| BackgroundDecentralization has been widely carried out throughout the world. China has implemented decentralization policy in health sector since mid 1980s. First, the 'director responsibility system', a form of managerial decentralisation, was implemented in health institutions to increase their autonomies. Second, township health centers were devolved from county health bureau to township government. Township government took the responsibilities of personnel and financial management, while county health bureau kept the technical support and supervision responsibilities.Decentralization has potential impact on health human resource management and the whole health system. Unfortunately, few in-depth studies have been conducted to evaluate the impact of decentralization on health human resource management. This paper aims to address this need and provide further evidence in this area. ObjectivesThe overall aim of this study is to explore whether or not decentralization can have positive impact on management and deployment of health personnel and on staff performance. It has five specific objectives: 1) To examine whether or not the actual impact of decentralization of the management of health services has provided opportunities to improve human resource management and staff performance; 2) To develop guidelines that can be used for measuring the impact of decentralization on human resource management and staff performance; 3) To assess the extent to which decentralization has led to increased efficiency in use of health human resources; 4) To examine changes in performance of health professionals under the decentralized health care system; 4) To provide policy-makers with appropriate policy recommendations and suggestions on how best to use the opportunities created by decentralization to improve human resource management.MethodologyThe case study was conducted in Xinluo and Liancheng County, Fujian Province. Itused both quantitative methods and qualitative methods to collect and analyze data. Quantitative methods include health facility-based survey and health staff survey. Three kinds of qualitative methods including key informant interview, focus group discussions and relevant documents review, were applied. Data in the following areas were collected: context of decentralization policy, implementation process, contents and organizational form, impact on staff deployment, impact on in-service training, impact on payment system, and impact on staff performance. Quantitative data were analyzed to identify the quantitative change of HRM before and after decentralization. Qualitative data were analyzed to explain the cause-effect relationship between decentralization and the quantitative changes of human resource management. In addition, using qualitative methods helped with understanding the policy context and process of policy implementation, both of which would affect the impact of the decentralization on HRM.Results and main findings 1. Decentralization was implemented under the context of nationwide economic reform. It aimed to encourage local governments and health institutions to invest in and manage health services at a local level, and ultimately promote health and health care.2. Two forms of decentralization were implemented: the 'director responsibility system' and the devolution of township health centers. The human resource function was one of the major components that were decentralized.3. The implementation of decentralization was not well prepared. 4. County hospitals and township health centers got higher autonomy on staff deployment after decentralization, which coincided with the improvement of health staff quantity and quality. 5. After decentralization, health staff had more opportunities to attend in-service training, which helped improve staff performance. However, in-service training system neglected the importance of disease prevention in rural township health center. Besides, it aggravated staff loss in poor rural area. Decentralization gave...
|
PDF Full Text Request