Abstract
Enhanced Health care services address not only one of the key Sustainable Development Goals (SDG) which is goal No 3, but also the development strategies for most developing countries. Good governance is critical to improving health care systems. Many developing countries therefore have decentralized health care systems as a way of improving good governance and as a means of attaining improved access to and delivering quality health care services to both urban and rural population. Decentralization involves the extent of planning, management and decision making from national to lower levels of government. From the 1990s the capacity of governments in developing countries to deliver public goods and services was stretched to the extent there was dire for partnerships. The Public Private Partnerships (PPP) therefore became fundamental in the provision of health services under decentralization. The nature of PPP differed from country to country and the level of decision making within each level of government. The paper has discussed the extent to which decentralized governance has facilitated the management of health care systems in the urban centres through Public Private Partnership initiatives, by conducting a comparative case study analysis of existing literature on urban health care systems under different forms of decentralized governance in Kenya, Uganda, Ghana and India, respectively. The study established that access to health care services differed with forms of decentralization. Secondly, there were more public private partnerships in devolved governments which also registered higher improvement in access to health care services in urban centres. The paper concluded that the more the involvement of public private partnership, the better health care services in terms of access was noted.
Highlights
The urban population in developing countries has moved from 1/4 in 1965 to 1/2 in 1990, and is projected to be 2/3 of the total population by the year 2025 (World Bank, 1992)
The paper has discussed the extent to which decentralized governance has facilitated the management of health care systems in the urban centres through Public Private Partnership initiatives, by conducting a comparative case study analysis of existing literature on urban health care systems under different forms of decentralized governance in Kenya, Uganda, Ghana and India, respectively
It has emerged that the decentralization of healthcare is commonly accepted amongst the countries as the best option even though similar forms of decentralization applied in different countries have sometimes yielded contrasting results
Summary
The urban population in developing countries has moved from 1/4 in 1965 to 1/2 in 1990, and is projected to be 2/3 of the total population by the year 2025 (World Bank, 1992). The significance of a decentralized governance of health systems is to improve decision making at local levels in different tiers of health service delivery and to ensure a constantly growing involvement at several levels of government as well as the private sector (Lama-Rewal, 2011) It is in this respect that the World Development report appreciated partnerships in the form of investment in the health sector by both bilateral and multilateral donors like UNICEF, USAID, World Bank support of projects (World Bank, 1993). Whereas in devolved systems the management of urban healthcare falls under the devolved unit in whatever name it is called, in delegated and deconcentrated systems, the national governments manage the healthcare in various ways In this process, the role of the state influences the role of other stakeholders resulting in different forms of public private partnerships. How does the form or level of decentralization influence PPP in an urban health system? Under what form of decentralization does PPP flourish and which one threatens the operations of PPPs?
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