Very well said! I couldn’t agree more! But beyond decentralization, other than the blurring of line of responsibility between the national government and the local government, the role of stewardship for health often fall on the local health officer, however, speaking from my own personal experience, as a previous municipal health officer, it is very difficult to function as such if local health officers do not have adequate support.
To further elaborate, I had no power for planning and budgetting and therefore had no real control over the health programs to be implemented. The mayor told me to fund for the activities myself for which my expenses will be refunded.
You described the transfer of responsibility from the national government to the local government but not fiscal power in your article, however, this also can happen even within the local government.
Thank you for sharing your experience, as it illustrates one of the most difficult realities of decentralization in practice. You’re absolutely right that the issue is not only the transfer of responsibility from the national government to local governments without sufficient fiscal authority. What often happens within local governments mirrors the same dynamic. As you noted, planning and budgeting decisions are frequently concentrated in political leadership, leaving local health officers responsible for population health but without the fiscal and administrative control to act effectively. I agree that these internal governance dynamics within local governments deserve more discussion.
On a related note, one of our papers highlights the crucial role of local health officers in addressing fragmentation by advancing the integration reforms within UHC. You might find it interesting: https://gh.bmj.com/content/9/1/e014118
Very well said! I couldn’t agree more! But beyond decentralization, other than the blurring of line of responsibility between the national government and the local government, the role of stewardship for health often fall on the local health officer, however, speaking from my own personal experience, as a previous municipal health officer, it is very difficult to function as such if local health officers do not have adequate support.
To further elaborate, I had no power for planning and budgetting and therefore had no real control over the health programs to be implemented. The mayor told me to fund for the activities myself for which my expenses will be refunded.
You described the transfer of responsibility from the national government to the local government but not fiscal power in your article, however, this also can happen even within the local government.
Thank you for sharing your experience, as it illustrates one of the most difficult realities of decentralization in practice. You’re absolutely right that the issue is not only the transfer of responsibility from the national government to local governments without sufficient fiscal authority. What often happens within local governments mirrors the same dynamic. As you noted, planning and budgeting decisions are frequently concentrated in political leadership, leaving local health officers responsible for population health but without the fiscal and administrative control to act effectively. I agree that these internal governance dynamics within local governments deserve more discussion.
On a related note, one of our papers highlights the crucial role of local health officers in addressing fragmentation by advancing the integration reforms within UHC. You might find it interesting: https://gh.bmj.com/content/9/1/e014118
Thank you so much! Will read it!