Skip to main content
SpringerLink
Log in

Decentralization in Africa: Local Government and Health Care in Ghana, Malawi and Tanzania

  • Chapter
  • First Online:
Governing Urban Africa

  • 354 Accesses

Abstract

There are several arguments that in sub-Saharan Africa urgent reforms are needed in local government for citizens to experience the benefits of development. This chapter examines how Ghana, Malawi and Tanzania have decentralized their health care delivery systems. Using a secondary literature approach, the study found out that in spite of the progressive strides made towards the implementation of ambitious health care decentralization plans, different forms of capacity and accountability gaps, as well as unclear and inadequate decision-making roles affect implementation. The study concludes that governments need to pay particular attention to socioeconomic contexts as they pursue decentralization in the sector. Doing this consistently and effectively over time will engender benefits for all sections of the population and for the governing of cities in Africa.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Ayee, J. R. A. (1994). An Anatomy of Public Policy Implementation: The Case of Decentralisation Policies in Ghana. Aldershot: Avebury.

    Google Scholar 

  • Ayee, J. R. A. (1997). The Adjustment of Central Bodies to Decentralization: The Case of the Ghanaian Bureaucracy. African Studies Review, 40(2), 37–57.

    Article  Google Scholar 

  • Ayee, J., & Dickovic, J. T. (2010). Comparative Assessment of Decentralization in Africa: Ghana Desk Study. Washington, DC: USAID.

    Google Scholar 

  • Bemelmans, M., van den Akker, T., Ford, N., Philips, M., Zachariah, R., Harries, A., et al. (2010). Providing Universal Access to Antiretroviral Therapy in Thyolo, Malawi Through Task Shifting and Decentralization of HIV⁄AIDS Care. Tropical Medicine and International Health, 15(12), 1413–1420.

    Article  Google Scholar 

  • Blair, H. (1998). Spreading Power to the Periphery. An Assessment of Democratic Local Governance. USAID Program and Operations Assessment Report No. 21.

    Google Scholar 

  • Bhuiyan, S. H. (2010). Decentralization and Local Governance in Kazakhstan. International Journal of Public Administration. 33(12–13).

    Google Scholar 

  • Bossert, J. T. (1998). Analyzing the Decentralization of Health Systems in Developing Countries: Decision Space, Innovation and Performance. Social Science and Medicine, 47(10), 1513–1527.

    Article  Google Scholar 

  • Bossert, J. T., & Beauvais, J. C. (2002). Decentralization of Health Systems in Ghana, Zambia, Uganda, and the Philippines: A Comparative Assessment of Decision Making Space. Health Policy and Planning, 17(1), 14–31 Oxford University Press.

    Article  Google Scholar 

  • Bradley, S., Kamwendo, F., Masanja, H., de Pinho, H., Waxman, R., Boostrom, C., et al. (2013). District Health Managers’ Perceptions of Supervision in Malawi and Tanzania, Biomed central. Human Resources for Health, 11, 1–43. doi:10.1186/1478-4491-11-43.

    Article  Google Scholar 

  • Brenyah, J. K. (2008). Decentralization in the Health Care Delivery in Ghana. A Case Study of Komfoanokye Teaching hospital-Kumasi

    Google Scholar 

  • Chattopadhyay, S. (2013). Decentralised Provision of Public Services in Developing Countries: A Review of Theoretical Discourses and Empirical Evidence. Social Change, 43(3), 421–441.

    Article  Google Scholar 

  • Chninsanga, B. (2010). Reflections on the Amendments to the Electoral and Local Government Acts. A Think Piece Prepared for the Malawi German Programme for Democracy and Decentralization (MGPDD). Retrieved April 4, 2016, from http://www.eldis.org/on

  • Coutolenc, B. F. (2012). Decentralization and Governance in the Ghana Health Sector. Washington, DC: World Bank.

