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Decentralization of the health system

2024-12Recensão Acesso aberto
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dc.contributor.authorMahmood, Shafaq
dc.contributor.authorSequeira, Rita
dc.contributor.authorSiddiqui, Muhammad Muneeb Ullah
dc.contributor.authorHerkenhoff, Marcos Batista Araujo
dc.contributor.authorFerreira, Patrícia Pita
dc.contributor.authorFernandes, Adalberto Campos
dc.contributor.authorSousa, Paulo
dc.contributor.institutionEscola Nacional de Saúde Pública (ENSP)
dc.contributor.institutionComprehensive Health Research Centre (CHRC) - Pólo ENSP
dc.contributor.institutionCentro de Investigação em Saúde Pública (CISP/PHRC)
dc.contributor.pblWorld Health Organization | BioMed Central (BMC)
dc.date.accessioned2024-06-15T00:21:15Z
dc.date.available2024-06-15T00:21:15Z
dc.date.issued2024-12
dc.descriptionFunding Information: The present publication was funded by Funda\u00E7ao para a Ci\u00EAncia e Tecnologia, IP National support through Comprehensive Health Research Centre - CHRC (UIDP/04923/2020). Publisher Copyright: © The Author(s) 2024.
dc.description.abstractBackground: Decentralization of a health system is a complex and multidimensional phenomenon that demands thorough investigation of its process logistics, predisposing factors and implementation mechanisms, within the broader socio-political environment of each nation. Despite its wide adoption across both high-income countries (HICs) and low-and-middle-income countries (LMICs), empirical evidence of whether decentralization actually translates into improved health system performance remains inconclusive and controversial. This paper aims to provide a comprehensive description of the decentralization processes in three countries at different stages of their decentralization strategies – Pakistan, Brazil and Portugal. Main body: This study employed a systematic analysis of peer-reviewed academic journals, official government reports, policy documents and publications from international organizations related to health system decentralization. A comprehensive search was conducted using reputable databases such as PubMed, Google Scholar, the WHO repository and other relevant databases, covering the period up to the knowledge cutoff date in June 2023. Information was systematically extracted and organized into the determinants, process mechanics and challenges encountered during the planning, implementation and post-decentralization phases. Although decentralization reforms have achieved some success, challenges persist in their implementation. Comparing all three countries, it was evident that all three have prioritized health in their decentralization reforms and aimed to enhance local decision-making power. Brazil has made significant progress in implementing decentralization reforms, while Portugal and Pakistan are still in the process. Pakistan has faced significant implementation challenges, including capacity-building, resource allocation, resistance to change and inequity in access to care. Brazil and Portugal have also faced challenges, but to a lesser extent. The extent, progress and challenges in the decentralization processes vary among the three countries, each requiring ongoing evaluation and improvement to achieve the desired outcomes. Conclusion: Notable differences exist in the extent of decentralization, the challenges faced during implementation and inequality in access to care between the three countries. It is important for Portugal, Brazil and Pakistan to address these through reinforcing implementation strategies, tackling inequalities in access to care and enhancing monitoring and evaluation mechanism. Additionally, fostering knowledge sharing among these different countries will be instrumental in facilitating mutual learning.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent851103
dc.identifier.doi10.1186/s12961-024-01145-3
dc.identifier.issn1478-4505
dc.identifier.otherPURE: 93324294
dc.identifier.otherPURE UUID: 5a3d3349-f88b-4142-84ad-f854dab02054
dc.identifier.otherScopus: 85194519700
dc.identifier.otherPubMed: 38802932
dc.identifier.otherPubMedCentral: PMC11129505
dc.identifier.otherWOS: 001232857300001
dc.identifier.urihttp://hdl.handle.net/10362/168569
dc.identifier.urlhttps://www.scopus.com/pages/publications/85194519700
dc.language.isoeng
dc.peerreviewedyes
dc.subjectDecentralization
dc.subjectDeveloped country
dc.subjectHealth sector reform
dc.subjectLMICs
dc.subjectPerformance of health systems
dc.subjectHealth Policy
dc.subjectSDG 3 - Good Health and Well-being
dc.subjectSDG 10 - Reduced Inequalities
dc.titleDecentralization of the health systemen
dc.title.subtitleexperiences from Pakistan, Portugal and Brazilen
dc.typereview
degois.publication.issue1
degois.publication.titleHealth Research Policy and Systems
degois.publication.volume22
dspace.entity.typePublication
rcaap.rightsopenAccess

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