How district health decision-making is shaped within decentralised contexts: A qualitative research in Malawi, Uganda and Ghana.
Glob Public Health
; 16(1): 120-135, 2021 01.
Article
em En
| MEDLINE
| ID: mdl-32657238
ABSTRACT
District Health Management Teams (DHMTs) are often entry points for the implementation of health interventions. Insight into decision-making and power relationships at district level could assist DHMTs to make better use of their decision space. This study explored how district-level health system decision-making is shaped by power dynamics in different decentralised contexts in Ghana, Malawi and Uganda. In-depth interviews took place with national- and district-level stakeholders. To unravel how power dynamics influence decision-making, the Arts and Van Tatenhove (2004) framework was applied. In Ghana and Malawi, the national-level Ministry of Health substantially influenced district-level decision-making, because of dispositional power based on financial resources and hierarchy. In Uganda and Malawi, devolution led to decision-making being strongly influenced by relational power, in the form of politics, particularly by district-level political bodies. Structural power based on societal structures was less visible, however, the origin, ethnicity or gender of decision-makers could make them more or less credible, thereby influencing distribution of power. As a result of these different power dynamics, DHMTs experienced a narrow decision space and expressed feelings of disempowerment. DHMTs' decision-making power can be expanded through using their unique insights into the health realities of their districts and through joint collaborations with political bodies.
Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Tomada de Decisões
Tipo de estudo:
Qualitative_research
Limite:
Humans
País como assunto:
Africa
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article