Case 6: health systems resillience & decentralisation

Question 1

What are the effects of a health system centralisation?

Answer 1

• better resource allocation
• implementation of large-scale preventative measures
• standardised responses.
• can lead to one-size-fits-all approach that doesn’t account for location variations in HC

Question 2

What are the effects of a decentralised health system?

Answer 2

• respond more flexibly & specifically to local needs
• promote stronger community engagement & ownership

Question 3

What is health system resilience?

Answer 3

ability to:
- prepare for
- manage (absorb, adapt, transform)
- learn from shocks to a system

Question 4

what is shock?

Answer 4

sudden and extreme change which impact a health system → unpredictable

Question 5

What are the 4 stages of shock?

Answer 5

1. preparedness
2. shock onset and alert
3. shock impact and management,
4. recovery and learning

Question 6

Why is resilience important?

Answer 6

Key to coping with catastrophic events e.g. economic crisis or pandemic → need to define resilience clearly for operationalism/assessment

Question 7

What are strategies to enhance resilience?

Answer 7

1. Governance
2. Financing
3. Resources
4. Service delivery

Question 8

How can governance enhance resilience?

Answer 8

• Effective & participatory leadership
• Coordination of activities
• Organisational learning responsive to crises
• Effective information systems & flows
• Surveillance enabling timely detection of shocks & impact

Question 9

How does financing enhance resilience?

Answer 9

• Ensuring sufficient monetary resources in system & flexibility to reallocate and inject extra funds
• Ensuring stability of health system funding through countercyclical health financing mechanisms and reserves
• Purchasing flexibility and reallocation of funding to meet changing needs
• Comprehensive health coverage

Question 10

How do resources enhance resilience?

Answer 10

Appropriate level/distribution of resources with ability to increase capacity to cope with a sudden surge in demand and a well-supported workforce

Question 11

How does service delivery enhance resilience?

Answer 11

Alternative and flexible approaches to delivery care

Question 12

*How do we assess resilience?

idk if this is correct

Answer 12

Resilience assessment: crisis- and context-specific and important to employ a range of
quantitative and qualitative metrics for meaningful analysis → important to look at aftermath

Question 13

*WHat is the impact of decentralisation?

idk if correct

Answer 13

Decentralisation in the health sector: rarely implemented in the health sector only → typically decentralisation may be implemented to stimulate economic growth, reduce rural poverty, deepen democracy and delegate responsibilities onto lower-level governments

Question 14

What are the effects of decentralisation?

Answer 14

equity in population health outcomes, system efficiency and system resilience → stakeholders need to understand and be equipped with strategies to maximise the positive and minimise the negative impacts of decentralisation reforms

Question 15

How is decentralisation defined?

Answer 15

1. As an intervention - arrangement in which power/resources/responsibilities are transferred from central to peripheral actors in a top-down approach
2. As a phenomenon - power, resources & responsibilities are widely distributed in society and consolidated in a top-down process or bottom-up process

Question 16

What are 3 mechanisms of decentralisation?

Answer 16

1. Voting with feet
2. close to the ground
3. Watching the watchers

Question 17

Explain voting with feet

Answer 17

People “vote with their feet” when respond to varying levels of public goods (e.g. police, army, levies) and the varying prices at which they are offered (e.g. taxes)

Question 18

Explain close to the ground as a mechanism for decentralisation

Answer 18

Having governance closer to the people “allows for better use of local initiative, information, feedback, input and control”

Question 19

Explain watching the watchers as a mechanism for decentralisation

Answer 19

mutual accountability between levels of governance that are multiplied by decentralisation (more decentralised = more levels of governance)

Question 20

What are the problems involved in decentralisation?

Answer 20

Incoherencies in achieving homogenous implementation of COVID rules → could be mitigated by the federal government creating a document on criteria for the implementation of public event bans etc.