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PubMedDate not supplied

[Decentralization of health services in Mexico in the 80's].

The objective of this article is to review the decentralization process that took place in the 1980s. First, some principles in relation to this topic are presented. Next, the legal foundations and the agreements which were established for Federation-states coordination are outlined, as well as basic points related to the introduction of the decentralization strategy. The favorable and unfavorable factors that affect the process are established and, finally, the possibility of carrying out decentralization of health services at the municipal level is briefly discussed.

Delivery of Health Care↗

PubMed1996

Surveying potential sites for a rural decentralized allied health education program.

Allied health education programs which are decentralized into medically underserved communities increase the likelihood that graduates will practice within these regions. However, assessing potential sites for decentralized allied health education programs is often done haphazardly, if at all. The University of Kentucky Physician Assistant Program obtained grant funds to develop and administer a survey to assess potential sites for establishing a rural baccalaureate-level physician assistant (PA) program. This article describes the written survey, how it was administered, and the preliminary survey results. The survey assessed academic, medical, and community resources and commitment to support a decentralized program. The survey instrument and assessment procedure were useful for evaluating, ranking, and comparing the sites. Although the survey was designed to meet PA education and training needs, components of the survey are applicable to any allied health education program wishing to evaluate potential sites for didactic and clinical training of students.

Community-Institutional Relations↗

PubMed1977

[Centralized and decentralized organization of cervical cytodiagnostics (author's transl)].

Results of cervical cytodiagnostics with centralized and decentralized forms of organization are compared. In particular, the author deals with the respective share of non-judgeable smears, the cytological diagnostic reliability with histologically proved malignant and premalignant cervical lesions, the respective share of pathological cell-pictures with a negative histological finding, as well with the differential-diagnostic reliability. By the simultaneous application of colposcopy cytologically wrongly negative findings are recognized or corrected at the centralized working style. At the decentralized working style the colposcope is not required, on principle. The partly smaller share of cytological errors is ascribed to this lack of control. A comparison of optimal examination material clarified by conization and gradual serial slides with the cases histologically treated by routine methods permits the conclusion that a pathological cell finding should be evaluated higher than a negative histological diagnostic finding established on the basis of an insufficient slide material. Therefore, a decentralized sending in cytology particularly requires careful, thorough bioptic methodics, being combined with the other well-known methods.

Biopsy↗

PubMedDate not supplied

[The decentralization of the Secretaría de Salud de México. The case of local health systems 1989-1994].

This article constitutes an analysis of the decentralization of the Ministry of Health of Mexico though the project to develop its jurisdictions to strengthen Local Health System (SILOS) implemented between 1989 and 1994. The relationship between decentralization and jurisdictional socioeconomic, demographic and resource availability differences was studied using qualitative and quantitative methods. The impact of jurisdictional strengthening on deconcentration and their combined effect on primary health care (PHC) and coverage were measured. The strengthening of technical capacity within the jurisdictions increased moderately but did not show a significant association with primary health care efficiency. However, when jurisdictions attain more autonomy, a significant association between strengthening and PHC efficiency appears. Deconcentration is a key factor to guarantee the strengthening of technical capacity and to assure that greater efficiency impacts on poverty reduction: however, deconcentration was limited due to the fact that the general strategies of the project were not differentiated according to the inequality across jurisdictions. To decentralize the Ministry of Health effectively, the federation must formulate objectives and strategies according to jurisdictional socioeconomic conditions and service need and capacity. Jurisdictions must be restructured and rescaled to improve their interaction with municipal governments, the health sector and the community.

Efficiency, Organizational↗

PubMed1998

Neuromodulatory inputs maintain expression of a lobster motor pattern-generating network in a modulation-dependent state: evidence from long-term decentralization in vitro.

