Decentralization Process Research Articles

Fiscal Decentralization and Educational Outcomes: Empirical Evidence from Pakistan

A large number of countries are transferring financial, administrative, and political powers to the local governments. In Pakistan, devolution reforms were launched through the Local Government Ordinance in 2001. This research investigates whether the higher autonomy of district governments could improve education outcomes in their respective districts or not. The Generalized Methods of Moments is employed for a panel of 34 districts of Punjab province, Pakistan, during 2003-2015. The results reveal that fiscal decentralization improves education outcomes in Punjab province of Pakistan. The enrolment in primary school is a measure of education outcome and improved in the districts of Punjab. In addition, the decentralization process during Pervez Musharraf's regime could not change the structure of the economy as a whole. Therefore, decentralization of the education sector in all provinces is suggested to reinforce the benefits of fiscal decentralization.

Decentralization of the health system - experiences from Pakistan, Portugal and Brazil.

Decentralization of a health system is a complex and multidimensional phenomenon that demands thorough investigation of its process logistics, predisposing factors and implementation mechanisms, within the broader socio-political environment of each nation. Despite its wide adoption across both high-income countries (HICs) and low-and-middle-income countries (LMICs), empirical evidence of whether decentralization actually translates into improved health system performance remains inconclusive and controversial. This paper aims to provide a comprehensive description of the decentralization processes in three countries at different stages of their decentralization strategies - Pakistan, Brazil and Portugal. This study employed a systematic analysis of peer-reviewed academic journals, official government reports, policy documents and publications from international organizations related to health system decentralization. A comprehensive search was conducted using reputable databases such as PubMed, Google Scholar, the WHO repository and other relevant databases, covering the period up to the knowledge cutoff date in June 2023. Information was systematically extracted and organized into the determinants, process mechanics and challenges encountered during the planning, implementation and post-decentralization phases. Although decentralization reforms have achieved some success, challenges persist in their implementation. Comparing all three countries, it was evident that all three have prioritized health in their decentralization reforms and aimed to enhance local decision-making power. Brazil has made significant progress in implementing decentralization reforms, while Portugal and Pakistan are still in the process. Pakistan has faced significant implementation challenges, including capacity-building, resource allocation, resistance to change and inequity in access to care. Brazil and Portugal have also faced challenges, but to a lesser extent. The extent, progress and challenges in the decentralization processes vary among the three countries, each requiring ongoing evaluation and improvement to achieve the desired outcomes. Notable differences exist in the extent of decentralization, the challenges faced during implementation and inequality in access to care between the three countries. It is important for Portugal, Brazil and Pakistan to address these through reinforcing implementation strategies, tackling inequalities in access to care and enhancing monitoring and evaluation mechanism. Additionally, fostering knowledge sharing among these different countries will be instrumental in facilitating mutual learning.

TAX REVENUE OF THE BUDGETS OF TERRITORIAL COMMUNITIES OF THE REGION

The article examines both theoretical and practical aspects of forming the budgets of regional territorial communities, highlighting that local budgets are primarily composed of tax revenues. Due to decentralisation processes in Ukraine, territorial communities have been consolidated, making the united territorial communities the primary units of local self-government. Consequently, the mechanisms for forming these budgets have evolved, with tax revenues becoming the main financial resource for local governments, enabling them to fund their functions. The article emphasises that the approaches to forming local budget revenues have changed significantly under martial law, with many financial laws being amended. The article analyses the changes to the legislation that affected the formation of local budgets' tax revenues in martial law conditions. It analyses legislative changes that have impacted the formation of local budget tax revenues during this period. A comparative analysis is provided, focusing on the formation of tax revenues for local budgets in the Odesa region before and after the imposition of martial law. This includes examining the main national and local taxes contributing to these budgets. The article specifically highlights the tax revenues of the territorial communities in the Odesa region, demonstrating how these revenues have fluctuated in recent years. As a result of the conducted analysis, it was established that since the beginning of the war, income from most tax revenues has decreased. The main factors of influence on the change in tax revenues of the budgets of territorial communities of the region under martial law conditions are substantiated. The paper reveals that most tax revenue streams have decreased since the onset of the war. It explores the key factors influencing these changes and the primary reasons for the region's decline in local budget revenues. The article underscores the necessity for new approaches to forming local budget tax revenues, emphasising the need to address taxation issues and effectively utilise budgetary and tax instruments.

