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In Terms of The Success of Health Reforms, The Decentralization-Recentralization Cycle and The Situation In Our Country

Yıl 2017, Cilt: 1 Sayı: 1, 1 - 6, 06.06.2017

Öz

Decentralization of health care services has been a popular tool of the health care reforms that had started
in several countries during 1980s by the infl uence of neoliberal economic policies. There are four major
types and degrees of decentralization: deconcentration, devolution, delegation and privatization. The
purposes of all types of health care decentralization are the transfer of power from center to the periphery
and encourage the local people to participate in decision-making procedures for provision of more
realistic, effi cient services and increased patient satisfaction. Applications made over time have shown
that decantralization can lead to many new problems instead of expected benefi ts if not well planned.
Particularly in communities where there is no participatory democracy culture, where health information
infrastructure and management skills are inadequate, it has been observed that these practices result
in regional inequalities, and increase in resource waste by the manipulation of local politicians. In our
country, the applications of decentralization within the Health Transformation Program are sought to be
among the unsuccessful examples in this sense.

Kaynakça

  • 1. Rondinelli, D. Government decentralization in comparative theory and practice in developing countries. Intern review administrative sciences, 1981;47:133-45.
  • 2. Conyers D. Decentralisation: The latest fashion in development administration. Public Administration and Development, 3, 1983, s.97-109.
  • 3. Mills A, Vaughan PJ, Smith DL, Tabipzadeh I, (eds). Health system decentralization. Concepts, issues and country experience. WHO, Geneva, 1990.
  • 4. Rondinelli DA. Government decentralization and economic development: the evolution of concepts and practices. Comparative Public Administration. 2006;15:433-445. doi:10.1016/S0732- 1317(06)15018-6.
  • 5. United Nations Development Programme (UNDP)/German Federal Ministry for Economic Cooperation and Development (BMZ). The UNDP role in decentralization and local governance (New York, UNDP Evaluation Offi ce, 2000), s.29 (box 13).
  • 6. Homedes N, Ugalde A. Why neoliberal health reforms have failed in Latin America. Health Policy. 2005;71(1):83-96. Doi:10.1016/j. healthpol.2004.01.011.
  • 7. Prudhomme R. The dangers of decentralization. World Bank Res Obs. 1995;10(2):201-220. Doi:10.1093/wbro/10.2.201.
  • 8. Collins P. Special issue-Decentralization and local governance in Africa. Public Adm Dev. 2003;23(1):1-3. Doi:10.1002/pad.266
  • 9. Castaneda T, Beeharry G, Griffi n C. Decentralization of health services in Latin American countries.: Issues and some lessons. Annual World Bank Conference on Development in Latin America and the Caribbean 1999, Proceedings, 2000:249-269.
  • 10. Gomez-Dantes O. Health reform and policies for the poor in Mexico. In: Lloyd-Sherlock P, Editor. Healthcare reform and poverty in Latin America. London:Institute of Latin American Studies, University of London, 2000, s.128-42.
  • 11. Bolis M. Legislacion y unidad en salud. Pan American Journal of Public Health, 2002;11(5-6):444-448.
  • 12. Saltman RB.Decentralization, re-centralization and future European health policy. European Journal of Public Health, 2008;18(2):104– 106.
  • 13. Fredriksson M, Blomqvist P, Winblad U. Recentralizing healthcare through evidence-based guidelines – striving for national equity in Sweden. BMC Health Services Research 2014;14:509.
  • 14. Osborne D, Gaebler T. Reinventing government. Reading, MA, Addison Wesley, 1993.
  • 15. Saltman RB, Figueras J. European health care reform: Analysis of current strategies. WHO Regional Publications, European Series, No. 72, 1997, s.53.

Sağlık Reformlarının Başarısı Açısından Desantralizasyon-Resantralizasyon Döngüsü ve Ülkemizdeki Durum

