Decentralisation, Governance and Health‐System Performance: ‘Where You Stand Depends on Where You Sit’

Advocates of local government often argue that when decentralisation is accompanied by adequate mechanisms of accountability, particularly those responsive to local preferences, improved service delivery will result. From the perspective of the health sector, the appropriate degree of decentralisation and the necessary mechanisms of accountability depend upon the achievement of health system goals. Drawing on evidence from six countries (Bolivia, Chile, India, Pakistan, Philippines, Uganda), this article comes to the conclusion that a balance between centralisation of some functions and decentralisation of others, along with improved mechanisms of accountability, is needed to achieve health system objectives.