Could you please discuss and send references that countries with successful examples and failure of dividing health authority into subnational governments (Provinces and Local level) after federalism?
I am currently working on a paper that looks at successes and oppourtunities of the devolved health functions from centralized into a decentralized authority. The paper is a case study from Kenya. Notably this is 2nd time that the national government has devolved health to sub-national authorities.
Notable successes
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(1) Over 75% of Kenya health problems are preventable diseases. Thus, this could be dealt with at dispensary and health center settings with current resource settings.
(2) Context plays a critical role in the manner healthcare is provided due to cultural diversity in Kenya.
Challenges
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(3) Most functions have been decentralized but not DECISION MAKING processes to the dispensaries, health centers and referral hospitals.
(4) Healthcare service delivery is driven by the political parties and their party mandates supersedes other health priorities.
(5) No incentives to use and re-use hospital generated data and other forms of evidence to guide decision making process
(6) The strong private sector healthcare providers interferes with noble government ideas under the cover of free market forces and choice of the customers is paramount.
(7) Health care financing particularly collection and use of revenues such as user-fees and facility-improvement-funds (FIF) as determined and allocated against competing health and non-health related priorities e.g. paying sub-national work force and parliamentary activities.
Conclusion:
From the foregoing, the devolved healthcare systems can work iff the leadership can take calculated risks especially concerning decision making, finances and supply chain management.