Yıl 2017, Cilt: 1 Sayı: 1, 1 - 6, 06.06.2017

Öz

Sağlık hizmetlerinde desantralizasyon, yani, yerinden yönetim, seksenli yıllarda önem kazanan neoliberal
politikaların da etkisi ile tüm ülkelerde gündeme gelen sağlık reformlarının önemli bir parçası olarak kabul
görmüştür. Dekonsantrasyon, devolusyon, delegasyon ve özelleştirme şeklinde farklı tür ve derecelerde
uygulaması olan desantralizasyonun amacı, merkeze ait çeşitli yetkilerin perifere devredilmesi, hizmeti
alanların da kararlara katılımının sağlanması, bu yolla daha gerçekçi, daha hızlı hizmet sunulabilmesi ve
hasta memnuniyetinin arttırılmasıdır. Geçen süre içerisinde yapılan uygulamalar, iyi planlanmadığı takdirde
desantralizasyonun beklenen faydalar yerine çok sayıda yeni sorunlara neden olabileceğini göstermiştir.
Özellikle katılımcı demokrasi kültürünün olmadığı, sağlık enformasyon alt yapısı ve yönetim becerilerinin
yetersiz olduğu toplumlarda bu uygulamaların bölgesel eşitsizliklere neden olduğu, yerel politikacıların
manipülasyonu sonucu kaynak savurganlığı ile sonuçlandığı, gözlenen başlıca sorunlardır. Ülkemizde,
Sağlıkta Dönüşüm Programı kapsamında gerçekleştirilen desantralizasyon uygulamaları bu anlamda
başarısız örnekler arasında yer almaya adaydır.

Kaynakça

  • 1. Rondinelli, D. Government decentralization in comparative theory and practice in developing countries. Intern review administrative sciences, 1981;47:133-45.
  • 2. Conyers D. Decentralisation: The latest fashion in development administration. Public Administration and Development, 3, 1983, s.97-109.
  • 3. Mills A, Vaughan PJ, Smith DL, Tabipzadeh I, (eds). Health system decentralization. Concepts, issues and country experience. WHO, Geneva, 1990.
  • 4. Rondinelli DA. Government decentralization and economic development: the evolution of concepts and practices. Comparative Public Administration. 2006;15:433-445. doi:10.1016/S0732- 1317(06)15018-6.
  • 5. United Nations Development Programme (UNDP)/German Federal Ministry for Economic Cooperation and Development (BMZ). The UNDP role in decentralization and local governance (New York, UNDP Evaluation Offi ce, 2000), s.29 (box 13).
  • 6. Homedes N, Ugalde A. Why neoliberal health reforms have failed in Latin America. Health Policy. 2005;71(1):83-96. Doi:10.1016/j. healthpol.2004.01.011.
  • 7. Prudhomme R. The dangers of decentralization. World Bank Res Obs. 1995;10(2):201-220. Doi:10.1093/wbro/10.2.201.
  • 8. Collins P. Special issue-Decentralization and local governance in Africa. Public Adm Dev. 2003;23(1):1-3. Doi:10.1002/pad.266
  • 9. Castaneda T, Beeharry G, Griffi n C. Decentralization of health services in Latin American countries.: Issues and some lessons. Annual World Bank Conference on Development in Latin America and the Caribbean 1999, Proceedings, 2000:249-269.
  • 10. Gomez-Dantes O. Health reform and policies for the poor in Mexico. In: Lloyd-Sherlock P, Editor. Healthcare reform and poverty in Latin America. London:Institute of Latin American Studies, University of London, 2000, s.128-42.
  • 11. Bolis M. Legislacion y unidad en salud. Pan American Journal of Public Health, 2002;11(5-6):444-448.
  • 12. Saltman RB.Decentralization, re-centralization and future European health policy. European Journal of Public Health, 2008;18(2):104– 106.
  • 13. Fredriksson M, Blomqvist P, Winblad U. Recentralizing healthcare through evidence-based guidelines – striving for national equity in Sweden. BMC Health Services Research 2014;14:509.
  • 14. Osborne D, Gaebler T. Reinventing government. Reading, MA, Addison Wesley, 1993.
  • 15. Saltman RB, Figueras J. European health care reform: Analysis of current strategies. WHO Regional Publications, European Series, No. 72, 1997, s.53.
Toplam 15 adet kaynakça vardır.

Ayrıntılar

Konular Sağlık Kurumları Yönetimi
Bölüm Derleme
Yazarlar

Osman Hayran

Yayımlanma Tarihi 6 Haziran 2017
Kabul Tarihi 22 Nisan 2017
Yayımlandığı Sayı Yıl 2017 Cilt: 1 Sayı: 1

Kaynak Göster

AMA Hayran O. In Terms of The Success of Health Reforms, The Decentralization-Recentralization Cycle and The Situation In Our Country. J Biotechnol and Strategic Health Res. Haziran 2017;1(1):1-6.
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