Department of Local Government Management, School of Public Administration and Management, Mzumbe University, Morogoro, Tanzania.
Department of Policy Planning and Management, College of Social Sciences and Humanities, Sokoine University of Agriculture, Morogoro, Tanzania.
Glob Health Action. 2022 Dec 31;15(1):2074662. doi: 10.1080/16549716.2022.2074662.
Health facility governing committees (HFGCs) were established by lower and middle-income countries (LMICs) to facilitate community participation at the primary facility level to improve health system performance. However, empirical evidence on their effects under decentralization reform on the functionality of HFGCs is scant and inconclusive.
This article reviews the effects of decentralization on the functionality of HFGCs in LMICs.
A systematic literature review was conducted using various search engines to obtain a total number of 24 relevant articles from 14 countries published between 2000 and 2020. Inclusion criteria include studies must be on community health committees, carried out under decentralization, HFGCs operating at the individual facility, effects of HFGCs on health performance or health outcomes and peer-reviewed empirical studies conducted in LMICs.
The study has found varied functionality of HFGCs under a decentralization context. The study has found many HFGCs to have very low functionality, while a few HFGCs in other LMICs countries are performing very well. The context and decentralization type, members' awareness of their roles, membership allowance and availability of resource to the facility in which HFGCs operate to produce the desired outcomes play a significant role in facilitating/limiting them to effectively carry out the devolved duties and responsibilities.
Fiscal decentralization has largely been seen as important in making health committees more autonomous, even though it does not guarantee the performance of HFGCs.
中低收入国家（LMICs）设立了卫生机构管理委员会（HFGCs），以促进社区在基层医疗机构的参与，从而改善卫生系统的绩效。然而，关于分权改革对 HFGC 功能的影响的实证证据很少且没有定论。
本文综述了分权对 LMICs 中 HFGC 功能的影响。
使用各种搜索引擎进行系统文献综述，共从 14 个国家获取了 2000 年至 2020 年期间发表的 24 篇相关文章。纳入标准包括：必须是关于社区卫生委员会的研究，在分权下进行，HFGC 在单个机构运作，HFGC 对卫生绩效或卫生结果的影响以及在 LMICs 进行的同行评议的实证研究。
研究发现，在分权背景下，HFGC 的功能各不相同。研究发现，许多 HFGC 的功能非常低，而在其他一些 LMIC 国家的 HFGC 则表现得非常好。分权类型、成员对自身角色的认识、成员津贴以及 HFGC 运作所在机构的资源可用性对促进/限制其有效履行下放职责和责任的能力起着重要作用。
财政分权在使卫生委员会更加自主方面被认为非常重要，尽管它不能保证 HFGC 的绩效。
