Abstract
The primary objective of this study is to assess and compile lessons learned in respect to impacts of health center devolution policy. Focus of the assessment is on administration and management, response to local health needs and increase access to health care of the devolved health centers. This study also aims to analyze contextual factors that explain the impact differences. Qualitative approach relying on data collection methods like in-depth interview, observation and documentary review was employed where study sites included 28 health-center- devolved areas. Data collection was carried out during the months of November 2011 and May 2012.
The study reveals that situation of the devolved health centers varied from area to area. Overall, about two-third of the health centers (16), their roles were not different from those during the period prior to the devolution. Only one-fourth (7) could fulfill the ideal roles (i.e. the provision of primary curative services, doing health promotion and prevention campaigns and inventing innovations to specifically respond to the local people’s health needs). In respect to transfer preparation, time and efforts for making both health center staff and local government’s officials and leaders prepared were found too short and less systematic. Problems of career development, capacity building and budget support from Contracting Unit for Primary Care-CUP abounded yet improving. No specific structure and system had been set up to curve the problems; most of the devolved health centers their vacant positions were mostly unfilled.
From the evidences gathered, it could be inferred that impacts of the devolution on health conditions, more equitable and easy access to health services were uneven. In the area where the transfer was smooth and health workers and local leaders could work harmoniously, a variety of innovative projects were created making services more accessible to the needy especially the chronically ill and the elderly. In some area doctors was employed as part-time staff. Yet, for the rest, insignificant difference of the service before and after the devolution was common.
This study concludes and recommends that 1)lessons learned from the 28 devolved health center shows successful tendency of health decentralization 2) Department of Local Administration-DLA and Ministry of Health-MOH have to seriously develop special policy and mechanisms to help make the devolution realistic especially the filling of vacant positions in the transferred health centers, 3) it is necessary for the policy bodies- DLA, MoH and the National Health Security Office-NHSO to have a clear and more committed policy direction to push forward the devolution of health centers; standard of practice guidelines and clear signal requiring CUP to support the devolved areas should be made explictely.
