Decentralized Systems of Health Care Delivery and the Role of Large Cities : A Comparative Analysis
South Africa is going through an important political and administrative reorganization and a series of structural reforms. The responsibility for primary health care, which was mostly provincial, is about to be decentralized to the Local Government...
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| Format: | Working Paper |
| Language: | English en_US |
| Published: |
World Bank, Washington, DC
2013
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| Online Access: | http://documents.worldbank.org/curated/en/2002/07/4101596/decentralized-systems-health-care-delivery-role-large-cities-comparative-analysis http://hdl.handle.net/10986/13622 |
| Summary: | South Africa is going through an
important political and administrative reorganization and a
series of structural reforms. The responsibility for primary
health care, which was mostly provincial, is about to be
decentralized to the Local Government level. The main
purpose of this paper is to analyze the on-going
decentralization process in the Gauteng province and
determine the role that Great Johannesburg can play within
this new decentralized framework. To extract lessons and
recommendations for Gauteng and Johannesburg, the paper
takes a close look at the case of three middle -income Latin
American countries, Chile, Colombia and Brazil, which offer
valuable experience in the design and implementation of
decentralized systems of health care delivery at the country
and city level. It also looks at other international
experiences. At the city level, the paper concludes that the
case of Bogota in Colombia seems to be particularly relevant
to the selection of a decentralized health care model for
Johannesburg. It also shows that, in the longer run, the
experiences provided by the current reforms in the UK and
New Zealand would be worth looking at. Finally, a more
general conclusion of the report is the finding that there
is a wide range of possible roles for large cities in
primary health care delivery and that the extent of this
role will very much depend on the decentralization strategy
adopted at the national level and on a number of key
characteristics at the city level, among which the political
and administrative structure, the fiscal and institutional
capacity and the demographic structure could be identified. |
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