Collins C, Green A
Nuffield Institute for Health, Leeds, England.
Int J Health Serv. 1994;24(3):459-75. doi: 10.2190/G1XJ-PX06-1LVD-2FXQ.
Decentralization is a highly popular concept, being a key element of Primary Health Care policies. There are, however, certain negative implications of decentralization that must be taken into account. These are analyzed in this article with particular reference to developing countries. The authors criticize the tendency for decentralization to be associated with state limitations, and discuss the dilemma of relating decentralization, which is the enhancement of the different, to equity, which is the promotion of equivalence. Those situations in which decentralization can strengthen political domination are described. The authors conclude by setting out a checklist of warning questions and issues to be taken into account to ensure that decentralization genuinely facilitates the Primary Health Care orientation of health policy.
权力下放是一个非常流行的概念，是初级卫生保健政策的关键要素。然而，权力下放存在一些负面影响，必须予以考虑。本文特别针对发展中国家对这些影响进行了分析。作者批评了权力下放与国家能力限制相关联的趋势，并讨论了将强调差异的权力下放与促进平等的公平性联系起来所面临的困境。文中描述了权力下放可能强化政治统治的情形。作者最后列出了一系列需要考虑的警示性问题清单，以确保权力下放真正有助于卫生政策的初级卫生保健导向。
