Does decentralization matter for primary health care services delivery? Insights from Mozambique
Salvador Forquilha (Institute for Social and Economic Studies (IESE))
Paper short abstract:
This paper seeks to analyse the scope and impact of decentralization in the health sector in Mozambique. It takes into account the dynamics and practices of actors at different levels of services delivery as a way to deepen the understanding of state building process through services delivery.
Paper long abstract:
In the late 1980s, many sub-Saharan African countries embarked on important political and economic reforms. Most of these reforms can be seen as a response to state failure, which was visible at two levels: political regulation and services delivery. Indeed, the euphoria of African independences and the process of state building were soon confronted with the decline of state capacity in terms of effective political regulation and basic services delivery. It was therefore believed that these reforms would not only improve services delivery, but also make the state more effective and legitimate. With regard to the health sector in Mozambique, different policies and strategies, that have been adopted by the sector over the last ten years, mention decentralization as a mean to improve services delivery, particularly primary health care services. However, while sectoral policies and strategies mention decentralization as an important element of reforms, it is also true that the practices observed in the sector's activities do not necessarily go in the same direction. Making use of a qualitative approach and based on a field work in five Mozambican districts, this paper seeks to analyze the scope and impact of decentralization in the health sector on primary health care. It takes into account the context, dynamics, logics and practices of actors at different levels of services delivery (central and local) as a way to deepen the understanding of state building process through services delivery.
Continuity and disruption in public service provision