González-Block M A
Centro para el Análisis en Sistemas de Salud, Fundación Mexicana para la Salud, México, D.F.
Gac Med Mex. 1997 May-Jun;133(3):183-93.
This article constitutes an analysis of the decentralization of the Ministry of Health of Mexico though the project to develop its jurisdictions to strengthen Local Health System (SILOS) implemented between 1989 and 1994. The relationship between decentralization and jurisdictional socioeconomic, demographic and resource availability differences was studied using qualitative and quantitative methods. The impact of jurisdictional strengthening on deconcentration and their combined effect on primary health care (PHC) and coverage were measured. The strengthening of technical capacity within the jurisdictions increased moderately but did not show a significant association with primary health care efficiency. However, when jurisdictions attain more autonomy, a significant association between strengthening and PHC efficiency appears. Deconcentration is a key factor to guarantee the strengthening of technical capacity and to assure that greater efficiency impacts on poverty reduction: however, deconcentration was limited due to the fact that the general strategies of the project were not differentiated according to the inequality across jurisdictions. To decentralize the Ministry of Health effectively, the federation must formulate objectives and strategies according to jurisdictional socioeconomic conditions and service need and capacity. Jurisdictions must be restructured and rescaled to improve their interaction with municipal governments, the health sector and the community.
本文通过1989年至1994年间实施的旨在拓展其辖区以加强地方卫生系统（SILOS）的项目，对墨西哥卫生部的权力下放进行了分析。运用定性和定量方法研究了权力下放与辖区社会经济、人口和资源可得性差异之间的关系。衡量了辖区强化对权力分散的影响及其对初级卫生保健（PHC）和覆盖范围的综合影响。辖区内技术能力的强化有适度提高，但与初级卫生保健效率未显示出显著关联。然而，当辖区获得更多自主权时，强化与初级卫生保健效率之间会出现显著关联。权力分散是保障技术能力强化以及确保更高效率对减贫产生影响的关键因素：然而，权力分散受到限制，原因是该项目的总体战略未根据辖区间的不平等情况加以区分。为有效实现卫生部的权力下放，联邦必须根据辖区的社会经济状况以及服务需求和能力来制定目标和战略。必须对辖区进行重组和重新划分规模，以改善其与市政府、卫生部门及社区的互动。
