Guidelines for Promoting Decentralization of Health Systems in Latin America

Both the advocates and the detractors of decentralization are probably wrong. A thoughtfully designed process of decentralization is not likely to radically improve a health system, nor is it likely to severely disrupt the system. We have evidence that a well-designed decentralization can improve equity of allocations and may have other positive effects such as increased funding of promotion and prevention. Its influence over efficiency and quality is not as clear. These guidelines suggest some mechanisms which can be effective in the design and implementation of decentralization. In addition, it is clear that the central authorities need improved monitoring systems in order to assess and evaluate how well the local authorities are achieving the goals and objectives of national policy. [from author]