BACKGROUND In Tanzania, decentralisation processes and reforms in the health sector aimed at improving planning and accountability in the sector. As a result, districts were given authority to undertake local planning and set priorities as well as allocate resources fairly to promote the health of a population with varied needs. Nevertheless, priority setting in the health care service has rema...

BACKGROUND A common challenge for health sector planning and budgeting has been the misalignment between policies, technical planning and budgetary allocation; and inadequate community involvement in priority setting. Health system decentralisation has often been promoted to address health sector planning and budgeting challenges through promoting community participation, accountability, and te...

BACKGROUND Policy makers, health staff and communities recognise that health services in lower- and middle-income countries need to improve people's access to HIV treatment and retention to treatment programmes. One strategy is to move antiretroviral delivery from hospitals to more peripheral health facilities or even beyond health facilities. This could increase the number of people with acces...

Acknowledgements This report is based largely on interviews with representatives from the Government, Panchayati Raj Institutions, NGOs, Self-help Groups and Academic Institutions. I would like to thank all of the respondents for the generous amounts of time they spared to discuss their experiences of Panchayati Raj and Watershed Development with me. I would like to thank Ashok Kumar of Develop...

Decentralisation has frequently been sold as a means to increase well-being and development. Yet, questions remain whether decentralisation improves economic performance. This is possibly because processes have often led ‘unfunded mandates’, that is, mismatch between the powers transferred subnational tiers of government resources allocated them. In this article, we analyse how unfunded mandate...

This paper evaluates the effect of two policy changes on the efficiency of Italian regional governments in the provision of health care services: first a change in the electoral system; second a process of fiscal decentralisation. The electoral system was changed in 1995 and replaced a pure proportional system by a majoritarian system, fostering the transition of regional governments towards a ...