Latest PERFORM2Scale paper - How district health decision-making is shaped within decentralised contexts

14 Jul 2020

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”.

Read the paper on the Global Public Health website.

Ghana; Uganda; Malawi; DHMT