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Reflexões sobre a política de descentralização em saúde: uma análise a partir do Hospital Monsenhor Walfredo Gurgel em Natal (RN)

Pereira, Maria Cristina Silva
Fonte: Universidade Federal do Rio Grande do Norte; BR; UFRN; Programa de Pós-Graduação em Serviço Social; Serviço Social, Formação Profissional, Trabalho e Proteção Social; Serviço Social, Cultura e Relaçõe Publicador: Universidade Federal do Rio Grande do Norte; BR; UFRN; Programa de Pós-Graduação em Serviço Social; Serviço Social, Formação Profissional, Trabalho e Proteção Social; Serviço Social, Cultura e Relaçõe
Tipo: Dissertação Formato: application/pdf
POR
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The process of decentralization of health policy in Brazil has evolved throughout the second half of the twentieth century, advancing by leaps and bounds in the last two decades. The various public institutions have assumed the function of responding to a growing demand for medical care and hospital. Monsenhor Hospital Walfredo Gurgel - H.M.W.G. fits into this context as an institution par excellence-oriented service the demand for medium and high complexity. This paper presents some questions about the process of decentralization and devolution occurred in Brazil. To do so is a brief historical background and politics, showing the concepts of reform and counter-reform and how the processes mentioned in the Country Correlates develop local social development of the decentralization process and discusses the modifications in policies social intervention in recent decades and the state health policies. Presents the implementation of a Health System in Brazil and the state showing how the decentralization of health policy occurs in Rio Grande do Norte. Finally, it explores the role of H.M.W.G. in health policy in RN. For this, portrays the institution and is located within the decentralized structure of health policy in the state and capital. An analysis of the demand for hospital care and the budget situation is realized at the close of work...

Analyse des nouvelles formes organisationnelles hospitalières en émergence au Mali

Sanogo, Moussa
Fonte: Université de Montréal Publicador: Université de Montréal
Tipo: Thèse ou Mémoire numérique / Electronic Thesis or Dissertation
FR
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Au Mali, une loi hospitalière a été adoptée en 2002 pour définir le cadre institutionnel d’une réforme majeure. Cette loi a décrété des transformations substantielles de la structure interne, tant administrative que clinique des établissements publics hospitaliers notamment l’implication des populations locales dans la prise de décision de l’établissement, l’autonomie administrative et financière à travers la délégation budgétaire et l’implication des professionnels de santé à la gestion, l’intégration des services de spécialité et la participation du secteur privé au service public hospitalier. Cependant, la capacité des hôpitaux à réussir les transformations prévues a été remise en question par la majorité des acteurs internes et externes. L’objectif de cette thèse a été d’étudier de quelle manière l’hôpital malien se transforme sous la pression de la décentralisation des pouvoirs de l’État et d’étudier comment les groupes d’acteurs réagissent face à ces changements à partir de deux cadres d’analyse. Le premier cadre intègre les caractéristiques essentielles des transformations hospitalières en termes de différents types de décentralisation et le second cadre inspiré des travaux de Crozier et coll. (1977) analyse les jeux de pouvoir entre les groupes d’acteurs hospitaliers selon deux niveaux à savoir un niveau stratégique et systémique. Pour cela...

Sudan - Strengthening Good Governance for Development Outcomes in Southern Sudan : Issues and Options

World Bank
Fonte: World Bank Publicador: World Bank
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This report is the product of a joint Government of Southern Sudan (GoSS) and World Bank initiative aimed at facilitating informed policy making in key areas of public service management. The objective was to facilitate a process in which a Bank-supported team will provide technical inputs and will support appropriate consultation leading to informed and pragmatic policy making and implementation. Coordination, in particular on policy formulation, is difficult and a key constraint in young governments and more so in post-conflict situations such as that of Southern Sudan. Available analytical and executive capacity is already stretched. The number of issues that need to be addressed is large and prioritization is difficult. There are sharp political divisions that are not easily reconciled. The report is presented in two parts. Part one provides the background as well as a summary of findings and recommendations. Chapter one provides a brief historical background and lessons from this experience but may be skipped without loss of continuity. Chapter two presents an overview of the issues and options facing the GoSS in managing the public service...

