Health Systems Decentralisation Training Course

Participants can map the health system architecture and responsibilities held at each level.

• WHO health system building blocks applied to decentralised service arrangements
• National, regional, district and facility roles mapped on service pathways
• Administrative boundaries compared with referral networks and catchment populations
• Public, private and faith-based providers positioned within local health systems
• Intergovernmental relations traced from policy direction to frontline service delivery
• Organisational charts tested against actual authority, reporting lines and incentives

Participants can assess political incentives, institutional constraints and reform readiness.

• Stakeholder mapping identifies interests, influence, incentives and potential reform resistance
• Political economy analysis separates formal mandates from informal power structures
• Readiness criteria assess legal authority, administrative capacity and fiscal predictability
• Veto players and reform champions analysed through an influence-interest matrix
• Sequencing options compare pilots, phased transfer and nationwide implementation
• Transition risks recorded in a decentralisation reform risk register

Participants can assess the authority available to subnational health managers using decision-space analysis.

• Bossert's Decision Space Framework applied to financing, workforce and service functions
• Formal, actual and perceived decision space compared for district managers
• Local discretion scored using evidence from laws, directives and practice
• Capacity and accountability conditions linked to effective use of autonomy
• Decision-space constraints diagnosed through interviews, records and approval pathways
• Autonomy recommendations matched to local managerial and fiduciary capability

Participants can allocate functions across levels without creating gaps or duplication.

• Functional assignment matrices distinguish policy, financing, delivery and oversight roles
• RACI analysis clarifies responsible, accountable, consulted and informed parties
• Essential public health functions allocated between national and local authorities
• Referral care responsibilities aligned with facility levels and population needs
• Regulatory, licensing and quality-assurance duties retained at appropriate government levels
• Service-package mandates matched with staffing, budget and procurement authority

Participants can identify legal provisions required for lawful and accountable decentralisation.

• Constitutional provisions reviewed for local government and health-sector mandates
• Health acts and local government laws checked for functional consistency
• Regulations specify delegated authority, reporting duties and sanctions
• Memoranda of understanding define shared functions across government entities
• Legal gaps identified through clause-by-clause mandate comparison
• Transition instruments protect service continuity during responsibility transfers

Participants can design fiscal arrangements that match devolved health responsibilities.

• Revenue assignments distinguish national taxes, local revenues and earmarked funds
• Conditional and unconditional grants compared against policy control requirements
• Formula-based transfers incorporate population, poverty, remoteness and disease burden
• Vertical fiscal imbalance calculated from assigned expenditure and revenue responsibilities
• Transfer predictability assessed using release calendars and cash-flow records
• Equalisation mechanisms protect underserved districts from resource allocation disparities

Participants can connect district health plans to budgets, releases and financial controls.

• Medium-term expenditure frameworks connect policy priorities with multiyear resource ceilings
• Programme budgets link district outputs, activities and accountable budget holders
• Commitment controls prevent unfunded procurement and arrears accumulation
• Cash-flow forecasting aligns facility payments with expected fund releases
• Internal controls separate approval, custody, recording and reconciliation duties
• Audit findings translated into corrective actions for decentralised health entities

Participants can prepare evidence-based district plans within local resource constraints.

• Situation analysis combines burden, coverage, utilisation and resource availability data
• District health plans prioritise interventions using burden and feasibility criteria
• Problem trees identify root causes behind persistent service-delivery gaps
• Theory of change links local actions with coverage and outcome targets
• Costed operational plans assign activities, owners, timing and budget lines
• Annual planning calendars align community input, budgeting and national guidance

Participants can build equity and citizen-accountability measures into decentralised health arrangements.

• Equity analysis disaggregates coverage by geography, wealth, gender and disability
• Benefit incidence analysis examines who receives publicly financed health services
• Community scorecards structure dialogue between service users and providers
• Health facility committees define representation, mandates and escalation routes
• Grievance mechanisms record, investigate and resolve service access complaints
• Remote-population safeguards shape funding formulas, outreach and referral support

Participants can manage workforce responsibilities transferred to subnational health authorities.