Neuromodulatory inputs play a critical role in governing the expression of rhythmic motor output by the pyloric network in the crustacean stomatogastric ganglion (STG). When these inputs are removed by cutting the primarily afferent stomatogastric nerve (stn) to the STG, pyloric neurons rapidly lose their ability to burst spontaneously, and the network falls silent. By using extracellular motor nerve recordings from long-term organotypic preparations of the stomatogastric nervous system of the lobster Jasus lalandii, we are investigating whether modulatory inputs exert long-term regulatory influences on the pyloric network operation in addition to relatively short-term neuromodulation. When decentralized (stn cut), quiescent STGs are maintained in organ culture, pyloric rhythmicity gradually returns within 3-5 d and is similar to, albeit slower than, the triphasic motor pattern expressed when the stn is intact. This recovery of network activity still occurred after photoinactivation of axotomized input terminals in the isolated STG after migration of Lucifer yellow. The recovery does not depend on action potential generation, because it also occurred in STGs maintained in TTX-containing saline after decentralization. Resumption of rhythmicity was also not activity-dependent, because recovery still occurred in STGs that were chronically depolarized with elevated K+ saline or were maintained continuously active with the muscarinic agonist oxotremorine after decentralization. We conclude that the prolonged absence of extraganglionic modulatory inputs to the pyloric network allows expression of an inherent rhythmogenic capability that is normally maintained in a strictly conditional state when these extrinsic influences are present.

Afferent Pathways↗

PubMed1992

Prevention of blood-borne HIV transmission using a decentralized approach in Shaba, Zaire.

OBJECTIVE: To prevent blood transfusion-acquired HIV infection with a decentralized approach to HIV screening of blood donors, using an instrument-free rapid test. SETTING: Shaba province, Zaire (496,877 km2). METHODS: The programme consisted of training health-care workers, distribution of a rapid HIV-antibody test (DuPont's HIVCHEK) for screening of all blood donations, and quality control of testing by a regional reference centre. RESULTS: Over a 2-year period, 11,940 rapid tests were distributed to 37 hospitals, covering 75% of all hospital beds outside the copper mine's health system in Shaba. Eighty-five per cent of the tests were used to screen blood donors (5.4% positive test rate) and 13% to test patients (39.7% positive test rate). At least 265 cases of HIV-positive blood donation were prevented, at an estimated cost of 137-279 ECU per case. Only 26% of initially positive specimens reached the central laboratory for supplemental testing, and sterile transfusion equipment and blood-grouping reagents were frequently unavailable. The lack of transport and communications and a deteriorating health system were major constraints. CONCLUSIONS: District hospitals in Africa are often long distances from major cities, difficult to reach for most of the year, and perform a small number of transfusions. In this context a classical centralized regional blood bank may not be a feasible option to ensure safe blood transfusions. However, safe blood transfusion can be achieved with a decentralized approach using a rapid test, provided that minimum standards of health-care services are available.

Blood Banks↗

PubMed1992

Restructuring federalism: the effects of decentralized federal policy on states' responsiveness to family planning needs.

The Reagan Administration sought to decentralize many federal programs by (1) consolidating categorical grants into black grants; (2) reducing their funding; and (3) relying more upon state fiscal support. This study examines the effects of this decentralist policy upon the federal family planning program. Two periods are analyzed: (1) FY 1976-1981, the period immediately prior to the Reagan Administration and (2) FY 1982-1987, the period during the Reagan Administration. Findings show that a more decentralized program produced less responsiveness to individual state needs for family planning, and that these effects could have been predicted from the previous period.

Family Planning Policy↗

PubMedDate not supplied

Decentralizing rural health services: a case study in China.

Many low and middle-income countries have decentralized their public health services in an effort to improve their equity, efficiency and effectiveness. This paper presents a case study of a poor rural county in China that devolved finance and management of basic health services to townships, the lowest level of government. It finds little evidence that townships mobilized additional financial resources or that they were able to address major management problems effectively. It cautions against unrealistically rapid decentralization of health services in poor rural areas.

China↗

PubMed2007

Public health expenditure and spatial interactions in a decentralized national health system.

One of the limitations of cross-country health expenditure analysis refers to the fact that the financing, the internal organization and political restraints of health care decision-making are country-specific and heterogeneous. Yet, a way through is to examine the influence of such effects in those countries that have undertaken decentralization processes. In such a setting, it is possible to examine potential expenditure spillovers across the geography of a country as well as the influence of the political ideology of regional incumbents and institutional factors on public health expenditure. This paper examines the determinants of public health expenditure within Spanish region-states (Autonomous Communities, ACs), most of them subject to similar financing structures although exhibiting significant heterogeneity as a result of the increasing decentralization, region-specific political factors along with different use of health care inputs, economic dimension and spatial interactions.

