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Reproductive Health and Decentralisation
Understanding the Impact of Decentralisation on Reproductive Health Services in AfricaThe provision of appropriate reproductive health care remains one of the major health care challenges in developing countries. The development of reproductive health service delivery is continually confronted by challenges from a changing environment an important element of which is health sector reform, particularly decentralisation, being undertaken by most governments in Africa. The general objective of this research is to make health sector decentralisation more effective in the development of appropriate reproductive health services. The general research question is: How does decentralisation affect reproductive health services? The project will compare different forms of decentralisation in two anglophone (South Africa and Uganda) and francophone (Burkina Faso and Mali) African countries to assess their impact on and importance for the development of reproductive health services.
The specific scientific and technical objectives are:
- to identify and explain the key features and changes in a) reproductive health policies and services and b) decentralised health systems in Burkina Faso, Mali, South Africa and Uganda
- to document, assess and explain the extent to which the key features and changes in reproductive health policies and services are affected by the features and changes in decentralisation in the study countries
- to identify those characteristics of decentralised health systems that are beneficial/ not beneficial/ neutral to reproductive health policies and to interpret the specific context of these features in the study countries
- to conduct a comparative analysis of francophone and anglophone systems / experiences within this field
- to identify lessons for policy-makers within and between the different health systems analysed
- to develop national and international guidelines / recommendations which can inform national reproductive health and health sector reform policy makers and multilateral / bilateral agencies
- to build the research capacity of partner research institutions in Africa and promote co-operative and collaborative links between African and European institutions involved in the research
- to disseminate findings to relevant national and international audiences.
Activities
Partners in the research are: Nuffield Institute for Health, University of Leeds, UK (co-ordinating institution), Department of Tropical Hygiene and Public Health (ATHOEG), University of Heidelberg, Health Systems Trust (HST), South Africa, The Institute of Public Health (IPH), Makarere University, Uganda, Centre de Recherche en Sante de Nouna (CRSN), Burkina Faso, Association Sante Communitaire de Banconi (ASACOBA), Mali.
Both qualitative and quantitative research methods will be used. The research is applied, multi-disciplinary, leads to capacity strengthening, and comparative within and between the mentioned anglophone and francophone African countries. The research is based on four stages during a three year period: 1) working with stakeholders and detailing methodology, 2) fieldwork and analysis 3) sharing experiences and comparative analysis 4) engaging with policy-makers for dissemination. Work will be conducted through documentary analysis, stakeholder analysis, interviews, service checklists, quantitative questionnaires, in-country case studies, quantitative data collection and analysis, observation, group discussions, comparative analysis techniques.
Expected results and outcome
Mutual team action learning together with research capacity strengthening will be conducted. For each of the study countries there will be two reports: country reports on research findings and lessons to be learned. These will be complemented by three international research documents: the Comparative Analysis Report, Comparative Lessons and the Guidelines for Policy-Makers. Reports will be disseminated in an innovative fashion. The research addresses a concern for the improvement of health systems from central to peripheral levels (the decentralisation focus addresses this and also has implications for other priorities of equitable, accessible and quality health care delivery) and reproductive health (which is the focal health package for this research). The research seeks to maintain a relationship with policy-makers and provide practical guidelines for the sustainable development of decentralisation and reproductive health services.
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