Jeppsson A, Okuonzi S A
Ministry of Health, Kampala, Uganda.
Int J Health Plann Manage. 2000 Oct-Dec;15(4):273-89. doi: 10.1002/hpm.597.
Many countries in Africa have embarked on health sector reforms. The design of the reforms differs considerably. A key feature of the reforms is decentralization, of which Uganda and Zambia are implementing two different models. This paper analyses the two models of health sector reform, and their implications for ultimate development goals. In Uganda, the whole government has been decentralized, with a wide range of powers and resources transferred to the districts. The health care system is part of the political set up of the country. In Zambia, only the health sector has been decentralized. Power and resources for health care have been divested to new parallel organizations. While useful lessons can be drawn from the managerial and administrative experience in the two countries, not least concerning donor coordination, it seems that neither form of decentralization has so far led to a clear and appreciable improvement of health services and, ultimately, to a clear focus on development goals, such as poverty alleviation. The conditions for this to happen are discussed in this paper.
非洲许多国家已着手进行卫生部门改革。改革的设计差异很大。改革的一个关键特征是权力下放，乌干达和赞比亚正在实施两种不同的模式。本文分析了卫生部门改革的两种模式及其对最终发展目标的影响。在乌干达，整个政府已进行权力下放，广泛的权力和资源已转移到各地区。医疗保健系统是该国政治体制的一部分。在赞比亚，只有卫生部门进行了权力下放。医疗保健的权力和资源已剥离给新的平行组织。虽然可以从两国的管理和行政经验中吸取有益的教训，尤其是在捐助者协调方面，但似乎到目前为止，这两种权力下放形式都没有带来卫生服务的明显和可观改善，最终也没有明确关注诸如减贫等发展目标。本文讨论了实现这一目标的条件。
