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- W22678028 abstract "Although decentralization has been introduced in many countries under varying contexts, it has remained confusing both conceptually as well as organizationally. The existing frameworks for analyzing decentralization provide limited guidance on how to research the process of decentralization. Responding to these limitations, this thesis argues that decentralization is purposeful, and its ‘meaning’ depends directly upon its objectives and implementation strategies, as well as the understanding and perceptions of the stakeholders who are involved in making the change. The implementation of the Devolution 2001 reforms in Pakistan provides an extraordinary case study for this type of analysis: a radical democratizing process introduced by a military dictatorship, devolving power from provincial to district levels of government. This study analyzes the context, process and organizational outcomes of devolution in health as a part of the broader governance reforms in Pakistan and answers the central research question: ‘What are the implications for the district health system of restructuring as a part of the broader government devolution reforms?’ Employing a case study design, the thematic analysis of the research findings from extensive document review, in-depth interviews and participant observation reveals that despite multiple opportunities presented by Devolution 2001, the health policy planners were unable to develop an effective model for district health governance, which left the health sector poorly prepared. Where health policymakers could not develop their own strategic plans, the health-policy formulation process became a mixture of ingredients from standalone health initiatives, which resulted in a hybrid situation. With the devolution process once more focused attention on governance at the district level, the health policymakers failed to strengthen this system. Today, Pakistan is at a critical stage of political change, with constitutional amendments again restructuring government systems. If the impact of recent devolutionary changes is not deeply understood, then the capacity to respond appropriately will be limited." @default.
- W22678028 created "2016-06-24" @default.
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- W22678028 date "2012-01-01" @default.
- W22678028 modified "2023-09-23" @default.
- W22678028 title "Devolution in Pakistan: implications for district health system" @default.
- W22678028 hasPublicationYear "2012" @default.
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