Latest PERFORM2Scale paper - How district health decision-making is shaped within decentralised contexts
The latest paper from the PERFORM2Scale team considers how district-level health system decision-making in Ghana, Malawi and Uganda - all decentralised contexts - is shaped by power dynamics.
Consortium members from Ghana, Malawi, Uganda, the Netherlands, Ireland and the UK collaborated on 'How district health decision-making is shaped within decentralised contexts: A qualitative research in Malawi, Uganda and Ghana'. They found that as a result of different power dynamics, district health management teams (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.
Susan Bulthuis said: “ It is remarkable that while on paper health system decision-making is decentralised, this study shows that in reality the national level is still having a substantial influence on district-level health system decision making in Ghana, Malawi and Uganda. This, in combination with the political influence of district bodies through devolution in Uganda and Malawi, resulted in a narrow decision space for DHMTs. Nevertheless, interestingly, this paper also identified opportunities related to decentralisation for increased power in health system decision making of DHMTs in the three countries”.