Decentralisation - Some questions for the experts
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Source: DECENTR-L@MAIL.MSH.ORG
Sylvia:
Thanks for starting a new track. I am not an expert and I am
certainly naive about the politics of this issue. I've been following
the discussion as an opportunity to learn more about decentralization
and to think through its implications for some of our own work here
at AVSC. It is very helpful to have the opportunity to participate in
this discussion, mostly by "listening", as I try to learn more.
I was very interested in what Michel Paque had to say about community
involvement. I believe strongly that there is a role for the
community in the design and management of health services. I have
some questions for the experts that arise from my reading and from
this discussion:
1) Is there any evidence to suggest that we do better in
decentralized systems with moving away from the vertical programs
that Tim France referred to? How are donors to health care
initiatives incorporating decentralization into their planning
processes?
2) What happens to preventive health care programs in a decentralized
system? I had assumed that part of the rationale for
decentralization or sustainability might be that preventive care
would achieve more prominence. From some reading that I have
done, I learned that at least in the initial stages the focus
often shifts to curative care as districts struggle to address
immediate health needs. Is there evidence to suggest that this
trend can be reversed? Is someone looking at this? Are there
good examples of preventive programs in a decentralized system?
3) What effect, if any, does decentralized power over health
resources have on subjects like contraception and abortion, or
health services in general for underserved or marginalized
groups?
4) Lastly, what actually happens to health services? I've seen a lot
in this discussion about drug policy, about power, about
democratisation, about management, etc. but not much about how it
affects providers and their clients or patients in their every day
interactions over health care. I suppose the million dollar
question is do they fare better, or at least as well, under a
decentralized system?
So - I wanted to let you know you are not the only woman involved in
following this discussion. I am happily married and treat my
colleagues with respect (I hope!) I also have a red car, but no black
briefcase. I am also metrically challenged, but 5 feet 4 inches!
Regards, Karen
Karen Beattie
AVSC International
79 Madison Avenue
New York, New York 10016
Tel. +1-212-561-8072
mailto:kbeattie@avsc.org
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