Decentralization Part One!

[assalamualaikum & salam sejahtera]

Today, my topic is decentralization. After listening to the evolution of global health lecture by Dr. Yodi Mahendradhata, M. Sc., I interested to study further about decentralization especially in Malaysia and Indonesia.

Before I further explain about my topic, let start with the definition of decentralization and centralization.

Centralization - to give the control of a country or an organization to a group of people in one particular place (Oxford Advanced Learner’s Dictionary). In a political context, “centralization” refers to the growth in power and authority of the modern state that comes at the expense of localisms such as kin, town, religious community, and custom. It represents the application of a detailed set of laws over the daily lives of persons and organic institutions in distinct localities. (Allan C. Carlson) However, in wikipedia, they define it according to the specific perspective views.

1. In political science, this refers to the concentration of a government's power - both geographically and politically, into a centralised government.

2. In neuroscience, centralization refers to the evolutionary trend of the nervous system to be partitioned into a central nervous system and peripheral nervous system.

3. In business studies centralisation and decentralisation is about where decisions are taken in the chain of command.

Decentralization - to give some of the power of a central government, organization, etc. to smaller parts or organizations around the country (Oxford Advanced Learner’s Dictionary).

"While frequently left undefined (Pollitt, 2005), decentralization has also been assigned many different meanings (Reichard & Borgonovi, 2007), varying across countries (Steffensen & Trollegaard, 2000; Pollitt, 2005), languages (Ouedraogo, 2003), general contexts (Conyers, 1984), fields of research, and specific scholars and studies." (Dubois and Fattore 2009)”

source: wikipedia

After we understand the policy of centralization and decentralization, I can summarize them as centralization is the decision making is belong to a particular group of people who has the highest/biggest hierarchy where as decentralization is decision making is distribute to nearer the citizen or small group of people authority.

In this first part, I want to share what is the impact either positive or negative of decentralization to the health system in the country.

There is no objection that decentralization in economic crisis is very important in order to enhance the growth of health system. Furthermore, there is evidence that Columbia and Chile has successfully went trough the economic crisis and the implementation of decentralization in health system. it is generally accepted that decentralization has very important role in enhancing the efficiency of health system performance, equity, narrowing the unmet demands of the community and its empowerment.

Decentralization in Health has many perspective itself. Technical, political and financial. In technical perspective is to enhance the administrative and care delivery effectiveness. On the political perspective used decentralization to increase local participation and autonomy, re-distribute power, and reduce ethnic and/or regional tensions. And but not least, the financial decentralization is recommended to increase cost efficiency, giving local units a greater control on resources and revenues and sharpening the accountability. These are the positive impact of the decentralization in health system.

However, this distribution will meet the purpose if there is evenly distributed of the population and resources. In Indonesia, there is uneven distribution of population and the resources. Decentralization may be useful in certain part of concept but not all the concept. The challenge of these decentralization is manage well by Indonesia trough certain action.

Continue in part two…