Health Expenditures↗

PubMedDate not supplied

Malaria control through municipalities in the Philippines: struggling with the mandate of decentralized health programme management.

This is a study on the management of the decentralized malaria control programme in Maharlika, Lipunan, a municipality in rural Philippines. The theoretical assumption is that the malaria control programme must be viewed as a system and that success of reform in malaria control depends upon the understanding of management issues by municipal officials. Through interviews, and documents and archival reviews, a framework for describing the dynamics of municipal management of the malaria control programme was developed. The overall finding was that the administrative management system was not functioning optimally: (a) planning and budgeting systems are not helpful; (b) malaria data do not inform planning; and (c) local financial resources are not utilized for malaria control. The underlying causes were: the absence of a clear statement from national offices regarding decentralization of health services, and the management processes, as stipulated in the Local Government Code, were not responsive to the needs of the municipality.

Communicable Disease Control↗

PubMedDate not supplied

Evidences on weaknesses and strengths from health financing after decentralization: lessons from Latin American countries.

OBJECTIVE: The main objective was to identify trends and evidence on health financing after health care decentralization. STUDY DESIGN: Evaluative research with a before-after design integrating qualitative and quantitative analysis. Taking into account feasibility, political and technical criteria, three Latin American countries were selected as study populations: Mexico, Nicaragua and Peru. DATA SOURCES: The methodology had two main phases. In the first phase, the study referred to secondary sources of data and documents to obtain information about the following variables: type of decentralization implemented, source of finance, funds of financing, providers, final use of resources and mechanisms for resource allocation. In the second phase, the study referred to primary data collected in a survey of key personnel from the health sectors of each country. FINDINGS: The trends and evidence reported in all five financing indicators may identify major weaknesses and strengths in health financing. CONCLUSIONS: Weaknesses: a lack of human resources trained in health economics who can implement changes, a lack of financial resource independence between the local and central levels, the negative behavior of the main macro-economic variables, and the difficulty in developing new financing alternatives. Strengths: the sharing between the central level and local levels of responsibility for financing health services, the implementation of new organizational structures for the follow-up of financial changes at the local level, the development and implementation of new financial allocation mechanisms taking as a basis the efficiency and equity principles, new technique of a per-capita adjustment factor corrected at the local health needs, and the increase of financing contributions from households and local levels of government.

Decision Making, Organizational↗

PubMed1993

Effect of decentralization or contralateral ganglionectomy on obstruction-induced hypertrophy of rat urinary bladder muscle and pelvic ganglion.

After urethral obstruction the musculature of the rat urinary bladder undergoes extensive hypertrophy, irrespective of whether its innervation is intact or whether one of the two pelvic ganglia has been decentralized or excised. Even the excision of both ganglia does not inhibit muscle hypertrophy. The presence of nerves is not a prerequisite for the muscle growth to occur. The stimulus for growth resides in the bladder itself, and the present and previous observations are in agreement with the notion that the distension of the muscle is a primary stimulus for muscle growth. With bladder hypertrophy, the pelvic ganglion neurons undergo hypertrophy, even when they are devoid of their preganglionic input. Synaptic connection with the preganglionic fibres and stimuli from the spinal cord are not prerequisites for neuronal hypertrophy. However, the hypertrophy is less marked in the decentralized ganglion neurons than in the neurons of the contralateral intact ganglion. With bladder hypertrophy and contralateral ganglionectomy, the neuronal hypertrophy is greater than with either procedure alone, suggesting that the two forms of neuronal growth stimulation can be added to each other.

Animals↗

PubMed1976

Decentralization of forensic services.

Decentralization of mental health services to persons in contact with the criminal justice system is essential in the application of community mental health concepts. This is feasible considering the levels of "dangerousness" of such persons, costs of the typical isolated central facility, and implications of the Supreme Court decision Jackson v. Indiana (406 U.S. 715, 1972). In Tennessee, reform began with legal review of unit records, pretrial screening in mental health centers, revision of state law, liaison with the Tennessee Board of Pardons and Paroles, and use of consultant staff. The results are positive wherever decentralization of services has been maintained.

