Loading menu…

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

§ Addis Ababa University

Send Message

To: Author

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

Article Fingerprint

ReserarchID

ICTL0

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 Banner

Key Research Insights

Synthesized scholarly intelligence & interactive research assistant
  • English
  • Afrikaans
  • Albanian
  • Amharic
  • Arabic
  • Armenian
  • Azerbaijani
  • Basque
  • Belarusian
  • Bengali
  • Bosnian
  • Bulgarian
  • Catalan
  • Cebuano
  • Chichewa
  • Chinese (Simplified)
  • Chinese (Traditional)
  • Corsican
  • Croatian
  • Czech
  • Danish
  • Dutch
  • Esperanto
  • Estonian
  • Filipino
  • Finnish
  • French
  • Frisian
  • Galician
  • Georgian
  • German
  • Greek
  • Gujarati
  • Haitian Creole
  • Hausa
  • Hawaiian
  • Hebrew
  • Hindi
  • Hmong
  • Hungarian
  • Icelandic
  • Igbo
  • Indonesian
  • Irish
  • Italian
  • Japanese
  • Javanese
  • Kannada
  • Kazakh
  • Khmer
  • Korean
  • Kurdish (Kurmanji)
  • Kyrgyz
  • Lao
  • Latin
  • Latvian
  • Lithuanian
  • Luxembourgish
  • Macedonian
  • Malagasy
  • Malay
  • Malayalam
  • Maltese
  • Maori
  • Marathi
  • Mongolian
  • Myanmar (Burmese)
  • Nepali
  • Norwegian
  • Pashto
  • Persian
  • Polish
  • Portuguese
  • Punjabi
  • Romanian
  • Russian
  • Samoan
  • Scots Gaelic
  • Serbian
  • Sesotho
  • Shona
  • Sindhi
  • Sinhala
  • Slovak
  • Slovenian
  • Somali
  • Spanish
  • Sundanese
  • Swahili
  • Swedish
  • Tajik
  • Tamil
  • Telugu
  • Thai
  • Turkish
  • Ukrainian
  • Urdu
  • Uzbek
  • Vietnamese
  • Welsh
  • Xhosa
  • Yiddish
  • Yoruba
  • Zulu
Reading Preferences
Font Size
Line Spacing
Background
This converted HTML version may contain rendering inconsistencies. Please refer to the PDF for the authoritative version, or click here to provide feedback.

Abstract

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.