УПРАВЛЕНИЕ АРХИТЕКТУРНО-СТРОИТЕЛЬНЫМИ ПРОЦЕССАМИ В ВОРОНЕЖСКОЙ ГУБЕРНИИ В КОНЦЕ XVIII – 60-х гг. XIX в.

The influence of all-Russian legislation and local administration on the formation and activities of the architectural and construction service in the Voronezh province during the period under study is analyzed. Based on archival data, changes in its structure and personnel composition, the activities of provincial and city architects in implementing installations coming from the capital were studied. Using the example of a province, the process of gradual decentralization of construction management on a state scale was studied, which led to the creation of an extensive structure of architectural and construction services built into local authorities. It is shown that in a number of cases the Voronezh experience had priority over the all-Russian one. The history of the creation of the first regular plan of Voronezh in 1774, which became an example of the interaction of provincial administrations with the “Commission on the stone structure of St. Petersburg and Moscow,” is studied. It has been proven that the position of provincial architect in Voronezh has existed since 1773, which is a unique phenomenon for the province. It has been established that Voronezh became one of the first provincial cities where the position of city architect was introduced. In 1805 it was occupied by T.S. Kondratiev. Previously unpublished materials from the collections of the Russian State Historical Archive and the State Archive of the Voronezh Region were analyzed and introduced into scientific circulation.

For better or worse: the influence of conflict-driven decentralization on the resilience of urban water supply infrastructure in the Middle East

ABSTRACT When armed conflicts disrupt urban water supply, local communities are forced to find other ways to fulfill their domestic water needs. In this paper, we analyze the development of decentralized water infrastructure as a coping strategy during armed conflict in five cities across Iraq, Syria and Yemen. We discuss the implications of conflict-driven decentralization on the resilience of urban water supply infrastructure, addressing its functionality, its recovery in case of disruption, and its sustainability on the long term. The results indicate that decentralized water supply systems developed throughout conflict uphold a basic level of functionality and minimize their vulnerability to conflict-related shocks. However, short-term resilience gains come at the cost of health risks and high water prices, and undermine system sustainability due to a lack of coordination. We conclude that decentralization processes implemented within the constraints of armed conflict are often detrimental to infrastructure resilience, particularly over longer timeframes.

Institutional governance and state-building in Somaliland

Governance is the combined principles of the effective rule of law within a framework of institutional capacity for legal entity, Institutional governance encompassed both administrative aspect and legal framework of institutional development linked with the state-building development. Institutional governance entails accountability, transparency to the demands of effective monitoring process, the aim of the paper is to know how institutional governance affect state-building in Somaliland, institution governance framework and the role of institutions to stat-building follow to accountability, transparency, rule of law and participation. The paper exams to understand the dynamics of institutional governance and state-building idea of governance in state-progress, state-building determinate, institutional Legal frameworks, discrepancies affecting institutions and the consequence. Somaliland is post-conflict country, the consequence from the destruction of infrastructural development brought some basic facilities including, peace, schools and institutional governance has destroyed, the paper presents the role of government bureaucrats (Civil Service)[1] in institutional building, peace restoration and institutional development, finally one of the ideas of paper discussed is the how citizens involved state-building and state-development. The Somaliland Civil Service Commission is a Somaliland government agency established in 1993 that oversees the employment of civil servants and lead reforms in Somaliland's decentralization process. The head of the agency is chairman and is appointed by the President of Somaliland.

Budgetary fund management in resource-constrained environments: financing strategies

In the process of European integration, it is necessary to implement economic reforms to ensure effective management of state finances. Changes in budgetary relations and the allocation of budget monetary resources are observed in connection with the process of decentralisation and transformation processes in the budgetary system. The aim of this article is to establish the significance of financing budget managers, even under resource constraints. The study focuses on the process of financing budget managers. The research methods employed include analysis, systemic-structural, comparative-legal, and dialectical methods. The results indicate that the current state and societal development necessitate the establishment of a strong and effective state economy. The financing of budget managers under resource constraints is a pertinent issue. Recent events in the country highlight that local budgets encounter various problems and inconsistencies, mainly due to limited financial resources, unclear expenditure powers between different levels of the budgetary system, inefficient spending models, and low investment capacity. Planning and executing local budgets' expenditure is a crucial aspect of budget policy that determines the effectiveness of local self-government bodies in fulfilling their functions and powers. Financial constraints of the state are especially significant in relation to the competence level of participants in the budget process, the ability to allocate budget funds rationally and in line with the priorities of budget policy, and the need to achieve maximum effect with minimal costs for socio-economic development. Proper use of local budgets requires evaluating financial procedures, monitoring the fulfilment of budgetary powers, assessing expected results, and accurately defining needs, among other factors. To address financial constraints, it is necessary to review and adjust budget expenditures and regulate the powers of local authorities regarding expenditure. Increasing spending by local budgets to complete their own responsibilities will enhance the investment aspect of local self-government budgets.

