Level of decentralisation in the delivery of health services in Blantyre district and perceptions on its effect

Abstract

As one way of improving the quality of services in the country, government adopted the decentralisation policy in 1998. The policy acted as a vehicle through which the reform can be implemented at the local level. This was after approval by cabinet in 1996 and subsequent enactment of the Local Government Act by parliament in 1998 which advocates for the implementation of the policy. Decentralisation is the transfer of power and authority from the centre to the peripheral. In the health sector, decentralisation means the transfer of power and authority from the Ministry of Health to the local councils. This is so because Malawi adopted devolution as a form of the Public Administration Framework of decentralisation to improve health service delivery at the local level. The main objective of the study was to assess the level of decentralisation in the delivery of health services in Blantyre District and perceptions on its effect. The study was based on both quantitative and qualitative methods of data collected and analysed. The data was collected in sampled health facilities of Blantyre District. While decentralisation has taken place, the results reveal that there is partial implementation of the policy in the district. This has rendered the reform ineffective and inefficient. Despite its wide application, the Public Administration Framework has had its diverse effects in different organisations including Blantyre. These can be categorised into positive and negative effects. Though decentralisation has improved people’s access to health services at the local level, the reform has also produced its adverse effects. Key to this is an increase in corruption at the local level due to abundant resources meant to improve service delivery. These issues, especially the effects on corruption are even higher in cases where there is no political will to implement the policy in full. To address problems associated with the reform, the study recommends that decentralisation must be implemented in full, by enforcing the decentralisation policy. The rationale is to build mechanisms that can adequately mitigate the effects of decentralisation on health service delivery and indicator performance.