References

58 Cites in Article
  1. 1. S Abayneh,H Lempp,A Alem,D Alemayehu,T Eshetu,C Lund,M Semrau,G Thornicroft,C Hanlon (2017). Service user involvement in mental health system strengthening in a rural African setting: Qualitative study. BMC Psychiatry, 17(187)
  2. 2. C Beard,S Redmond (1979). Declaration of Alma-Ata. Lancet, 313(8109), 217-218.
  3. 3. W Brinkerhoff (2004). Accountability and health systems: toward conceptual clarity and policy relevance. Health Policy and Planning, 19(6), 371-379.
  4. 4. Nigussie Seboka,Endashaw Bekele,Shimelis Nigussie,Yonas Bekele,Kidist Bobosha,Demissew Beyene (2013). Haptoglobin polymorphism, plasma haptoglobin level and ABO blood group in leprosy patients. Journal of Coastal Life Medicine, 5(12), 550-555.
  5. 5. (2017). Ethiopia Demographic and Health Survey 2016. Ethiopia Demographic and Health Survey 2016
  6. 6. H Dereje,A Haymanot,T Degefa (2004). Predictors of child stunting in Fitche town, North Shewa zone, Ethiopia. African Journal of Food, Agriculture, Nutrition and Development, 20(03), 15992-16012.
  7. 7. C Collins,Mayeh Omar,Ehsanullah Tarin (2002). Decentralization, health care and policy process in the Punjab, Pakistan in the 1990s. The International Journal of Health Planning and Management, 17(2), 123-146.
  8. 8. J Dickovick,Tegegne Gebre-Egziabher (2014). 4 Ethiopia: Ethnic Federalism and Centripetal Forces. Decentralization in Africa, 69-90.
  9. 9. (1995). Public Expenditure and Financial Accountability Assessment: Federal Democratic Republic of Ethiopia (The City of Addis Ababa). The Constitution of 1995
  10. 10. Peter Ventevogel (2006). Mental health in Africa: time for action. Report of the annual conference of the Association of African Psychiatrists & Allied Health Professions, April 24???25 2006, Addis Ababa, Ethiopia. Intervention, 4(3), 272-274.
  11. 11. A Fiseha (2007). Theory versus practice in the implementation of Ethiopia's ethnic federalism. Ethnic federalism: The Ethiopian experience in comparative perspective, 131-164.
  12. 12. Lynne Franco,Sara Bennett,Ruth Kanfer (2002). Health sector reform and public sector health worker motivation: a conceptual framework. Social Science & Medicine, 54(8), 1255-1266.
  13. 13. Gasto Frumence,Tumaini Nyamhanga,Mughwira Mwangu,Anna-Karin Hurtig (2013). Challenges to the implementation of health sector decentralization in Tanzania: experiences from Kongwa district council. Global Health Action, 6(1), 20983.
  14. 14. Santosh Mehrotra (2006). Governance and basic social services: ensuring accountability in service delivery through deep democratic decentralization. Journal of International Development, 18(2), 263-283.
  15. 15. S Menon (2006). Decentralization and health care in the former Yugoslav Republic of Macedonia. International Journal of Health Planning and Management, 21(1), 3-21.
  16. 16. A Mills (1990). Decentralization concepts and issues: A review. Health system decentralization: Concepts, issues and country experiences, 10-42.
  17. 17. Gloria Molina,Julian Vargas,Beatriz Londoño (2017). Decentralization and Public Health: An Analysis of the Health System in Five Latin American Countries: Argentina, Brazil, Chile, Colombia and Mexico. Decentralizing Health Services, 10, 33-62.
  18. 18. R Murthy,B Klugman (2004). Service accountability and community in the context of health sector reforms in Asia: Implications for sexual and and reproductive health services. Health Policy Plan, 19(1), 78-86.
  19. 19. Justine Nannyonjo,Nicholas Okot (2013). Decentralization, Local Government Capacity and Efficiency of Health Service Delivery in Uganda. Journal of African Development, 15(1), 125-158.
  20. 20. Adugna Girma,Gerema Abera,Shewareged Girma,Immabet Sori,Gululat Teklu,Gemta Hailu,Zennebech Gelalcha (2015). Prevalence and Associated Risk Factors of Ovine Fasciolosis in Ejere District, West Shewa, Ethiopia. Austin Journal of Veterinary Science & Animal Husbandry, 10(3)
  21. 21. Dereje Olana (2001). Malaria, Oromia Regional State, Ethiopia, 2001-2006. Emerging Infectious Diseases, 17(7), 1336-1337.
  22. 22. Haile Abebe,Abebaw Melaku (2001). Prevalence of Undernutrition and Associated Factors among Children Aged 6- 59 Months in Bishoftu Town, Oromia Region, Ethiopia. Food Processing & Nutritional Science, 1(1), 8-24.
  23. 23. Gadissa Melkamu Bulcha (2002). Ethnobotanical study on Assessment of Indigenous Attitude on Traditional Plant Medicine Use Among People of Wonchi District, Southwest of Addis Ababa , Oromia Regional State, Ethiopia. IAR Journal of Clinical & Medical Biochemistry, 01(01), 1-6.
  24. 24. (2005). Assessment of Human Resource Development Practices of Oromia Cooperative Promotion Agency, Oromia Regional State, Ethiopia. Research Journal of Finance and Accounting
  25. 25. Haile Abebe,Abebaw Melaku (2013). Prevalence of Undernutrition and Associated Factors among Children Aged 6- 59 Months in Bishoftu Town, Oromia Region, Ethiopia. Food Processing & Nutritional Science, 1(1), 8-24.
  26. 26. Haile Abebe,Abebaw Melaku (2014). Prevalence of Undernutrition and Associated Factors among Children Aged 6- 59 Months in Bishoftu Town, Oromia Region, Ethiopia. Food Processing & Nutritional Science, 1(1), 8-24.
  27. 27. B Panda,P &thakur (2016). Decentralization and health system performance: A focused review of dimensions, difficulties, and derivatives in India. BMC Health Services Research, 16(Suppl 6), 1-14.
  28. 28. R Pundhi,A Boke (2015). Assessment of decentralized local governance performance for service delivery in Ethiopia : The case study of Experiences from Kongwa district council. Global Health Action, 1-11.