Synergistic Impacts of Built-Up Characteristics and Background Climate on Urban Vegetation Phenology: Evidence from Beijing, China

Vegetation is an important strategy for mitigating heat island effects, owed to its shading and evaporative cooling functions. However, urbanization has significantly affected regional vegetation phenology and can potentially weaken the cooling potential of vegetation. Previous studies have mainly focused on national and regional vegetation phenology, but local-scale vegetation phenology and dynamic variations in built-up areas remain unclear. Therefore, this study characterized the vegetation phenology in the densely built-up area of Beijing, China over the period of 2000–2020 based on high-resolution NDVI data using Savitzky–Golay filtering and explored its spatiotemporal characteristics and drivers. The results indicate that the vegetation phenology exhibits significant spatial heterogeneity and clustering characteristics. Compared with vegetation in peripheral blocks, vegetation in central urban blocks generally has an earlier start in the growing season (SOS), later end in the growing season (EOS), and a longer growing season length (GSL). However, the overall distribution of these parameters has experienced a process of decentralization along with urbanization. In terms of drivers, vegetation phenology indicators are mainly influenced by background climate. Specifically, SOS and GSL are mainly affected by temperature (TEP), whereas EOS is mainly influenced by annual precipitation (PRE). Additionally, local environmental factors, particularly the percentage of water body (WAP), also have an impact. Notably, the local environment and background climate have a synergistic effect on vegetation phenology, which is greater than their individual effects. Overall, this study extends the current knowledge on the response of vegetation phenology to urbanization by investigating long-term vegetation phenology dynamics in dense urban areas and provides new insights into the complex interactions between vegetation phenology and built environments.

Some aspects of regulating the procedure for the adoption and appeal of normative legal acts of local councils in Ukraine

Research on this topic is important and relevant for several reasons. Effective and fair regulation of procedures for the adoption and appeal of normative legal acts at this level is crucial for ensuring the rights and interests of citizens in practice. The alignment of national legal norms with international standards is key for the organic integration of Ukraine into the European legal system, and the processes of decentralization necessitate the study of this topic through the prism of local authorities.
 The article uses such research methods as comparison, analysis, induction and deduction.
 During the research, results were obtained, consisting of the formation of a clear and comprehensive vision of normative legal acts that regulate the procedures for the adoption and appeal of normative legal acts of local councils in Ukraine. Existing legal problems were highlighted, and solutions were proposed. The primary issue in the normative-legal regulation of the studied topic is the insufficient clarity in defining normative-legal acts and the narrowing of the range of subjects of appeal compared to the Constitution. Considering the points stated in this article will contribute to the improvement of the legal regulation of the discussed issues and the further application of legal norms.
 The study of the chosen topic is crucial for understanding and addressing current problems in the regulatory and legal foundations of the functioning of local self-government and ensuring guarantees of the protection of citizens’ rights at the local level.
 Further research on this topic allows for a deeper understanding of the role of local self-government in ensuring the harmonious functioning of society and identifying possible ways to improve regulatory and legal frameworks. Specifically, in the context of addressing issues such as the lack of clarity in defining the concept of «regulatory and legal act» and restricting the scope of subjects for challenging regulatory and legal acts, as identified in this study, it is crucial to emphasize the need for transparency in legal processes at the local level. The findings of this research can serve as a foundation for subsequent reforms in the field of local self-government and the establishment of effective mechanisms for protecting citizens’ rights at the local level.

SIANCO: reflexiones sobre su fundamentación desde la óptica de la gestión fiscal y la descentralización

An approach from the economic analysis of law allows us to overcome a purely instrumental view of norms, thereby broadening the legal analysis and enriching the understanding of these norms within the framework of public policy decisions, taking into account the regional context and economic relations. The connection between economics and law, and efficiency and law, in relation to the fiscal manager, surpasses the mere exegetical exercise of public functions. It opens the horizon to the incorporation of technological tools that improve the objectives of the administrative function, thereby maximizing democracy, the decentralization processes established in the 1991 Constitution, and strengthening citizen participation. In this context, which also adheres to the principle of harmonious collaboration that should precede relations between territories and the Nation, and considering the importance of revenue derived from the consumption tax on liquor, beer, and cigarettes in territorial incomes, the Consumption Tax Support System (SIANCO) is created.

