The impact of decentralisation on health systems: A systematic review of reviews
Authors: Sapkota, S., van Teijlingen, E. et al.
Journal: BMJ Global Health
Volume: 8
Issue: 12
eISSN: 2059-7908
DOI: 10.1136/bmjgh-2023-013317
Abstract:Background Decentralisation is a common mechanism for health system reform; yet, evidence of how it impacts health systems remains fragmented. Despite published findings from primary and secondary research illustrating range of impacts, a comprehensive and clear understanding is currently lacking. This review synthesised the existing evidence to assess how decentralisation (by devolution) impacts each of the six WHO building blocks, and the health system. Method We systematically searched five electronic databases for reviews exploring impact of decentralisation on health systems, globally. Reviews, both systematic and non-systematic, published in the English language from January 1990 to February 2022 were included. Data were synthesised across each of six building blocks. Quality assessment of the reviews was conducted using Critical Appraisal Skills Program for systematic and Scale for Assessment of Narrative Review Articles for non-systematic reviews. Results Nine reviews, each addressing somewhat different questions, contexts and issues, were included. A range of positive and negative impacts of decentralisation on health system building blocks were identified; yet, overall, the impacts were more negative. Although inconclusive, evidence suggested that the impacts on leadership and governance and financing components in particular shape the impact on overall health system. Assessment of how the impact on building blocks translates to the broader impact on health systems is challenged by the dynamic complexities related to contexts, process and the health system itself. Conclusions Decentralisation, even if well intentioned, can have unintended consequences. Despite the difficulty of reaching universally applicable conclusions about the pros and cons of decentralisation, this review highlights some of the common potential issues to consider in advance. PROSPERO registration number CRD42022302013.
https://eprints.bournemouth.ac.uk/39295/
Source: Scopus
The impact of decentralisation on health systems: a systematic review of reviews.
Authors: Sapkota, S., Dhakal, A., Rushton, S., van Teijlingen, E., Marahatta, S.B., Balen, J., Lee, A.C. and Nepal Federal Health System Team
Journal: BMJ Glob Health
Volume: 8
Issue: 12
ISSN: 2059-7908
DOI: 10.1136/bmjgh-2023-013317
Abstract:BACKGROUND: Decentralisation is a common mechanism for health system reform; yet, evidence of how it impacts health systems remains fragmented. Despite published findings from primary and secondary research illustrating range of impacts, a comprehensive and clear understanding is currently lacking. This review synthesised the existing evidence to assess how decentralisation (by devolution) impacts each of the six WHO building blocks, and the health system. METHOD: We systematically searched five electronic databases for reviews exploring impact of decentralisation on health systems, globally. Reviews, both systematic and non-systematic, published in the English language from January 1990 to February 2022 were included. Data were synthesised across each of six building blocks. Quality assessment of the reviews was conducted using Critical Appraisal Skills Program for systematic and Scale for Assessment of Narrative Review Articles for non-systematic reviews. RESULTS: Nine reviews, each addressing somewhat different questions, contexts and issues, were included. A range of positive and negative impacts of decentralisation on health system building blocks were identified; yet, overall, the impacts were more negative. Although inconclusive, evidence suggested that the impacts on leadership and governance and financing components in particular shape the impact on overall health system. Assessment of how the impact on building blocks translates to the broader impact on health systems is challenged by the dynamic complexities related to contexts, process and the health system itself. CONCLUSIONS: Decentralisation, even if well intentioned, can have unintended consequences. Despite the difficulty of reaching universally applicable conclusions about the pros and cons of decentralisation, this review highlights some of the common potential issues to consider in advance. PROSPERO REGISTRATION NUMBER: CRD42022302013.
https://eprints.bournemouth.ac.uk/39295/
Source: PubMed
The impact of decentralisation on health systems: a systematic review of reviews
Authors: Sapkota, S., Dhakal, A., Rushton, S., van Teijlingen, E., Marahatta, S.B., Balen, J. and Lee, A.C.K.
Journal: BMJ GLOBAL HEALTH
Volume: 8
Issue: 12
ISSN: 2059-7908
DOI: 10.1136/bmjgh-2023-013317
https://eprints.bournemouth.ac.uk/39295/
Source: Web of Science (Lite)
The impacts of decentralisation on health systems: a systematic review of reviews
Authors: Sapkota, S., Dhakal, A., Rushton, S., van Teijlingen, E., Balen, J., Lee, A., Marahatta, S. and Nepal Federal Health System Team
Journal: BMJ Global Health
Publisher: BMJ Publishing Group
ISSN: 2059-7908
Abstract:Background: Despite decentralisation being a common mechanism through which health systems around the world have been reformed, a clear understanding of how decentralisation impacts health systems is lacking. Although both primary and secondary research exists, the evidence remains scattered. This review collected and synthesised evidence generated by previous reviews on the impact of decentralising health system governance on the six WHO (World Health Organization) health system building blocks.
Methods: We systematically searched for reviews exploring the impact of decentralisation on the health system from five databases. Reviews, both systematic and non-systematic, published in the English language from 1990 to February 2022 were included. Quality assessment of the reviews was conducted using CASP for systematic reviews and SANRA for non-systematic reviews.