  29. 29. T Gebre-Egziabher (2014). Assessment Practices in the Center for Regional and Local Development Studies, College of Development Studies in Addis Ababa University, Ethiopia. Journal of Education and Practice, 130-168.
  30. 30. Paul Hutchinson (1999). Health care in Uganda. Nature Science, 1(3), 343-365.
  31. 31. Anders Jeppsson,Sam Okuonzi (2000). Vertical or holistic decentralization of the health sector? Experiences from Zambia and Uganda. The International Journal of Health Planning and Management, 15(4), 273-289.
  32. 32. D Jiménez,P Smith (2005). Decentralisation of health care and its impact on health outcomes. Decentralisation of health care and its impact on health outcomes, 05
  33. 33. A Kassa,Y Shawel (2013). Integrating all stakeholders: Health service governance in Addis of public sector reforms in Africa:Selected country experiences. Integrating all stakeholders: Health service governance in Addis of public sector reforms in Africa:Selected country experiences, 55-131.
  34. 34. A Kassa (2015). District level decentralization and public service delivery in Ethiopia: Cases from Amhara region Intern. J African Asian Studies, 10, 24-39.
  35. 35. Emmanuel Kilewo,Gasto Frumence (2015). Factors that hinder community participation in developing and implementing comprehensive council health plans in Manyoni District, Tanzania. Global Health Action, 8(1), 26461.
  36. 36. Helmut Kloos (1998). Primary Health Care in Ethiopia: From Haile Sellassie to Meles Zenawi. Northeast African Studies, 5(1), 83-113.
  37. 37. S Kojo,K Awoonor,F Adzei (2011). Barriers to implementing health sector administrative decentralization in Ghana: A study of the Nkwanta district health management team. J Health Organ Mgmt, 25, 400-419.
  38. 38. A Kwamie,A Agyepong,V Dijk (2015). What governs district manager decision making? A case study of complex leadership in Dangme. Health Systems Reform, 1(2), 167-177.
  39. 39. J Lee (2015). The process of decentralisation in Ethiopia since 1991: Issues on improving efficiency. Korea Review of International Studies, 3-16.
  40. 40. Zacharia Masanyiwa,Anke Niehof,Catrien Termeer (2013). A gendered users′ perspective on decentralized primary health services in rural Tanzania. The International Journal of Health Planning and Management, 30(3), 285-306.
  41. 41. Farah Purwaningrum,Stephanie Short (2010). Epistemic layers in development planning: A case study of the health sector in the Gunungkidul District, Indonesia. The International Journal of Health Planning and Management, 33(4)
  42. 42. K Regmi,J Naidoo,P Pilkington,A Greer (2017). Decentralization and district health services in Nepal: understanding the views of service users and service providers. Journal of Public Health, 32(3), 406-417.
  43. 43. B Rifkin (2014). Examining the links between community participation and health outcomes: a review of the literature. Health Policy and Planning, 29(suppl 2), ii98-ii106.
  44. 44. D Rondinelli,J Mccullough,R Johnson (1989). Analysing decentralization policies in developing countries: A political -economy framework. Development and Change, 20, 57-87.
  45. 45. K Sakyi (2008). A retrospective content analysis of studies on factors constraining the implementation of health sector reform in Ghana. The International Journal of Health Planning and Management, 23(3), 259-285.
  46. 46. Innocent Semali,Marcel Tanner,Don De Savigny (2005). Decentralizing EPI services and prospects for increasing coverage: the case of Tanzania. The International Journal of Health Planning and Management, 20(1), 21-39.
  47. 47. C Smith (1997). The decentralization of health care in developing countries: organizational options. Public Administration and Development, 17(4), 399-412.
  48. 48. Shenglan Tang,Gerald Bloom (2000). Decentralizing rural health services: a case study in China. The International Journal of Health Planning and Management, 15(3), 189-200.
  49. 49. A Tong,P Sainsbury,J Craig (2018). Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349-357.
  50. 50. Benjamin Tsofa,Sassy Molyneux,Lucy Gilson,Catherine Goodman (2017). How does decentralisation affect health sector planning and financial management? a case study of early effects of devolution in Kilifi County, Kenya. International Journal for Equity in Health, 16(1), 151.
  51. 51. (2009). Multi-agency radiation survey and site investigation manual (MARSIM). Final report. Democratic decentralization programming handbook
  52. 52. G Wamai (2009). Reviewing Ethiopia's health system. JMAJ, 52(4), 279-286.
  53. 53. Yan Wang,Charles Collins,Shenglan Tang,Tim Martineau (2002). Health systems decentralization and human resources management in low and middle income countries. Public Administration and Development, 22(5), 439-453.
  54. 54. (2004). Ethiopia : A Country Status Report on Health and Poverty, Volume 2, Main Report. Ethiopia : A Country Status Report on Health and Poverty, Volume 2, Main Report
  55. 55. James Wunsch (2014). 1 Decentralization: Theoretical, Conceptual, and Analytical Issues. Decentralization in Africa, 1-22.
  56. 56. C Yang,Y Yan,S Fang,S Inamdar,H Lin (2017). The association of hospital governance with innovation in Taiwan. Int J Health Plann Mgmt, 1-9.
  57. 57. S Yilmaz,V Venugopal (2008). Local government discretion and accountability in Ethiopia (Working Paper 08-38. Local government discretion and accountability in Ethiopia (Working Paper 08-38
  58. 58. R Yin (2003). Case study research: design and methods. Case study research: design and methods

