BU Research Blog

BMJ Global Health published our latest paper today under the title ‘The impact of decentralisation on health systems: a systematic review of reviews‘ [1].  This so-called review of reviews is part of a larger study funded by the UK Health Systems Research Initiative [Grant ref. MR/T023554/1].  in this larger Nepal Federal Health System Project we study the consequences for the health system of Nepal’s move from a centralised political system to a more federal government structure.  This joint project is led by the University of Sheffield in collaboration with Bournemouth University, the University of Huddersfield, and two collaborating institutions in Nepal, namely Manmohan Memorial Institute of Health Sciences (MMIHS) and PHASE Nepal.  We have managed to publish four papers from this project prior to today’s one. [2-5]

This latest paper, is Open Access and it includes nine reviews, each addressing somewhat different questions, contexts and issues. More negative than positive impacts of decentralisation on health system building blocks were identified. Although inconclusive, evidence suggested that the impacts on leadership and governance and financing components in particular shape the impact on the overall health system. Assessment of how the impact on building blocks translates to the broader impact on health systems is challenged by the dynamic complexities related to contexts, process and the health system itself.  This review highlights some of the common potential issues to consider in advance.

Prof. Edwin van Teijlingen

CMWH (Centre for Midwifery & Women’s Health)

References:

1. Sapkota, S., Dhakal, A., Rushton S., et al. (2023) The impact of decentralisation on health systems: a systematic review of reviews. BMJ Global Health 8:e013317. doi:10.1136/bmjgh-2023-013317.
2. Wasti, S.P., van Teijlingen, E., Rushton, S., et al. (2023) Overcoming the Challenges Facing Nepal’s Health System During Federalisation: An Analysis of Health System Building Blocks, Health Research Policy & Systems 21(117) https://doi.org/10.1186/s12961-023-01033-2
3. Sapkota, S., Panday, S., Wasti, S.P., et al. (2022) Health System Strengthening: The Role of Public Health in Federal Nepal, Journal of the Nepal Public Health Association 7(1):36-42.
4. Adhikary, P., Balen, J., Gautam, S., et al. (2020) The COVID-19 pandemic in Nepal: Emerging evidence on the effectiveness of action by, and cooperation between, different levels of government in a federal system, Journal of Karnali Academy of Health Sciences 3 (3): 1-11.
5. Rushton, S., Pandey, S., van Teijlingen, E., et al. (2021) An Investigation into the Impact of Decentralization on the Health System of Nepal. Journal of Manmohan Memorial Institute of Health Sciences, 7(1): 3–14. https://doi.org/10.3126/jmmihs.v7i1.43146