Management for health services delivery

Sub-national and district management: Reforms

Some reform experiences

  • Learning from Thailand’s health reforms
    A. Towse, A. Mills, V. Tangcharoensathien, 2004, BMJ Vol 328
    In 2001 Thailand extended coverage to 18.5 million (of 62 million) people who were previously uninsured with a concurrent shift in funding away from major urban hospitals in order to build up primary care.
    (3 pages, pdf 96kb)
  • TEHIP Case Study - Crunching the Numbers, Using Evidence about the Population’s Health Helps to Effect Change
    TEHIP, International Development Resource Centre, Canada, 2004
    Using population based data to plan, budget and monitor health services more effectively
    (4 pages, pdf 77kb)
  • District Health Programmes and Health Sector Reform in the Lao People's Democratic Republic
    C. Perks, M. Toole, K. Phouthonsy, WHO, Bulletin of the World Health Organization 2006; 84:132-138
    Strengthening district management; improving access to health services; focusing on the most common causes of mortality and morbidity among women and children; significan improvement in access between 1991 and 2003 with reduced mortality at an additional cost of $1 per person per year; horizontally integrated primary health care;
    (7pages, pdf 163kb)
  • Impact of Health Sector Reform Project Summaries
    Consortium for Research on Equitable Health Systems, London School of Hygiene & Tropical Medicine
    Brief notes on reform activities in several countries including India, Kenya, Nigeria, South Africa, Tanzania and Thaniland.
    (4 pages, pdf 140kb)
  • Improving Health Services and Strengthening Health Systems: Adopting and Implementing Innovative Strategies, Working Paper No.5
    pdf, 677kb

    2005, Katja Janovsky, David Peters; Annesa Arur, Sandhya Sundaram
    Contracting with NGO's, delegation of authority, user fees exemptions, subsidies for the poor, performance related pay and incentives; contracting and performance incentives used less often; community engagement strategies not reaching national level; lack of information on implementation and results; few plans for scaling up from pilot to national level
    (29 pages, 895kb)
  • Decentralization and equity of resource allocation: evidence from Colombia and Chile
    Thomas J. Bossert, Osvaldo Larran aga, Ursula Giedion, Jose Jesus Arbelaez & Diana M. Bowser, 2003, WHO, Bulletin of the World Health Organization 2003;81:95-100
    Under certain conditions and with some specific policy mechanisms, decentralization can improve equity of resource allocation. Equitable levels of per capita financial allocations at the municipal level were achieved through different forms of decentralization — the use of allocation formulae, adequate local funding choices and horizontal equity funds. Findings on equity of utilization of services were less consistent, but did show that increased levels of funding were associated with increased utilization.
    (6 pages, pdf 78kb)
  • An Assessment of Service Delivery Capacity of the District Health Systems in Kenya
    pdf, 543kb

    T M Maina & T N Kibua, Institute of Policy Analysis and Research, Discussion Paper No. 075/2005
    Delivery capacity of District Health Management Boards and District Health Management Teams; ineffective communication between institutions, lack of capacity in planning and management, flawed selection process of the board members, cautious implementation of decentralization; autonomy to engage district health staff; review of public sector rules and regulations to allow decentralization of procurement and financial responsibilities; development of performance indicators; and putting in place transparent criteria for selecting board members.
    (40 pages, pdf 531kb)
  • Extending Social Protection in Health: Developing Country Experiences, Lessons, Recommendations
    pdf, 3.79Mb

    2007, GTZ-ILO-WHO-Consortium on Social Health Protection in Developing Countries
    Universal coverage, social dialogue, poverty reduction, mixed financing systems, experiences spanning four continents, advancing the socio-economic development agenda: the concern for equity, solidarity and poverty reduction; learning from evidence;
    (24 pages, 908kb)