Funding

No external funding was declared for this work.

Conflict of Interest

The authors declare no conflict of interest.

Ethical Approval

No ethics committee approval was required for this article type.

Data Availability

Not applicable for this article.

How to Cite This Article

Tolera H, Tegegne Gebre-Egziabher, Helmut Kloos. 2019. "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". Global Journal of Medical Research - K: Interdisciplinary GJMR-K Volume 19 (GJMR Volume 19 Issue K2).

More Citation Formats

Download Citation

Journal Specifications

Crossref Journal DOI 10.17406/gjmra

Print ISSN 0975-5888

e-ISSN 2249-4618

Keywords
Classification
GJMR-K Classification NLMC Code: W 84
Version of record
v1.2

Issue date
March 30, 2019

Language
English
Order Article Reprint
Experience in AR

Explore published articles in an immersive Augmented Reality environment. Our platform converts research papers into interactive 3D books, allowing readers to view and interact with content using AR and VR compatible devices.

Read in 3D

Your published article is automatically converted into a realistic 3D book. Flip through pages and read research papers in a more engaging and interactive format.

Article Matrices
Total Views: 888
Total Downloads: 45
All Trends

Request Access

Please fill out the form below to request access to this research paper. Your request will be reviewed by the editorial or author team.
X

This is the heading

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.

High-quality academic research articles on global topics and journals.

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

Tolera H
Tolera H Addis Ababa University
Tegegne Gebre-Egziabher
Tegegne Gebre-Egziabher <p>Addis Ababa University</p>
Helmut Kloos
Helmut Kloos <p>Addis Ababa University</p>