DECENTRALIZATION AND ITS INFLUENCERS IN HUMAN LIFE

We analyze the evidence from the literature to understand why, how and under what circumstances
decentralization influences the health, equity, efficiency and resilience of the system.
Beyond the findings that the effects of decentralization on health systems and outcomes are mixed, this
review presents mechanisms and contextual factors that policymakers and implementers should pay
attention to in their efforts to maximize the positive impact and minimize the negative impact of
decentralized governance.
The decentralization of the health system has constituted in a quantitative analysis of large subnational,
national or inter-country jatus, they have treated decentralization in different environments as the same.
With the constant reviews and evaluations of decentralization, the results are mixed.
Now that decentralization is an intervention, the most important thing is to generate evidence to inform
implementation strategies; therefore, we synthesized the literature to understand this. In doing this, we
adopted the realist approach of evidence, synthesis, and included quantitative and qualitative studies in
high-, low-, and middle-income countries that evaluated the impact of decentralization on health
systems.
Decentralization can occur by mandate.
Entities pool their resources to reap economies of scale or to adjust for externalities (negative and
positive) that may arise when each of their business starts independently. The theoretical benefits of
decentralization are often part of the inspiration for reforms in previously centralized nations.
In Colombia, a survey was conducted in municipalities that were mostly decentralized; the results of this
questionnaire were that the level of institutional development of the health sector of the municipalities is
not in accordance with their socio-economic category; nor do the municipalities have an integral
development of the different aspects of their institutional capacity. Some small municipalities with a low
socioeconomic level present similar and even better developments than municipalities with a higher
socioeconomic level.
Finally, according to all this, decentralization has the sole objective of developing and transferring
resources, functions and responsibilities, which sets the guidelines for national health policy in order to
increase efficiency and equity.