Results: Nine reviews, each addressing slightly different questions, contexts and health system issues, were synthesised. They showed that devolution can have positive or negative impacts on the health system and its components. Moreover, impact assessments are significantly affected by complexities surrounding decentralisation and health system concepts: their dynamic mechanisms, inconsistent and often differently operationalized health system and health system component variables, and methodological challenges. For the WHO health system components, more negative than positive impacts were reported. The reviews highlight the importance of closely assessing (pre-)existing (political and non-political) characteristics of countries and their health systems to better understand impacts.
Conclusions: Decentralisation can have a negative or a positive impact on the health system and its components; the impacts are shaped by pre-existing country contexts. Generating conclusive and generalisable evidence of the impacts of decentralisation on health systems is challenging. Whilst decentralisation may seek to enhance community engagement and improve the responsiveness of decision-making, it has the potential to create serious challenges to the health system, the manifestations of which are likely to be context-specific.
Protocol Registration: PROSPERO CRD42022302013
https://eprints.bournemouth.ac.uk/39295/
Source: Manual
The impact of decentralisation on health systems: a systematic review of reviews.
Authors: Sapkota, S., Dhakal, A., Rushton, S., van Teijlingen, E., Marahatta, S.B., Balen, J., Lee, A.C. and Nepal Federal Health System Team
Journal: BMJ global health
Volume: 8
Issue: 12
Pages: e013317
eISSN: 2059-7908
ISSN: 2059-7908
DOI: 10.1136/bmjgh-2023-013317
Abstract:Background
Decentralisation is a common mechanism for health system reform; yet, evidence of how it impacts health systems remains fragmented. Despite published findings from primary and secondary research illustrating range of impacts, a comprehensive and clear understanding is currently lacking. This review synthesised the existing evidence to assess how decentralisation (by devolution) impacts each of the six WHO building blocks, and the health system.Method
We systematically searched five electronic databases for reviews exploring impact of decentralisation on health systems, globally. Reviews, both systematic and non-systematic, published in the English language from January 1990 to February 2022 were included. Data were synthesised across each of six building blocks. Quality assessment of the reviews was conducted using Critical Appraisal Skills Program for systematic and Scale for Assessment of Narrative Review Articles for non-systematic reviews.Results
Nine reviews, each addressing somewhat different questions, contexts and issues, were included. A range of positive and negative impacts of decentralisation on health system building blocks were identified; yet, overall, the impacts were more negative. Although inconclusive, evidence suggested that the impacts on leadership and governance and financing components in particular shape the impact on overall health system. Assessment of how the impact on building blocks translates to the broader impact on health systems is challenged by the dynamic complexities related to contexts, process and the health system itself.Conclusions
Decentralisation, even if well intentioned, can have unintended consequences. Despite the difficulty of reaching universally applicable conclusions about the pros and cons of decentralisation, this review highlights some of the common potential issues to consider in advance.Prospero registration number
CRD42022302013.https://eprints.bournemouth.ac.uk/39295/
Source: Europe PubMed Central
The impacts of decentralisation on health systems: a systematic review of reviews
Authors: Sapkota, S., Dhakal, A., Rushton, S., van Teijlingen, E., Marahatta, S., Balen, J., Lee, A.C.K. and Nepal Federal Health System Team
Journal: BMJ Global Health
Volume: 8
Publisher: BMJ Publishing Group
ISSN: 2059-7908
Abstract:Background: Despite decentralisation being a common mechanism through which health systems around the world have been reformed, a clear understanding of how decentralisation impacts health systems is lacking. Although both primary and secondary research exists, the evidence remains scattered. This review collected and synthesised evidence generated by previous reviews on the impact of decentralising health system governance on the six WHO (World Health Organization) health system building blocks.
Methods: We systematically searched for reviews exploring the impact of decentralisation on the health system from five databases. Reviews, both systematic and non-systematic, published in the English language from 1990 to February 2022 were included. Quality assessment of the reviews was conducted using CASP for systematic reviews and SANRA for non-systematic reviews.
Results: Nine reviews, each addressing slightly different questions, contexts and health system issues, were synthesised. They showed that devolution can have positive or negative impacts on the health system and its components. Moreover, impact assessments are significantly affected by complexities surrounding decentralisation and health system concepts: their dynamic mechanisms, inconsistent and often differently operationalized health system and health system component variables, and methodological challenges. For the WHO health system components, more negative than positive impacts were reported. The reviews highlight the importance of closely assessing (pre-)existing (political and non-political) characteristics of countries and their health systems to better understand impacts.
Conclusions: Decentralisation can have a negative or a positive impact on the health system and its components; the impacts are shaped by pre-existing country contexts. Generating conclusive and generalisable evidence of the impacts of decentralisation on health systems is challenging. Whilst decentralisation may seek to enhance community engagement and improve the responsiveness of decision-making, it has the potential to create serious challenges to the health system, the manifestations of which are likely to be context-specific.
Protocol Registration: PROSPERO CRD42022302013
https://eprints.bournemouth.ac.uk/39295/
Source: BURO EPrints