Decentralization and Corruption : New Cross-country Evidence

Ivanyna, Maksym; Shah, Anwar
Fonte: Banco Mundial Publicador: Banco Mundial
Tipo: Artigo de Revista Científica
EN
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We attempt to improve the understanding and measurement of decentralization and its relationship with corruption in a worldwide context. This is done by presenting the conceptual underpinnings of such a relationship as well as using more defensible measures of both decentralization in its various dimensions as well as corruption for a sample of 158 countries. It is the first paper that treats various tiers of local governments (below the intermediate order of government) as the unit of comparative analysis. By pursuing rigorous econometric analysis we demonstrate that decentralization, when properly measured to mean moving government closer to people by empowering local governments, is shown to have a significant negative effect on the incidence of corruption regardless of the choice of the estimation procedures or the measures of corruption used. In terms of various dimensions of decentralized local governance, political decentralization matters even when we control for fiscal decentralization. Further voice (political accountability) is empirically shown to be more important in combating corruption than exit options made available though competition among jurisdictions.

Strengthening Local Government Budgeting and Accountability

Schaeffer, Michael; Yilmaz, Serdar
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
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In many developing and middle-income countries, decentralization reforms are promoting changes in governance structures that are reshaping the relationship between local governments and citizens. The success of these decentralization reforms depends on the existence of sound public financial systems both at the central and local levels. This paper focuses on the role of budgeting as a critical tool in reform efforts, highlighting problems that might impede successful local government budget development and implementation. The attainment of effective local government accountability and transparency is not an end itself, but rather it represents the means to support better decision-making on national and local budgeting. Community based schemes for enhancing local government accountability need to combine legal, political, and administrative mechanisms with proactive community involvement. Of particular importance are the legal and budgetary instruments that require input from local community members on certain local government decisions and instruments that increase accessibility for the press or the general public at large to information on government activities.

How-to Note : A Framework for the Assessment of Political Decentralization

Gurkan, Asli; Yilmaz, Serdar; Aslam, Ghazia
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
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Political decentralization is the primary mechanism through which citizen preferences are represented in the decision making, and is therefore essential to an effective system of decentralization. The purpose of this note is to elucidate components of a well-designed political decentralization system and is aimed to assist task teams and stakeholders to evaluate political decentralization effort in any given country. There are two main components of political decentralization system: a) discretion allowed to the local government to perform fundamental functions that allow them to represent the preferences of the citizens in decision making process; and b) mechanisms that hold the local government accountable for appropriate use of this discretion.

Ethiopia : Public Finance Review 2010

World Bank
Fonte: Washington, DC Publicador: Washington, DC
EN_US
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Ethiopia Public Finance Review (PFR) is an analytical input to the regular Government-Donor dialogue on public finance and aid effectiveness. It forms the basis for policy focused analyses and sustained dialogue that facilitate close partnership and enhanced mutual accountability between Government and the development partners. The PFR is also an important instrument for determining the level and quality of aid and it fulfills a due diligence requirement for operations like the Protection of Basic Services. The 2010 PFR analyzes the effectiveness of decentralized service delivery in Ethiopia. While the Government of Ethiopia (GoE) has pursued decentralization for the last two decades, neither a comprehensive documentation of the functioning of the system nor a thorough evaluation of its effectiveness is available. This study attempts to fill this gap by linking policy and institutional variables related to decentralization with service delivery outcomes at the sub-national level.

Beyond Wage Bill Ceilings : The Impact of Government Fiscal and Human Resource Management Policies on the Health Workforce in Developing Countries, Background Country Study for Rwanda

World Bank
Fonte: Washington, DC Publicador: Washington, DC
EN_US
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One of the main explanations put forth on why access to health workers is so low in developing countries is that there are insufficient resources within the public sector to pay the wage bill - the salary and allowance payments - of an expanded health workforce. In turn, the lack of wage bill resources for the health sector is thought to be a direct result of restrictive macroeconomic policies that limit the expansion of the overall public sector wage bill. The overarching message in this report is that, despite the relative contraction of the public sector wage bill, Rwanda has not only protected the health sector, but has succeeded through decentralization and the introduction of performance-based financing in linking salaries to performance in the health sector. The decentralization of budgets, along with the implementation of the performance-based grants scheme, has had two major effects. First, it has increased the resource envelope available for hiring health workers since there is a lot of flexibility in how the performance based grants can be used. Second...

