implementation of health policies and plans.
Political decentralisation often requires constitutional law reform as well as changes to other laws. Silent hunter iii controls system.
2. Administrative decentralisation
Administrative decentralisation involves redistributing authority, responsibility and financial resources for providing public services from the national government to local units of government agencies, sub national government or semi-autonomous public authorities or corporation.
There are three major forms of administrative decentralisation: deconcentration, delegation, and devolution. Each form raises different legal issues.
Deconcentration involves redistributing decision making authority and financial and management responsibilities among different levels of a national government. For example, it may involve shifting responsibilities from government officials working in the head office of a health ministry, to ministry staff working in regions, provinces or districts. Deconcentration does not usually involve any changes to existing laws. Though in some countries, changes to who may exercise a legal power have to follow a specific legal procedure.
Delegation involves a national government transferring responsibility for decision-making and administration of public functions to semi-autonomous public sector organizations such as hospital corporations. These organizations usually have separate legal status and have a great deal of discretion and autonomy around management decision-making.
Delegation usually involves extensive legal changes including passing laws to establish the new public sector organizations and specify their duties, powers, accountabilities and relationship to national government. It also may involve introducing new regulatory controls. This is because independent decision making may generate a need for state regulation to ensure that decisions made by autonomous bodies are made in line with government’s broader health policy objectives.
Devolution is where national governments devolve functions to sub national government.
In a devolved system, sub national governments often have clear and legally recognized geographical boundaries over which they exercise authority and within which they perform these functions.
Devolution may involve constitutional law reform as we as law reform to formalise the devolution of powers, roles and accountabilities.
3. Fiscal decentralisation
Financial responsibility is a core component of decentralisation. If sub national governments and private organizations are to carry out decentralised functions effectively, they must have an adequate level of revenues either raised locally or transferred from the national government– as well as the authority to make decisions about expenditure.
Law changes are likely be required to give effect to the fiscal devolution, to authorise the transfer of revenue and to authorise local decision making and revenue raising.
4. Market decentralisation
Market decentralisation involves shifting responsibility for health functions from the public to the private sector including businesses and non-government organizations.
Market decentralisation may involve constitutional law reform as well as the passage of new laws to:
- allow the private sector to perform functions that had previously been performed by government; and
- to regulate the performance of those functions.
Working on decentralisation - the importance of legal and institutional reform
Key legal and institutional issues for countries working on health system decentralisation include:
- Settling the objectives of the decentralisation process. The objectives of the process and the context in which it will take place, are the key factors for designing and implementing appropriate legal and institutional frameworks to implement decentralisation.
- Ensuring that relevant laws are amended to specify the core functions, roles and responsibilities necessary for the effective operation of a decentralised health system and to support the relevant health policy objectives of government.
- Identifying existing laws and regulations that regulate the health system, including those that affect it indirectly, such as civil service laws and local government laws. These laws need to be assessed and modified as necessary to implement the desired decentralisation reforms.
- Ensuring that appropriate institutional arrangements for the process are in place, including the assignment of functions, responsibilities and resources necessary for the effective operation of the desired decentralised system.
- Ensuring that appropriate accountability obligations, mechanisms and process are introduced consistent with the roles and responsibilities of the various organisations which form part of the decentralised system. This may include introducing specific legal requirements to facilitate the participation of local communities in decision making.
- Determining the sequencing for the making of necessary law changes; estimating the time and resources needed for implementing each step and the phases of the transition to the new system.