I could see that the process of decentralization was going to be hard to study with this kind of political interplay between the center and the local governments. The myths of years of ideology about the advantages of decentralization were going to be challenged. And the myths were great. Decentralization has been touted as a means of improving the equity, efficiency, quality, and financial soundness of health systems. It is argued, especially by economists, that local people with local information can make much better decisions than distant bureaucrats.
Local people can reflect local preferences better and make better management decisions.
They know who works hard and can assign people and resources in more flexible ways without the rigid centrally determined rules. On the other side, there have been fewer voices, mainly Health Ministry officials, who have feared decentralization as an invitation to chaos, disruption of effective priority programs, local patronage, and waste. While decentralization is being implemented in a growing number of countries, there are few studies that show whether the advocates or the detractors are right. Decision Making Project of the Harvard School of Public Health. These studies, funded by the LAC Health Sector Reform Initiative of the United States Agency for International Development, selected countries with a significant period of actual implementation of decentralization policies.