TY - JOUR
T1 - The impacts of decentralisation on health-related equity
T2 - A systematic review of the evidence
AU - Sumah, Anthony Mwinkaara
AU - Baatiema, Leonard
AU - Abimbola, Seye
N1 - Publisher Copyright:
© 2016 Elsevier Ireland Ltd
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Background Decentralised governance of health care has been widely adopted globally over the past three decades. But despite being implemented as a management strategy across many health systems, its impact on health equity is yet unclear. Objective To conduct a systematic literature review of the implications of decentralised governance of health care on equity in health, health care and health financing. Methods A systematic search of CINAHL, EconLit, Embase, MEDLINE, PsycINFO, PubMed, Scopus, and Cochrane database of systematic reviews was conducted. Articles that met the inclusion criteria examined entire health systems and the relationship between implementing decentralised governance and health-related equity. The quality of reporting of the included studies was assessed using a 10-point quality rating tool. Results Out of 808 articles identified, 9 met the inclusion criteria. The included studies were mostly explorative and used a range of quantitative techniques to analyse the relationship between variables of interest. The review found that depending on context, decentralisation could either lead to equity gains or exacerbate inequities. The impact of decentralisation on inequities in health and health care depends on pre-existing socio-economic disparities and financial barriers to access. While decentralisation can lead to inequities in health financing between sub-national jurisdictions, this is minimised with substantial central government transfers and cross subsidisation. Conclusion The implications of decentralised governance of health systems on health-related equity are varied and depend on pre-existing socio-economic and organisational context, the form of decentralisation implemented and the complementary mechanisms implemented alongside decentralisation.
AB - Background Decentralised governance of health care has been widely adopted globally over the past three decades. But despite being implemented as a management strategy across many health systems, its impact on health equity is yet unclear. Objective To conduct a systematic literature review of the implications of decentralised governance of health care on equity in health, health care and health financing. Methods A systematic search of CINAHL, EconLit, Embase, MEDLINE, PsycINFO, PubMed, Scopus, and Cochrane database of systematic reviews was conducted. Articles that met the inclusion criteria examined entire health systems and the relationship between implementing decentralised governance and health-related equity. The quality of reporting of the included studies was assessed using a 10-point quality rating tool. Results Out of 808 articles identified, 9 met the inclusion criteria. The included studies were mostly explorative and used a range of quantitative techniques to analyse the relationship between variables of interest. The review found that depending on context, decentralisation could either lead to equity gains or exacerbate inequities. The impact of decentralisation on inequities in health and health care depends on pre-existing socio-economic disparities and financial barriers to access. While decentralisation can lead to inequities in health financing between sub-national jurisdictions, this is minimised with substantial central government transfers and cross subsidisation. Conclusion The implications of decentralised governance of health systems on health-related equity are varied and depend on pre-existing socio-economic and organisational context, the form of decentralisation implemented and the complementary mechanisms implemented alongside decentralisation.
KW - Decentralisation
KW - Equity
KW - Health care governance
KW - Health outcomes
KW - Health system
KW - Health-related equity
KW - Healthcare access
KW - Heath financing
UR - http://www.scopus.com/inward/record.url?scp=84994762078&partnerID=8YFLogxK
U2 - 10.1016/j.healthpol.2016.09.003
DO - 10.1016/j.healthpol.2016.09.003
M3 - Review article
C2 - 27663406
AN - SCOPUS:84994762078
SN - 0168-8510
VL - 120
SP - 1183
EP - 1192
JO - Health Policy
JF - Health Policy
IS - 10
ER -