Applying Systems Thinking to Understand the Process of Decentralization

Abstract

Abstract Decentralization of health services entails empowering local governments to take the lead on decision-making and governance of health services provided in their districts. If managed properly, decentralization has the potential to strengthen governance, leadership, management, and accountability of the district health system; improve efficiency and responsiveness of the district healthcare system at all levels; and increase investments in human capital. Undergoing decentralization since 1998, Malawi has made significant progress in devolving human resources for health (health workforce), strengthening governance and leadership, and enhancing accountability through devolved health financing and health information systems. However, challenges remain, including lack of clarity on the roles, responsibilities, and the decision-making process within the context of decentralization, insufficiency of funds, and insufficient human resources for health. Using human resources for health as an entry point, and the case example of Malawi, this chapter demonstrates that systems thinking offers a useful framework through which to understand the process of decentralization in a particular context.