Health Strategy in a Post-Crisis, Decentralized Indonesia

Lieberman, Samuel S.; Marzoeki, Puti
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
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The study reviews the strategy for a prospective health development, and the health benefits associated with decentralization, in a likely challenging near to medium term period in Indonesia. It addresses the major government reorganization, expected to take effect in January 2001, which could well define the social process during the next decade, consisting of decentralization of spending authority, enhanced access to resources at local government levels, and civil service reform. The potential health system benefits, associated with decentralization, will enable citizens to become involved systematically in decisions regarding health policy, design, and financing, as well as influencing service provision. The report describes the health system performance, and costs in the country, namely an adaptation of health for all, aimed at a wide coverage, featuring integrated service provision at the primary health level. However, mixed results proved great imbalances, for low income families lagged behind other quintiles in terms of infant mortality rates...

Health Strategy in a Post-Crisis, Decentralizing Indonesia

World Bank
Fonte: Washington, DC Publicador: Washington, DC
EN_US
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The study reviews the strategy for a prospective health development, and the health benefits associated with decentralization, in a likely challenging near to medium term period in Indonesia. It addresses the major government reorganization, expected to take effect in January 2001, which could well define the social process during the next decade, consisting of decentralization of spending authority, enhanced access to resources at local government levels, and civil service reform. The potential health system benefits, associated with decentralization, will enable citizens to become involved systematically in decisions regarding health policy, design, and financing, as well as influencing service provision. The report describes the health system performance, and costs in the country, namely an adaptation of health for all, aimed at a wide coverage, featuring integrated service provision at the primary health level. However, mixed results proved great imbalances, for low income families lagged behind other quintiles in terms of infant mortality rates...

Democratic Republic of Congo Rebuilding the Public Service Wage System : Synthesis Note

World Bank
Fonte: Washington, DC Publicador: Washington, DC
EN_US
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This note focuses on some of the key problems confronting the civil and public service in the Democratic Republic of Congo (DRC), in particular the reform of the wage system and the impact of the decentralization process on civil service reform. It was produced by the World Bank in collaboration with the ministries of public service and budget, as well as with experts of the Cooperation Technique Belge (CTB). The paper is based on an in-depth analysis of the Congolese public service system, published in a separate note, as well as on a series of analytical papers on the decentralization process in DRC, which are available separately. It also incorporates feed-back and comments received during a presentation at the National Forum on Decentralization that was held in Kinshasa, October 3-5, 2007. This analytical paper offers several options aimed at solving the problems that have been identified and discusses in detail the three issues relating to the current reform agenda that are now the key to resolving the fundamental issues below: 1. the impact of the decentralization process on the organization and management of the civil service; 2. the reform of the wage system and...

Kingdom of Lesotho Local Governance, Decentralization, and Demand-Driven Service Delivery, Volume 2. Annexes

World Bank
Fonte: Washington, DC Publicador: Washington, DC
EN_US
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After more than 35 years, the elected local government system in Lesotho was reestablished in 2005 through the election of the Local Authorities, i.e. the Community and District Councils (CCs and DCs). Across the political spectrum, the political will to move forward was at its peak. An exemplary campaign to educate the entire population as to the purposes and functioning of the new Local Authorities, and the electoral process preceded the election. The purposes of the new system are the improvement in services and access to government, broad participation of the local population in their own development combined with enhanced accountability to them, and promotion of equitable development in all parts of the country. The establishment of the Local Authorities and their election was received by even the remotest populations with great enthusiasm, and the elected Councilors have taken up their job with energy and commitment. The objectives of this report derive from the general priorities of the Poverty Reduction Strategy (PRS) of Lesotho which emphasizes pro-poor growth...