    Book  Google Scholar 

  • Crawford, G. (2009). Making Democracy a Reality? The Politics of Decentralisation and the Limits to Local Democracy in Ghana. Journal of Contemporary African Studies, 27(1), 57–83.

    Article  Google Scholar 

  • Dickovick, J. T., & Wunsch, J. S. (2014). Decentralization in Africa: The Paradox of State Strength. Boulder: Lynne Rienner.

    Google Scholar 

  • Dillinger, W. (1994). Decentralization and its Implications for Urban Service Delivery. Urban Management Program Discussion Paper 16, World Bank

    Google Scholar 

  • Ergo, A., Shahi, N., Rashidi, T., & Rozario, A. (2010). Health System Strengthening and Maternal Health: Malawi Case Study. Washington, DC: MCHIP, USAID.

    Google Scholar 

  • Frumence, G., Nyamhanga, T., Mwangu, M., & Hurtig, A. (2013). Challenges to the Implementation of Health Sector Decentralization in Tanzania: Experiences from Kongwa District Council. Global Health Action, 6, 20983. doi:10.3402/gha.v6i0.20983.

    Article  Google Scholar 

  • Government of Ghana. (1996). Health Service and Teaching Hospitals Act, 1996 (Act 525), Accra

    Google Scholar 

  • Government of Malawi. (2005a). A Strategy for Capacity Development for Decentralisation in Malawi report on Phase 1: Capacity Assessment. Malawi: GIZ.

    Google Scholar 

  • Government of Malawi. (2005b). Malawi Country Profile. Retrieved January 13, 2016, from www.afro.who.int/index.php?option=com_docman&task=doc

  • Government of Malawi. (2011). Malawi Health Sector Strategic Plan (2011–2016). Retrieved January, 2016, from http://www.mamaye.org/en/evidence/malawi-health-sector-strategic-plan-2011-2016

  • Government of Tanzania. (1996). The Local Government Reform Agenda 1996–2000. Civil Service Department: Dar es Salaam.

    Google Scholar 

  • Government of Tanzania. (2003). Second Health Sector Strategic Plan (HSSP): Reforms towards delivering quality health services and clients satisfaction. Ministry of Health: Dar es Salaam.

    Google Scholar 

  • Government of Tanzania. (2009). Health Sector Strategic Plan III July 2009–June 2015 Partnership for Delivering the MDGs. Ministry of Health and Social Welfare: Dar es Salaam.

    Google Scholar 

  • Hoffman, B. D. and Metzroth, K. M. (2010). The Political Economy of Decentralization in Ghana. Center for Democracy and Civil Society, Georgetown. Paper Prepared for the World Bank, World Bank, Washington DC

    Google Scholar 

  • Inkoom, D. K. B. (2011). Ghana’s Decentralization: Two Decades and Still Crawling? Development, 54(3), 393–399.

    Article  Google Scholar 

  • Jagero, N., Kwandayi, H. H., & Longwe, A. (2014). Challenges of Decentralization in Malawi. International Journal of Management Sciences, 2(7), 315.

    Google Scholar 

  • Kachala, R. L. J. (2011). Evaluation of Sector Wide Approach in Public Health Infrastructure Development In Malawi. Master of Science—International Cooperation Policy, Public Health Management. Thesis Presented to the Higher Degree Committee of Ritsumeikan Asia Pacific University.

    Google Scholar 

  • Khan, S. A. (2013). Decentralization and Poverty Reduction: A Theoretical Framework for Exploring the Linkages. International Review of Public Administration, 18(2), 145–172.

    Article  Google Scholar 

  • Kisumbe, L., Sanga, D., & Kasubi, J. W. (2014). More than a Decade of Decentralization in Tanzania: Its implications on Pro-Poor Service Delivery. The Case of Primary Education and Health Services. International Journal of Scientific and Research Publications, 4(12), 1–8.

