期刊
GLOBAL PUBLIC HEALTH
卷 16, 期 1, 页码 120-135出版社
ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD
DOI: 10.1080/17441692.2020.1791213
关键词
District level; health system decision-making; power; decentralisation
资金
- European Union [733360]
- H2020 Societal Challenges Programme [733360] Funding Source: H2020 Societal Challenges Programme
This study explored how power dynamics influence district-level health system decision-making in different decentralized contexts in Ghana, Malawi, and Uganda. It found that in Ghana and Malawi, the national Ministry of Health had a substantial influence on district-level decision-making, while in Uganda and Malawi, decision-making was strongly influenced by local political bodies.
District Health Management Teams (DHMTs) are often entry points for the implementation of health interventions. Insight into decision-making and power relationships at district level could assist DHMTs to make better use of their decision space. This study explored how district-level health system decision-making is shaped by power dynamics in different decentralised contexts in Ghana, Malawi and Uganda. In-depth interviews took place with national- and district-level stakeholders. To unravel how power dynamics influence decision-making, the Arts and Van Tatenhove (2004) framework was applied. In Ghana and Malawi, the national-level Ministry of Health substantially influenced district-level decision-making, because of dispositional power based on financial resources and hierarchy. In Uganda and Malawi, devolution led to decision-making being strongly influenced by relational power, in the form of politics, particularly by district-level political bodies. Structural power based on societal structures was less visible, however, the origin, ethnicity or gender of decision-makers could make them more or less credible, thereby influencing distribution of power. As a result of these different power dynamics, DHMTs experienced a narrow decision space and expressed feelings of disempowerment. DHMTs' decision-making power can be expanded through using their unique insights into the health realities of their districts and through joint collaborations with political bodies.
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