Colombia - Toward increased efficiency and equity in the health sector : can decentralization help?
DHV Consultans BV | Lahmeyer International GMBh
Decentralization presents an excellent opportunity for the Colombian Government to realize its objectives for its public health care system: extending coverage, improving efficiency and quality, and stimulating community participation. But to date the results of decentralization have been mixed. Despite legal mandate, few municipalities have initiated the decentralization process. Among those municipalities that have achieved autonomy over health services, only the wealthiest jurisdictions appear to have improved the care offered to their residents. In less affluent jurisdictions, where the public health system is already the weakest, decentralization has threatened to diminish the system's effectiveness at serving those in need. The central government has correctly recognized that decentralization does not equate to the abdication of its responsibilities to promote national objectives and standards. It should continue to pursue decentralization wholeheartedly. But in doing so, it should implement financial incentives and administrative guidelines to influence local decision-makers and health service providers to act in a manner that promotes efficiency, coverage, quality, and participation. The Government should also maximize the abilities of public health service consumers to exact accountability from local officials and have direct voice in investment planning and service delivery. Decentralization, in and of itself, does not guarantee improvement in public health services. If the Government does not take steps to define how decentralization will improve these services, this promising policy may end in failure.
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