DECENTRALIZATION AS A FACTOR IN THE DEVELOPMENT OF TERRITORIAL COMMUNITIES IN UKRAINE: EXPERIENCE OF THE EU COUNTRIES

The analysis of modern Ukrainian political and legal research suggests that the theory is dominated by the understanding of the territorial organization of power according to which the territorial community is the basis for the organization of the system of community development management. According to the researchers, it is the excessive number of small administrative-territorial units of the basic level that has determined the need for reform. The lack of the necessary economic and human resources makes it impossible for basic local government units to effectively exercise their powers. The main problem of decentralization is that the creation of new territorial communities did not take into account resource provision, transportation tasks, and economic and geographical zoning in general. The author analyzes and compares the experience of EU countries in decentralization. To ensure a favorable climate for the decentralization process, special regional development institutions have been created in different countries as executive bodies that assist various departmental structures in their activities, and these can also be independent institutions for the development of regional development programs and fund management, public non-profit organizations, and other non-governmental organizations working in partnership with government institutions. Today, in the context of war, our state as a whole and each individual territorial community in particular lives by different principles, budgets are formed and used in a completely different way, many projects have been suspended, funds allocated for them have been redirected to other areas, and mass migration has taken place both within the country and abroad.
 The article reveals that, according to the researchers, an excessive number of small administrative-territorial units of the basic level determined the need for decentralization reform. It is found that the main problem of decentralization is that the creation of new territorial communities did not take into account resource provision, transportation tasks, and economic and geographical zoning in general. The author analyzes and compares the experience of EU countries on decentralization issues. It is determined that the goals and objectives of the state policy on reform and decentralization are formed and coordinated with each other, they are specified in various programs and regulations. It can be argued that, in general, Ukraine is moving in the right direction in terms of reforming local self-government and territorial organization of power and covers all socially important areas.

THE PRESIDENT OF THE REPUBLIC OF KAZAKHSTAN AND LOCAL AUTHORITIES: HISTORICAL AND LEGAL ASPECT

The author notes in his research that from 1993 to 1995 a new system of local government was formed, local executive and representative bodies were allocated. With regard to the formation and activities of local executive bodies, the head of state played a key role, the system was based on vertical subordination. At the same time, local representative bodies have gained some independence. In the article, the author examines the history of the formation and development of the institution of local authorities, the development of relations between the head of state and territorial authorities. The subject of the study is the legal acts of the Republic of Kazakhstan, the legal norms formulated in them and the practice of their implementation, program documents. The objectives of the work are to identify problems in the system of relations between the President and local authorities. In the course of the study, the author examines the processes of centralization and decentralization. Thus, within the framework of the constitutional reform of the development of local authorities and self-government, the introduction of direct elections of the leadership of administrative-territorial units of some types, the system of vertical power and subordination is maintained. Moreover, the article shows some inconsistency in the ongoing reforms of local government, leveling the increase in the status of local authorities at the expense of other norms and rules. The paper shows that after the constitutional reform of 2022, the President of the Republic of Kazakhstan retains full authority over local governments (taking into account the presence of some elements of independence of territorial governments). The article and in conclusion assesses some provisions of the legal acts of Kazakhstan.

The Effect of Crises on Fiscal and Political Re-Centralization

Economic stability plays a crucial role in any fiscal and political decentralization process. In the face of financial and economic shocks, when revenues and expenditures are reduced, countries may decide to gather resources at the central level creating a re-centralization scenario or may take away devolved powers and centralize political institutions. Using data from 75 countries, we examine the effects of the economic crisis on fiscal and political decentralization. We find that several types of crises lead to fiscal re-centralization. However, in the case of domestic borrowing crises, the effect is further revenue decentralization, probably reflecting the central government's willingness to empower sub-national governments to avoid similar crises. In addition, we explore the impact of the economic crisis on political decentralization and find that they are concordant with the fiscal decentralization effects, suggesting an alignment of the impact along political and fiscal dimensions of subnational autonomy. We also explore whether the economic crises trigger more permanent rather than just transitory changes in the level of decentralization, and we generally find more long-lasting effects in the case of fiscal decentralization measured from the expenditure side. This pattern is apparent in the cases of inflation and banking crises and is less precise but still present in the cases of currency and external debt crises. The main results are robust to different specifications, estimation methods, and the measurement of decentralization.