• Workforce functions mapped across recruitment, deployment, payroll and performance management
• Establishment controls compare approved posts, funded posts and occupied positions
• Rural retention packages combine hardship allowances, housing and career progression
• Workload indicators estimate staffing needs from service volumes and activity standards
• Performance agreements connect manager objectives with service-delivery targets
• Dual reporting lines resolved through explicit supervisory and appraisal arrangements

Participants can assign decentralised supply-chain roles while protecting availability and quality.

• Procurement authority matched with aggregation, market capacity and quality assurance
• Essential medicines lists guide local forecasting and purchasing decisions
• Consumption-based quantification uses stock records, morbidity and service data
• Reorder levels calculated from lead times, consumption rates and buffer stock
• Framework agreements balance local flexibility with national price and quality controls
• Stockout accountability traced across ordering, financing, warehousing and distribution processes

Participants can establish information flows and performance data responsibilities across decentralised levels.

• Routine health information system flows mapped from facility to national level
• Data quality reviews test completeness, timeliness, consistency and validity
• Indicator reference sheets define numerators, denominators, sources and reporting frequency
• District dashboards combine coverage, quality, financial and workforce indicators
• Data governance assigns access, stewardship, validation and correction responsibilities
• Performance data interpreted with denominators, trends and geographic disaggregation

Participants can align purchasing and provider payment with decentralised service responsibilities.

• Purchaser-provider splits clarify purchasing decisions and service-delivery accountability
• Capitation, case-based payment and line-item budgets compared for local providers
• Facility autonomy assessed across revenue retention, procurement and staffing decisions
• Payment mechanisms tested for incentives affecting volume, quality and referrals
• Contract management specifies outputs, payment terms, monitoring and remedies
• Strategic purchasing uses local health needs and provider performance evidence

Participants can preserve clinical standards and coordinated response under decentralised governance.

• National clinical standards maintained through supervision, accreditation and reporting
• Supportive supervision plans combine observation, coaching, follow-up and escalation
• Referral pathways define clinical criteria, transport, feedback and receiving capacity
• Quality improvement teams use Plan-Do-Study-Act cycles for local problems
• Incident reporting systems connect facilities, districts and national regulatory bodies
• Emergency operations roles align district command with national public health authority

Participants can create performance arrangements that hold each level accountable for results.

• Performance frameworks connect inputs, outputs, outcomes and equity measures
• Key performance indicators selected using validity, feasibility and actionability criteria
• Intergovernmental performance agreements specify commitments, targets and reporting schedules
• Quarterly review meetings use variance analysis and documented corrective actions
• Social accountability findings incorporated into management performance discussions
• Escalation protocols address persistent non-performance without disrupting essential services

Participants can sequence decentralisation reforms with practical controls for service continuity.

• Implementation roadmaps sequence legal, fiscal, workforce and system readiness actions
• Critical path analysis identifies dependencies, milestones and decision points
• Change impact assessments identify affected roles, processes and stakeholders
• Communication plans tailor reform messages to political, managerial and community audiences
• Pilot evaluation criteria determine readiness for adaptation, expansion or suspension
• Risk mitigation plans assign owners, triggers, contingencies and review dates

Participants can monitor reform effects and adapt implementation using credible evidence.

• Evaluation questions distinguish implementation fidelity, outcomes and unintended consequences
• Baseline assessments establish pre-reform authority, financing and service conditions
• Difference-in-differences logic tests changes across phased implementation areas
• Process indicators monitor transfer completion, fund releases and managerial capacity
• Outcome dashboards track coverage, quality, equity and financial protection
• Learning reviews convert monitoring evidence into policy and operational adjustments

Participants can build, review and present a complete decentralisation implementation package for a defined health system context.

• Country or district reform case defined with evidence-based problem statement
• Decision-space assessment identifies priority autonomy gaps and enabling conditions
• Functional assignment matrix allocates accountable roles across government levels
• Fiscal transfer model links responsibilities, equity criteria and reporting conditions
• Performance framework specifies indicators, reviews, escalation and corrective actions
• Phased implementation roadmap integrates risks, milestones, owners and resource requirements