Decentralization in Africa: Local government and health care in Ghana, Malawi and Tanzania

There are several arguments that in sub-Saharan Africa urgent reforms are needed in local government for citizens to experience the benefits of development. This chapter examines how Ghana, Malawi and Tanzania have decentralized their health care delivery systems. Using a secondary literature approach, the study found out that in spite of the progressive strides made towards the implementation of ambitious health care decentralization plans, different forms of capacity and accountability gaps, as well as unclear and inadequate decision-making roles affect implementation. The study concludes that governments need to pay particular attention to socioeconomic contexts as they pursue decentralization in the sector. Doing this consistently and effectively over time will engender benefits for all sections of the population and for the governing of cities in Africa.