Kyrgyz Republic Public Expenditure Review Policy Notes : Intergovernmental Fiscal Relations

World Bank
Fonte: Washington, DC Publicador: Washington, DC
EN_US
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Intergovernmental fiscal relations have advanced over the last decade in the Kyrgyz Republic. Since the previous public expenditure review in 2004, the government of the Kyrgyz Republic has developed a number of policy changes in the area of intergovernmental fiscal relations. These policy changes helped the country to introduce a more transparent and equitable system of local government financing. Still, effective decentralization continues to face challenges. A set of policy recommendations for the government to consider are designed to clarify the role of local government and provide better incentives for improved service delivery. These are based on a review of the four pillars of intergovernmental fiscal relations in Kyrgyz Republic: (i) the expenditure assignment (of who does what); (ii) revenue assignment (with what resources) assignment; (iii) the system of transfers; and (iv) borrowing. In this context, the report is structured as follows: section one gives executive summary. Section two provides a brief description of the institutional context in terms of the structure of government and the elements of political and administrative decentralization. Section three analyzes the delineation of expenditure responsibilities among government tiers. Section four analyzes revenue sources assigned to each tier of government. Section five focuses on the system of intergovernmental transfers. Section six examines subnational public investments and borrowing. In each of these sections main issues and problems are identified in the current system and the desired directions for reform are pointed out.

Georgia Public Expenditure Review

World Bank Group
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Relatório
EN_US
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Georgia has an impressive growth record but social vulnerabilities persist. The current government has therefore made spending on social sectors and agriculture a high priority and has launched a decentralization reform to support regional inclusive growth. It remains a challenge to tackle social vulnerabilities within a sustained macroeconomic framework. The government has intensified its efforts to reduce social vulnerability, as evidenced by the increase in social spending from 7.1 percent of gross domestic product (GDP) in 2012, to 9.6 percent in 2014. As a result, the fiscal deficit widened from 2.8 percent of GDP in 2012 to 3.0 percent in 2014. This public expenditure review (PER) analyzes the impact of recent reforms including the social programs that were either introduced or scaled up in 2013. It gives an overview of the recent macroeconomic and fiscal developments, including the fiscal implications of the social programs in chapter one. As requested by the government, it addresses three questions in the rest of the report: (1) has the realignment of spending toward social sectors resulted in better distributional outcomes; (2) have the agriculture support programs been targeted at productivity growth to support real incomes in poor rural regions; and (3) what is the fiscal and equity impact of the ongoing decentralization process? The first question is addressed by combining micro household survey data with administrative fiscal data to analyze the distributional impact of both taxes and government spending on poverty and inequality in Georgia in chapter two. The second question is addressed by comparing the cost of new agriculture programs with their estimated impact on agricultural productivity in chapter three. Finally...

Fiscal Decentralization and Economic Growth

Martinez-Vazquez, Jorge; McNab, Robert M.
Fonte: Escola de Pós-Graduação Naval Publicador: Escola de Pós-Graduação Naval
Tipo: Artigo de Revista Científica
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International Studies Program, Working Paper #01-1, SSRN-id259281; This paper reviews the current knowledge on an issue of increasing policy interest: what impact fiscal decentralization has on economic growth. Fiscal decentralization may indeed have a direct impact on economic growth but the theoretical underpinnings for this relationship remain largely underdeveloped. The absence of an adequate theoretical framework has undermined the validity of the empirical work on this subject. A fair summary of the empirical search for a direct relationship between fiscal decentralization and economic growth is that it remains an open question. Much less attention has been devoted in the literature to the indirect channels through which fiscal decentralization may affect economic growth, through the impact of fiscal decentralization on economic efficiency, the regional distribution of resources, and macroeconomic stability. This paper explores the nature of these links and concludes with some thoughts and policy advice.

The United Republic of Tanzania : Decentralisation Sector Work

World Bank
Fonte: Washington, DC Publicador: Washington, DC
ENGLISH; EN_US
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The primary objectives of the Tanzania Decentralization Sector Work (DSW) are: To develop a strategic analysis of the decentralization process in Tanzania, commonly known as the Local Government Reform Programme (LGRP); and on this basis, to formulate proposals regarding a) the orientation of the World Bank towards the LGRP and the modalities of the Bank's potential involvement in the Programme, and b) appropriate responses by the Bank at the project level in those sectors affected by the LGRP. The DSW is intended to enhance the Bank's understanding of developments in the decentralization theme area and to optimize Bank decision-making regarding its involvement here. It also aims to assist the Bank in structuring its projects such that the impact of the decentralization process is taken into proper account.