    Google Scholar 

  • Kwamie, A., I.A., A., & van Dijk, H. (2015a). What Governs District Manager Decision Making? A Case Study of Complex Leadership in Dangme West District, Ghana. Health Systems & Reform, 1(2), 167–177.

    Article  Google Scholar 

  • Kwamie, A., van Dijk, H., Ansah, H. K., & Agyepong, I. A. (2015b, August). The Path Dependence of District Manager Decision-Space in Ghana. Health Policy and Planning, 1–11. doi:10.1093/heapol/czv069.

    Google Scholar 

  • Levey, I. R., Gitonga, N., Smith, M., Crosby, D., Baleva, J., Sanders, E., & Wakefield, A. (2011). Malawi Private Health Sector Assessment. Bethesda, MD: Strengthening Health Outcomes through the Private Sector Project, Abt Associates Inc..

    Google Scholar 

  • Loewenson, R., Machingura, F., Kaim, B., and Rusike, I. (2014). Health Centre Committees as a Vehicle for Social Participation in Health Systems in East and Southern Africa. EQUINET Discussion Paper 101, TARSC with CWGH and Medico, EQUINET: Harare. Retrieved from http://www.equinetafrica.org

  • Loquai, C. and Klavert, H. (2011). Supporting Domestic Accountability in the Context of Budget Support: Findings from a Stock-Taking Exercise on German Development Cooperation in Malawi’. European Centre for Development Policy Management, Debriefing Note 28, August 2011, ECDPM, Maastricht.

    Google Scholar 

  • Makaula, P., Bloch, P., Banda, H. T., Mbera, G. B., Mangani, C., de Sousa, A., et al. (2012). Primary Health Care in Rural Malawi—A Qualitative Assessment Exploring the Relevance of the Community-Directed Interventions Approach. BMC Health Services Research, 12, 328. doi:10.1186/1472-6963-12-328.

    Article  Google Scholar 

  • Maluka, S. O. (2011). Strengthening Fairness, Transparency and Accountability in Health Care Priority Setting at District Level in Tanzania. Global Health Action, 4, 7829. doi:10.3402/gha.v4i0.7829.

    Article  Google Scholar 

  • Maluka, S. O., Anna-Karin, H., Sebastián, M. S., Shayo, E., Byskov, J., & Kamuzora, P. (2011). Decentralization and Health Care Prioritization Process in Tanzania: from National Rhetoric to Local Reality. International Journal of Health Planning and Management, 26(2), e102–e120.

    Article  Google Scholar 

  • Mawhood, P. (1983). Local Government in the Third World. Chichester: John Wiley.

    Google Scholar 

  • Mbuyata, S. and Makemba, A. (2007). Equity in Health in Tanzania: Translating National Goals to District Realities. EQUINET Discussion Paper 54, EQUINET, Harare.

    Google Scholar 

  • Molel, A. H. (2011). Participation for Local Development: The Reality of Decentralization in Tanzania. Leiden: African Studies Centre.

    Google Scholar 

  • Mueller, D. H., Lungu, D., Acharya, A., & Palmer, N. (2011). Constraints to Implementing the Essential Health Package in Malawi. PLoS ONE, 6(6), e20741. doi:10.1371/journal.pone.0020741.

    Article  Google Scholar 

  • Mujinja, P. G. and Kida, T. M. (2014). Implications of Health Sector Reforms in Tanzania: Policies, Indicators and Accessibility to Health Services. Background Paper No. 8, ESRF Discussion Paper 62.

    Google Scholar 

  • National Institute for Medical Research (NIMR). (2011). Tanzania District Health Assessment 2008–2009. Summary Report. Tanzania: National Institute for Medical Research (NIMR).

    Google Scholar 

  • Olowu, D., & Wunsch, J. S. (Eds.). (2004). Local Governance in Africa: The Challenges of Democratic Decentralization. London: Lynne Rienner.

