Decentralization

 Decentralization is the result of delegation of authority. Every organization

practices some degree of decentralization.
 According to Dale S.Beach,” Decentralition means placing the authority and
decision making power as close as possible to the level at which the work is
done.
 According to Fayol,”Everything that goes to increase the importance of the
subordinate’s role is decentralization and everything that goes to reduce it is
centralization.”
 In decentralization, Right to take decisions is shared by top management and
other level of management.

 Decentralization is closely related to the span of control of authority in an

organization.

 When authority is widely dispersed or delegated through out an organization, the

organization is called decentralization.

 Decentralization pushes down decision making to the managers who are closer
to the action.

 In other words, decentralization can be called the degree to which decision-

making is defused throughout the organization.

 Decentralization entails the transfer of political, fiscal and administrative powers

to sub national units of government
 Is a dynamic process
 To vest people with self contained authority
 To make decision for their betterment

Historical prospective
 Decentralization is not a new concept for Nepal
 It has developed long before and implemented in different forms and modality
 Before rana rule, the concept of decentralization was developed and
implemented to some extent
 During rana regime,establishing the Gauda they exercised concept of
decentralization
 After establishing the panchayat Nepal was divided into 75 disricts and 5 region

Social perspective
In the angle of decentralization,contextual factors are :
 poverty
 Health
  Health care
 Ethnicity
 Local domain
 Self-help group
 Political perspective
 Political regime
 Public bureaucracy
 Insurgency
Play a vital role to accelerate the decentralization

Economic growth
Stakeholder and decision making instances

Type of Decentralization
Decentralization can be geographic or administrative

• Geographic decentralization: The organization is dispersed geographically.

Regional,district,village level offices are established. This is also called physical
decentralization.

• Administrative decentralization: Dispersal of decision making all authority is

done to lower levels. The recently enacted local self-governance act of Nepal
has decentralization many decision making powers to local authorities.

Forms of Decentralization

1. Deconcentration
2. Delegation
3. Privation
4. Devolution

Deconcentration
 Handing over of some authorities to local offices of the concerned Ministry
e.g.. to DHO in MoHP case by administrative means.
 Establishing local management with defined administrative duties with a
degree of discretion
 Enabling D(P)HO to manage without constant referring MoHP (centre)
 Delegation
 Involves the transfer of managerial responsibility for defined functions that
are outside central government structure but only indirectly controlled by
centre say the MoHP.
 Remains ultimate responsibility with the MoHP but its agent has broad
discretion(freedom of choice) to carry out specified duties.
 Varies exact managerial relationship but day to day executive authorities is
given.

Privation

• Occurs in competitive markets where people are aware of their right and
duty

• Government formulates policy and makes rule and regulation in broad

aspects

• On the basis of LSGA 1999, 28 districts health institutions are handed over
to the local bodies

• Orientation and training are being given to the health management

committee to strengthen the decentralization process
Devolution
 Creation or strengthening of sub-national of government
 Transfers legal power to locally elected political bodies e.g., DDCs
 Gives substantially independence from the national level with respect to a
defined set of functions
 Rarely “completely autonomous” but are bodies largely independent of the
national government in their areas of responsibility
 Such as raising a revenue of staff appointment
 /Such units are governed by statutory acts/by-laws
(DDC,municipalities,VDCS)

Some policy,act and plan concerned with decentralization are :

• Decentralization act 1982

• Health policy 1991

• Long term health plan 1997- 2017

• LSGA 1999

• NHSP-IP
MoHP in decentralization

• Hand over as incomplete devolution

• Capacity an issue to address

• Strengthen Local capacity that helps in any shape and size of structure

• Participatory assessment of their need and flexible methods of capacity building

• A modular menu of package will be made available and delivered as per local
need.

Guiding principles of decentralization in health services

• Focus on people
• Equity
• Quality
• Sustainability
• Efficient

Challenges
• Forms of decentralization not understandable
• No evidence base
• Legislative compatibility
• Definition of central and district responsibility
• Relation between levels
• Classification of local bodies
• Accountability and participation
• Central grants- not sufficient
• Performance and capacity of DDCs

• Planning process not in practice

• Staffs management –not functioning

• Postponed handover process

• Devolution district announced but not functioning

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