[The decentralization of the Secretaría de Salud de México. The case of local health systems 1989-1994].

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.