    Google Scholar 

  • Osei-Kufuor, P. (2012). Does Institutionalizing Decentralization Work? Rethinking Agency, Institutions and Authority in Local Governance. A Case Study of Ntonaboma in Kwahu-North District, Ghana. Doctoral dissertation, University of Bradford, Bradford.

    Google Scholar 

  • Pearson, M. (2010). Malawi Impact Evaluation of the Sector Wide Approach. Malawi: DFID.

    Google Scholar 

  • Prud’homme, R. (2010). Decentralization in Malawi: An Overview. Washington, DC: World Bank.

    Google Scholar 

  • Ribot, J. C. (2002). African Decentralization Local Actors, Powers and Accountability Programme on Democracy. Governance and Human Rights. Paper Number 8, UNRISD.

    Google Scholar 

  • Rudner, N. (2011). German Financial Cooperation with Malawi SWAP II and Results based financing (RBF): Study on the alignment of financial mechanisms. KFW, March 2011.

    Google Scholar 

  • Smith, B. C. (1985). Decentralization: The Territorial Dimension of the State. London: George Allen and Unwin.

    Google Scholar 

  • Smoke, P. (Ed.). (2003). Decentralisation and Local Governance in Africa. Public Administration and Development, 23, 7–16. doi:10.1002/pad.255.

    Google Scholar 

  • Sumah, A. M., Bowan, P. A., & Insah, B. (2014). Decentralization in the Ghana Health Service: A Study of the Upper West Region. Developing Country Studies, 4(12), 1–9.

    Google Scholar 

  • Tidemand, P., Bjorn, H. O., & Sola, N. (2008). Local Level Service Delivery, Decentralisation and Governance: A Comparative Study of Uganda, Kenya and Tanzania Education, Health and Agriculture Sectors. Tanzania Case Report. Tokyo: Research Group, Institute for International Cooperation, Japan International Cooperation Agency.

    Google Scholar 

  • Yeboah-Assiamah, E. (2014, November 3). Power to the People! How Far has the Power Gone to the People? A Qualitative Assessment of Decentralization Practice in Ghana. Journal of Asian and African Studies, Published online before print. doi:10.1177/0021909614555349.

    Google Scholar 

  • Habitat, U. N. (2002). Local Democracy and Decentralisation in East and Southern Africa: Experiences from Uganda, Kenya, Botswana, Tanzania and Ethiopia. Nairobi: UN Habitat.

    Google Scholar 

  • United States Government. (2012).Ghana Global Health Initiative Strategy 2012–2017. Retrieved January 25, 2016, from http://www.ghi.gov/wherewework/docs/ghanastrategy.pdf

  • World Bank. (1989). Sub-Saharan Africa: From Crisis to Sustainable Growth—A Long-Term Perspective. Washington, DC: World Bank.

    Google Scholar 

  • World Bank. (2000). World Development Report 1999/2000: Entering the 21st Century: The Changing Development Landscape. Oxford: Oxford University Press.

    Google Scholar 

  • Zacharia, S. (2006). Participation in Health Care Delivery and Management: A Case Study of Northern Ghana. Doctoral dissertation, University of Ghana, Accra.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

    Daniel Kweku Baah Inkoom

  2. International Institute of Social Studies, Erasmus University Rotterdam, The Hague, Netherlands

    Adwoa Yeboah Gyapong

Authors
  1. Daniel Kweku Baah Inkoom
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adwoa Yeboah Gyapong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel Kweku Baah Inkoom .

Editor information

Editors and Affiliations

  1. University of Lisbon, Lisboa, Portugal

    Carlos Nunes Silva

Copyright information

© 2016 The Author(s)

About this chapter

Cite this chapter

Inkoom, D.K.B., Gyapong, A.Y. (2016). Decentralization in Africa: Local Government and Health Care in Ghana, Malawi and Tanzania. In: Silva, C. (eds) Governing Urban Africa. Palgrave Macmillan, London. https://doi.org/10.1057/978-1-349-95109-3_4

Download citation

Publish with us

Policies and ethics

Search

Navigation