The Centre for Social Research (CSR) is delighted to announce that six of its staff members have collaborated with colleagues from other institutions to publish a paper titled “Political economy analysis of subnational health management.” The study was conducted in three countries namely Malawi, Kenya and Uganda. The researchers conducted a problem-driven political economy analysis to explore local decision-making environments and how they affect management and governance practices for health, using document review and a series of key informant interviews.

 

The paper finds that decentralization improves primary health care (PHC) by supporting better decisions in line with local priorities from community input. It also finds weak accountability between local government and development partners, uneven community engagement and insufficient public administration capacity to negotiate these challenges. It further observes that thick bureaucracy, path-dependent and underfunded budgets resulting in trade-offs and unfulfilled plans, management support systems are less aligned to local priorities.

 

Other interesting findings in the paper are that COVID-19 did put greater pressures on health teams and budgets but resulted in improved communication with central government in addition to flexible funding.

The paper concludes that without addressing the disconnection between decentralization and the reality of health managers mired in unhelpful processes and politics, delivering on PHC, universal health coverage and sustainable development goals will remain out of reach.

 

The authors from the Centre for Social Research include Elita Chamdimba, Juba Kafumba, Dadirai Mkombe, Tawonga Mwase-Vuma, Associate Professor Maxton Tsoka and Professor Alister Munthali. Dr Jacob Mazalale from the Economics Department of the University of Malawi is also one of the co-authors.