Effects of decentralization on the functionality of health facility governing committees in lower and middle-income countries: a systematic literature review
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Date
2022-05-02
Journal Title
Journal ISSN
Volume Title
Publisher
Taylor & Francis
Abstract
Background: Health facility governing committees (HFGCs) were established by lower and
middle-income countries (LMICs) to facilitate community participation at the primary facility
level to improve health system performance. However, empirical evidence on their effects
under decentralization reform on the functionality of HFGCs is scant and inconclusive.
Objective: This article reviews the effects of decentralization on the functionality of HFGCs in
LMICs.
Methods: A systematic literature review was conducted using various search engines to
obtain a total number of 24 relevant articles from 14 countries published between 2000
and 2020. Inclusion criteria include studies must be on community health committees, carried
out under decentralization, HFGCs operating at the individual facility, effects of HFGCs on
health performance or health outcomes and peer-reviewed empirical studies conducted in
LMICs.
Results: The study has found varied functionality of HFGCs under a decentralization context.
The study has found many HFGCs to have very low functionality, while a few HFGCs in other
LMICs countries are performing very well. The context and decentralization type, members’
awareness of their roles, membership allowance and availability of resource to the facility in
which HFGCs operate to produce the desired outcomes play a significant role in facilitating/
limiting them to effectively carry out the devolved duties and responsibilities.
Conclusion: Fiscal decentralization has largely been seen as important in making health
committees more autonomous, even though it does not guarantee the performance of
HFGCs.
Description
Article
Keywords
Effects, Health facility governing committees, Functionality, Lower and middle-income countries, Systematic literature review
Citation
https://doi.org/10.1080/16549716.2022.2074662