Decentralized Service Delivery for the Poor; Mexico - Descentralizacion y entrega de servicios para los pobres

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Other Poverty Study; Economic & Sector Work
ENGLISH; EN_US
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This report on the decentralized service delivery for the poor is structured in two volumes. Volume one is a cross-sectoral report, the core report. The first part includes the program and performance overview which describes the programs (including their poverty goals) and their process of decentralization, the overview of expenditures, the access of the poor to these services, and the evidence on the quality of services. The second part of the core report is on the institutional dimensions of decentralized service delivery which includes the World Development Report (WDR) 2004-type framework of accountability, adapted to the situation in Mexico. Volume two contains the sectoral pieces. For this report-the third phase of a programmatic series of studies on poverty in Mexico-Mexico's social cabinet requested that the Bank analyze service delivery of a specific list of programs that are essential to the government's development strategy in the context of decentralization. The elements of the government's strategy considered here-basic education, health care for the population without social security coverage, local social infrastructure, and local rural development-all aim directly or indirectly to reduce poverty. Both social and economic services shape the opportunities of poor people. Social services contribute to human capital formation and risk management...

Czech Republic : Intergovernmental Fiscal Relations in the Transition

World Bank
Fonte: Washington, DC Publicador: Washington, DC
ENGLISH; EN_US
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The study presents an overview of the most relevant, current intergovernmental fiscal issues in the Czech Republic, centered on the options available to prod policy planning. The fragmentation at the lowest tier of government is the most striking feature of the administrative structure, thus suggesting a strategic direction for further administrative reforms to sustain fiscal decentralization, by empowering territorial self-governing units, through meaningful autonomy, through the establishment of a multilevel government coordinating body, for the definition of autonomous functions on expenditures, and revenues, and, by creating financial, and legal incentives, to facilitate an asymmetric assignment of revenue, and expenditure. Specific policy actions to clarify responsibilities of the strategic direction for expenditure assignments should include institutional inter-governmental cooperation, and dialogue, through a broad based commission to recommend regional expenditures, and, the Budget Rules Law should be amended to preempt unfounded mandates to local governments. Revenue autonomy should be boosted by increasing predictability of local budgets...

Romania - Building Institutions for Public Expenditure Management : Reforms, Efficiency and Equity - A Public Expenditure and Institutions Review

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Public Expenditure Review; Economic & Sector Work
ENGLISH; EN_US
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This Public Expenditure and Institutions Review (PEIR) was undertaken at a critical juncture of public expenditure management in Romania. Following three years of economic decline, the economy began growing in 2000, reaching a real GDP growth rate of 5.3 percent in 2001. The Government thus defined an economic reform strategy, to move forward the banking system and enterprise privatization, contain fiscal deficit, and reduce central government expenditures, with further fiscal decentralization. The PEIR focuses on five areas: (i) Structure of central state budget; (ii) Fiscal decentralization; (iii) Social expenditure; (iv) Pension reform; and (vi) Military and defense sector budget. The PEIR presents a policy framework for enhancing the effectiveness of processing, and allocating public expenditures, to improve Treasury accounting, curbe budget ceilings by accumulating payment arrears, and, by subjecting foreign financed public investments to full budgetary scrutiny. By emphasizing accountability in the management of extra-budgetary funds...

Ethiopia Public Sector Reform Approach : Building the Developmental State - A Review and Assessment of the Ethiopian Approach to Public Sector Reform

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Other Public Sector Study; Economic & Sector Work
ENGLISH; EN_US
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The objective of this report is to review and recommend improvements to Ethiopia's approach to public sector reform in order to advise the Government and executive institutions on the future of its public sector reform. The report also serves as a think piece for the World Bank, other partners, and policy makers. The report provides important basic information about the features of Ethiopia's public sector reform approach and reviews what worked well and what did not. It draws lessons from other countries' experience to help develop ideas and instruments of future public sector reforms in Ethiopia. Ethiopia's system of decentralization process has been credible in devolving power, improving governance and service delivery well as narrowing the per capital differences among Regional Governments and districts. The second phase of decentralization was 'big bang' and brought some gaps on addressing administrative and fiscal decentralization issues associated with: a) detailed clarity of expenditure and revenue assignments...