Health Systems & Reform

Decentralization of Health Systems: New Research for Assessing the Consequences

The last decade has seen an important evolution in research on decentralization of health systems.  Earlier work tended to accept simplified definitions (decentralized vs. centralized) and often relied exclusively on anecdotal evidence or expert opinion.  More recently, research in this field has progressed in utilizing innovative approaches for both conceptualizing and assessing the consequences of decentralization.  Analytical frameworks with multi-faceted conceptualizations of decentralization are now commonplace and scholars continue adding new factors based on theory and case context.  Based on those frameworks, researchers increasingly deploy innovative research designs and mixed methods to assess their theories and generate credible evidence on the consequences of health systems decentralization.

Research using new approaches and research methods is needed to provide detailed, context-sensitive policy advice for expanding or restricting the decisions made by local authorities and for understanding the conditions under which decentralization is likely to be more or less effective at improving health system performance.  With respect to the common first-order objectives of decentralization, studies may focus on outcomes like improved delivery of health services, improved health status at the population or individual levels, improved perceptions by patients or providers, improved personnel management, and greater equity in allocation of resources or any of the preceding outcomes.  We also seek studies focusing on the secondary consequences of decentralization, for example, controlling elite capture or corruption and policy feedback in terms of public or health worker behaviour.

With those aims in mind, Health Systems & Reform is pleased to launch this call for the article collection, “Decentralization of Health Systems: New Research for Assessing the Consequences.”  This collection invites researchers to submit papers that report original research studies on decentralization of health systems around the world, especially with new approaches and methods.  We are interested in the effects on health services, health outcomes, and policy choices of different types and degrees of decentralization. We seek systematic reviews of literature and empirical studies of specific countries, multiple country studies and decentralization of specific system issues such as logistic and information systems as well as how decentralization influences disease specific policies and outcomes.  While most of the studies will be about public health systems and the national and subnational characteristics of decentralization, studies of decentralization within facilities like hospitals or regional networks of health clinics will also be considered. While we seek articles utilizing “decision space analysis,” papers with other new approaches are also encouraged, for example, those that focus on specific health system functions and build on political economy theories.

Keywords: Decentralisation, Health system research, Health policy, Health sector reform, Decision space analysis

Dr. Thomas John Bossert is a Senior Lecturer Emeritus in the Department of Global Health and Population of the Harvard T. H. Chan School of Public Health.  His innovative “decision space” approach to decentralization has appeared in many peer reviewed journals and recently in two edited books on decentralization. He has worked in almost 80 countries on health systems issues.

Dr. Alan Zarychta is an Associate Professor at the University of Chicago Crown Family School of Social Work, Policy and Practice.  He is also the current Faculty Director of the Susan and Richard Kiphart Center for Global Health and Social Development.  His research focuses on policy implementation, street-level bureaucracy, and the politics of health service delivery, particularly in the context of decentralization reform.

All manuscripts submitted to this Article Collection will undergo desk assessment and peer review if they can pass the desk assessments as part of our standard editorial process; the Guest Advisor for this Collection will not be handling the manuscripts (unless they are an Editorial Board member).
The deadline for submitting manuscripts is 6th August 2027.
Please contact Saniya Qureshi at saniya.qureshi@taylorandfrancis.com with any queries and discount codes regarding this Article Collection.