Mohammed Jalal, Ashton Toni, North Nicola
The University of Auckland, Auckland, New Zealand
The University of Auckland, Auckland, New Zealand.
Asia Pac J Public Health. 2016 Apr;28(3):232-43. doi: 10.1177/1010539516635270. Epub 2016 Mar 10.
Decentralization in the health sector has been widely implemented since the 1970s as a reform mechanism with mixed results. This study describes Fiji's 2 attempts at decentralizing its health sector and examines the implications they have had for the functions of planning, financing, and delivery of health services. The first wave attempted a major restructure by devolving Fiji's health system. Political instability, along with a lack of acceptance, stalled its implementation resulting in a delegated system. While the functions of planning and financing remained centralized, the function of delivery was delegated to geographic regions. The second wave was a more focused effort that targeted the deconcentration of outpatient services in one division. This attempt also decentralized the delivery function while keeping the other 2 functions centralized. Fiji's incremental approach to decentralization could provide lessons for Asia-Pacific countries that have had failed attempts in large scale decentralization efforts.
自20世纪70年代以来，卫生部门的权力下放作为一种改革机制已被广泛实施，但结果喜忧参半。本研究描述了斐济在卫生部门权力下放方面的两次尝试，并探讨了这些尝试对卫生服务规划、融资和提供功能的影响。第一波尝试通过下放斐济的卫生系统进行重大重组。政治不稳定以及缺乏接受度，使其实施受阻，导致了一个委托系统。虽然规划和融资功能仍集中化，但提供功能被下放到地理区域。第二波是一项更有针对性的努力，目标是在一个部门实现门诊服务的非集中化。这次尝试也将提供功能下放，同时保持其他两项功能的集中化。斐济渐进式的权力下放方法可以为在大规模权力下放努力中失败的亚太国家提供经验教训。
