Nuria Homedes and Antonio Ugalde (eds), Decentralizing health services in Mexico, a case study in state reform. US-Mexico Contemporary Perspectives Series, 25, Center for US-Mexican Studies, University of California, San Diego, 2006. 314 pp. ISBN 13:978-878367-56-3 (PAPER); 10:1-878367-56-0 (PAPER); 13:978-878367-57-0 (CLOTH); 10:1-878367-57-9 (CLOTH)

✍ Scribed by Robert B. Kuganab Lem

• Publisher: John Wiley and Sons
• Year: 2007
• Tongue: English
• Weight: 53 KB
• Volume: 22
• Category: Article
• ISSN: 0749-6753
• DOI: 10.1002/hpm.905

✦ Synopsis

57-0 (CLOTH); 10:1-878367-57-9 (CLOTH) £15.5 (paperback).

It was once the general understanding that decentralisation of health services was the way forward if low-income nations were to achieve efficiency, improved quality of service, equity and community participation in their health care delivery systems. This perception was fuelled by the World Bank who prescribed decentralisation as an adjunct to Structural Adjustment Programmes (SAP). Health services decentralisation was to correct the deplorable state of health delivery systems of low-income countries which was largely as a result of SAP in the first place. The objectives of decentralisation were thought to be too good and very attractive and therefore were not opposed or challenged not only in Latin America but other low-income nations that were keen to reform their health sector.

Eleven authors have contributed to this book. In spite of this, the book is very cohesive, eloquently written and well integrated. The purpose of the book is to verify through empirical evidence whether after 27 years of decentralisation in Mexico the objectives promised by promoters of decentralisation have been attained. To answer this question, the authors draw on evidence from five States of Mexico, supported by interviews with many health professionals and political leaders and managers of the health services.

The book is in three main parts. The first part is a presentation of a theoretical and historical account of decentralisation in general and an overview of decentralisation of the health sector of Mexico. The second part deals with the first attempt of decentralising health services in Mexico within the period 1983-1988. The third and last part of the book deals with the experiences of the five States as they embarked on decentralising health care institutions during the period 1994-2004, the second attempt.

The first part of the book offers a comprehensive review of the literature on decentralisation, noting particularly the difficulties created by the different definitions of the concept of decentralisation. It then establishes firmly the justification for decentralisation of various economic sectors in various political, historic and social contexts. The context for health services decentralisation in Latin America is also established in this first part of the book.

It notes that the then deplorable state of health services justified the introduction of a new strategy to mitigate the situation. That the World Bank proposed a model of health reform which included decentralisation of services, privatisation and a package of basic services to be provided to the poor without cost. It was the thinking of the World Bank that these policies would promote efficiency, equity, quality and user satisfaction.