Attitude of Health Personnel↗

PubMed2004

[Measurement method for the determination of rotation and decentration of intraocular lenses].

PURPOSE: In the past 50 years the IOL has been improved. Nowadays it is possible to exactly calculate the necessary IOL power and correct toric refractive errors. In this study we developed methods for measuring rotation and decentration using the example of a hydrophilic acrylic IOL. METHODS: Following cataract surgery, the first retroilluminated photograph was taken. The position of the IOL was determined with the image analysis program Adobe Photoshop. RESULTS: Measurement of a rotational movement or of a decentration of an IOL can be done accurately and rapidly. Evaluation of the stability of rotation of the hydrophilic acrylic IOL measured here showed an average rotation of the IOL of 5.3+/-1.4 degrees after 6 months compared to the position directly after implantation. CONCLUSION: The measurement methods presented here are easy to use and provide reliable results. Examiners must have basic knowledge of the computer programs used. Also, these methods depend on good quality of the retroilluminated photographs.

Cataract↗

PubMed2006

The impact of government decentralization on county health spending for the uninsured in California.

We analyze Program Realignment, California's 1991 policy of decentralizing control of health, mental health, and social services, from the state to the counties. Drawing from the economics literature on intergovernmental transfers and using data constructed for this study, we analyze the impact of Realignment on uninsured health spending. We find a change in the pattern of spending on indigent health services by counties following decentralization. Our results suggest, however, that county-level governments maintain a level of commitment to social-service spending that recent studies indicate may be lacking at the state level.

California↗

PubMed1981

Differentiation of alpha-adrenergic responsiveness in the neonatal rat iris after decentralization or extirpation of the superior cervical ganglion.

The effects of stimulating alpha-adrenergic receptors in the iris of neonatal rats (up to 30 days of age) whose superior cervical ganglion (SCG) has been decentralized or extirpated 3 days after birth were investigated by measuring changes in pupil diameter. The responses of these experimental animals were compared with those of normal animals of similar age. Alpha-adrenergic stimulation was effected by topical application of noradrenaline (NA) after blockade of beta-adrenoceptors with dichlorisoproterenol and cholinoceptors with atropine. The results reveal that although decentralization of the SCG depletes the NA content of the ipsilateral iris as demonstrated by radio-chemical assay and formaldehyde-induced fluorescence, it does not affect the development of alpha-adrenoceptor responsiveness. Even the more severe disruption of the innervation caused by extirpation of the SCG did not affect the responsiveness of the ipsilateral iris.

Aging↗

PubMed1989

Effect of preganglionic stimulation or chronic decentralization on neurotensin-like immunoreactivity in sympathetic ganglia of the cat.

In pentobarbital-anesthetized cats, supramaximal stimulation (40 Hz, 2 h) of the preganglionic input to the acutely decentralized right stellate (RSG) or superior cervical (RSCG) ganglion resulted in a decrease in neurotensin (NT)-like immunoreactivity (IR), by 83% in the SG and by 46% in the SCG, as determined by radioimmunoassay. Chronic (7 days) decentralization of the ganglia resulted in a similar depletion of NT-like IR (SG: 86%; SCG: 76%). Supramaximal stimulation (40 Hz, 2 h) of the intact postganglionic outflow of either ganglion had no effect on NT-like IR. These data suggest that NT in the SG and SCG is present in preganglionic axons and is released by activation of these axons.

Animals↗

PubMed1986

Vasoactive intestinal polypeptide elicits a discharge in chronically decentralized sympathetic ganglia.

Vasoactive intestinal polypeptide (VIP, 5-50 micrograms) injected intraarterially to the chronically decentralized cat superior cervical ganglion elicited a prolonged (2-5 min) postganglionic discharge which was resistant to cholinergic blocking agents but was blocked by [Leu5]enkephalin and GABA (10-200 micrograms i.a.). VIP did not elicit a discharge in acutely decentralized ganglia. These findings indicate that VIP has direct excitatory effects on ganglion cells and that these excitatory effects are enhanced following degeneration of the preganglionic nerve terminals.

Action Potentials↗