Тенденції децентралізації публічного управління: сучасний стан та перспективи розвитку

The article deals with the current state and prospects for developing decentralization in public administration by transferring managerial functions and central authorities’ powers to the local administration level. The article emphasizes that despite being tested by war, Ukrainian decentralization received an impeccable assessment from the European Commission, which preceded granting our country the candidate status for the European Union membership. The history of decentralization is analyzed, and successive stages are singled out. The stages mainly relate to the normative and legal regulation of this process: the first stage (2014– 2019), the second stage (2020–2021), and the third stage (2022 – present). The third stage of the local self-government reform seems to be the most difficult since it occurred during the martial law period. The hostilities only emphasized the effectiveness of the decentralization reform: local self-government bodies responded promptly to the situation, resolving issues of settling internally displaced persons, repairing housing for them, providing facilities and premises for evacuated enterprises, and organizing humanitarian headquarters. An essential task of the third stage is adopting the Law on Amendments to the Constitution of Ukraine (regarding decentralization of power), a prerequisite for continuing decentralization reforms and their completion. The article examines the achievements that are positively reflected in the activities of the united territorial communities due to the decentralization process in the following areas: budget, healthcare, security, international cooperation, culture, education, and service provision. At the same time, the factors complicating the decentralization process and leading to problems in the practical and proper functioning of local authorities are considered. Attention is drawn to the need to adopt important laws, including the Laws “On the principles of the administrative and territorial structure of Ukraine”, “On service in local selfgovernment bodies” (revised version), “On state supervision over the legality of decisions of local self-government bodies”, “On local referendum”, as well as updating laws on local selfgovernment, on local state administrations, etc.

Economic Consequences of Geopolitical Conflicts for the Development of Territorial Communities in the Context of Economic and National Security of Ukraine

"The article examines peculiarities of the influence of geopolitics and geopolitical conflicts on territorial communities in Ukraine in a comparative and historical context. Particular attention is paid to the economic consequences of such influence. The importance of taking into account factors of the environment created by realities of the modern world the hybrid peace is emphasized. It is shown that the processes of internationalization and globalization are accompanied by processes of decentralization and autonomation, determining the inevitability of the influence of geopolitical conflicts specifically on territorial communities."

Legal regulation of formation of budgets of united territorial communities as key subjects of local self-government

This article is devoted to the study of certain aspects of the formation of local self-government budgets, namely united territorial hromadas. It is summarized that the armed actions of the aggressor led to a deep economic crisis in Ukraine, which affected the financial capacity of the state as a whole and local self-government bodies, in particular.
 Attention is focused on the fact that with the beginning of a full-scale invasion, the process of approving the budget of local self-government has undergone certain changes: the heads of the respective territorial communities can dispose of the funds of local budgets only in the territory where hostilities are not conducted and the military administration of the settlement (settlements) is not formed. The amendments to the Budget Code of Ukraine related to the payment of personal income tax by military personnel are analyzed. Attention is paid to the content of these innovations, namely, to direct to the state budget revenues from the paid tax on the income of an individual from payers- military personnel. It is noted that these changes should contribute to a more efficient distribution of financial resources, in particular, to influence the state's ability to purchase drones and weapons to ensure the country's defense capability.
 Particular attention was paid to the issues of formation of local budgets, their distribution and use. It is emphasized that the process of decentralization of power, proposed by the government to meet the financial needs of hromadas, is based on local budgets, which will ensure financial independence and personalize responsibility for the consequences of ineffective management of local finances. It is emphasized that the successor of the property and duties of territorial communities are the communities themselves, but according to the innovations, the remaining funds received from the community budget over the past year will be directed to activities related to Russia's armed aggression against Ukraine.
 The article focuses on the importance of ensuring transparency in spending budget funds and the right of communities to establish their own mandatory procedures for ensuring publicity in managing local finances.

The coming twilight of a petro-state? Traumatic decarbonization as a driver of political transformation in Iraq

Iraq is a compelling example of a state highly dependent on a singular source of rent, namely oil revenue. Since 2003, Iraq has also been characterized by a fractured, rivalrous elite without central control over organized violence. This formula represents a “rentier political marketplace” in which state funds for salaries and contracts are the essential lubricant of the political system. During 2014–2021, successive shocks to national oil revenues represented a partial and temporary, but traumatic, decarbonization of Iraq’s government and political finance. In turn, this triggered a series of governance and political reconfigurations including a nominal decentralization process and fracturing of sectarian power, followed by a nationwide civic movement demanding transformational change. This paper traces these changes and the abrupt return to business as usual when oil prices rebounded. In doing so, the paper further investigates the nexus between oil and democracy in Iraq and addresses the unanswered question of how Iraq can decarbonize and democratize in the future.

