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Low decision space means no decentralization in Fiji: comment on “Decentralisation of health services in Fiji: a decision space analysis”

Faguet, Jean-Paul ORCID: 0000-0002-7188-0098 (2016) Low decision space means no decentralization in Fiji: comment on “Decentralisation of health services in Fiji: a decision space analysis”. International Journal of Health Policy and Management, 5 (11). pp. 663-665. ISSN 2322-5939

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Identification Number: 10.15171/ijhpm.2016.82


Mohammed, North, and Ashton find that decentralization in Fiji shifted health-sector workloads from tertiary hospitals to peripheral health centres, but with little transfer of administrative authority from the centre. Decision-making in five functional areas analysed remains highly centralized. They surmise that the benefits of decentralization in terms of services and outcomes will be limited. This paper invokes Faguet’s (2012) model of local government responsiveness and accountability to explain why this is so – not only for Fiji, but in any country that decentralizes workloads but not the decision space of local governments. A competitive dynamic between economic and civic actors that interact to generate an open, competitive politics, which in turn produces accountable, responsive government can only occur where real power and resources have been devolved to local governments. Where local decision space is lacking, by contrast, decentralization is bound to fail because it has not really happened in the first place.

Item Type: Article
Official URL:
Additional Information: © 2016 Kerman University of Medical Sciences
Divisions: International Development
Subjects: R Medicine > RA Public aspects of medicine
Sets: Departments > International Development
Research centres and groups > Suntory and Toyota International Centres for Economics and Related Disciplines (STICERD)
Date Deposited: 30 Jun 2016 10:53
Last Modified: 20 Feb 2021 05:42

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