Public Health Service Delivery in a Decentralized System: A Qualitative Study of the Perception of Health Providers and Community Members in Gida Ayana Woreda, Western Ethiopia
Some policy-makers believe a decentralized health system enhances service delivery by improving authority, autonomy, accountability, and community participation at the local level. Evidence on the extent to which these benefits have been realized and whether there are gaps in service delivery is essential for policy designs and system reinforcing strategies. The study gathered data through 29 interviews with service providers and policy-makers and eight FGDs with residents and analyzed it for themes. The results showed several benefits of the decentralization system program that includes increased autonomy over staff planning, budgeting, appointments; increased participation in service boards, in cash and kinds. The findings also revealed several challenges that hinder the effective functioning of decentralization including lack of authority to recruit staff, interference in the appointment, transfer of cases, procurement; limited decision making power over local revenue resources; lack of community responsibility in service planning and monitoring. Although the designing of decentralized health program was appropriate in earnest, critical elements for attaining adequate decentralization are still lacking. The region has still played the biggest role in staff recruitment, resource transfer, planning/ programming. These deficiencies have resulted in inadequate information, nominal service monitoring, and low quality of services outcomes. Better quality of service delivery necessitates financial independence and significant service monitoring.