Development of A More State-led Approach of Chinese Railway Express During and After the Epidemic

Starting from the decentralization during the reform and opening-up period in 1978, the growth of China's railroad has gone through the process of decentralization and then re-centralization, which is also one of the most special stages. The development process of CR Express is a epitome of the history of China's railroad development. Since its opening in 2011, its transportation volume has been showing a trend of steady growth. Since the epidemic, the China-Europe liner has ushered in a period of extremely rapid development. The fundamental reason for this is that the unexpected demand under the ad hoc situation has shaped the decentralized policy into a more state-led approach to developing the freight train operation. This paper will focus on this phenomenon, analyze the reasons for this trend from various aspects such as politics, economy, international situation, etc., and elaborate the challenges faced by the CR Express in the post epidemic era as well as the implications of this development process for China's infrastructure construction.

Women and Rural Development in the Context of Decentralisation in Tubah Council, North West Region of Cameroon

Purpose: Before 1990s, the decentralisation process in Cameroon has gone through several stages. This process really materialised with the revision of the Cameroon Constitution in 1996. Owing to that, several laws concerning this process were promulgated. Decentralisation should eventually make all decentralised territorial authorities autonomous. This government policy, which is part of the bottom-up approach, has the responsibility to promote the participation of the population. Thus, one is entitled to ask how decentralisation in Cameroon can impact women’s participation in rural development in the Tubah council?
 Materials and Methods: To answer this question, primary and secondary data were mobilised and processed according to appropriate methods for the variables studied. Primary data were collected from observation, interviews of key informants and administration of questionnaires addressed to a sample of 145 people in the council area. Secondary data were obtained from internet sources, textbooks as well as documentations and libraries. Quantitative data were analysed using descriptives and inferentials statistics meanwhile content analysis was used for qualitative data analysis.
 Findings: The results show that even if the decentralisation process does not pay particular attention to women, it contributes to the creation of a favourable framework for local development initiatives. Thus, 79% of the women in the Tubah area act individually, compared with 21% who take part in group actions. Their actions varied, with 40% in the field of agriculture and 30% to drinking water supply projects. Identified as one of the pillars of development in rural areas, the intervention of women, if well supervised and structured, it can boost development in a sustainable and effective way.
 Implications to Theory, Practice and Policy: The study recommends that councils within the process of decentralisation should encourage women participation in rural development by ensuring their high representativeness. It also goes in line with the theory of decentralisation, which states that in order to promote local and participatory development, the transfer of power to local authorities must be effective. The study emphasises on the fact that, the transfer should not only be at the level of power and finances, but it should also include the social categories, must especially women, who are one of the main actors of rural development in Cameroon.

Prospects for the development of community-based care in remote rural areas: a stakeholder analysis in Laos

BackgroundCommunity-based health programmes have been a cornerstone of primary care in Laos for decades. The study presented here aimed to document prospects for the development of current programmes, considering perceptions about health and health care priorities in the communities, implementation challenges, the policy landscape and opportunities associated with the availability of new technologies.MethodsThe research design primarily involved qualitative in-depth interviews with stakeholders (n = 35) responsible for the planning, management, or implementation of community-based care in Laos at different levels of the health system. These included health managers at central departments or institutes of the Ministry of Health, provincial health departments, district health offices, heads of health centres, village health volunteers, community representatives, and international stakeholders.ResultsThere was consensus that service delivery is still a challenge in many areas, due to geographic inaccessibility of health facilities, communication barriers, health-seeking behaviour, trust, and gender discrimination, particularly among ethnic minorities. In these settings, community health workers have the potential to extend the reach of the formal health system, acting as cultural brokers across sectors of society, ethnicities, and worldviews. To maximise impact, planners need to carefully consider the implementation model, financing arrangements, health system integration, and changing health priorities in the communities.ConclusionsThis study examined challenges to, and opportunities for, the expansion and health system integration of community-based care in Laos. Further development and horizontal integration of community-based care remains a complex financing and governance challenge, although the renewed emphasis on primary care and the ongoing process of decentralisation provide a favourable policy environment in the country to sustain and potentially expand existing programmes.