"Low Decision Space Means No Decentralization in Fiji" Comment on 'Decentralisation of Health Services in Fiji: A Decision Space Analysis'
Abstract
Mohammed, North, and Ashton find that decentralization in Fiji shifted health-sector workloads from tertiary hospitals to peripheral health centres, but with little transfer of administrative authority from the centre. Decision-making in five functional areas analysed remains highly centralized. They surmise that the benefits of decentralization in terms of services and outcomes will be limited. This paper invokes Faguet’s (2012) model of local government responsiveness and accountability to explain why this is so – not only for Fiji, but in any country that decentralizes workloads but not the decision space of local governments. A competitive dynamic between economic and civic actors that interact to generate an open, competitive politics, which in turn produces accountable, responsive government can only occur where real power and resources have been devolved to local governments. Where local decision space is lacking, by contrast, decentralization is bound to fail because it has not really happened in the first place.
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Low Decision Space Means No Decentralization in Fiji
Comment on “Decentralisation of Health Services in Fiji: A Decision Space Analysis”
Jean-Paul Faguet*
Abstract
Mohammed, North, and Ashton find that decentralization in Fiji shifted health-sector workloads from tertiary
hospitals to peripheral health centres, but with little transfer of administrative authority from the centre. Decision-
making in five functional areas analysed remains highly centralized. They surmise that the benefits of decentralization
in terms of services and outcomes will be limited. This paper invokes Faguet’s (2012) model of local government
responsiveness and accountability to explain why this is so – not only for Fiji, but in any country that decentralizes
workloads but not the decision space of local governments. A competitive dynamic between economic and civic actors
that interact to generate an open, competitive politics, which in turn produces accountable, responsive government
can only occur where real power and resources have been devolved to local governments. Where local decision space
is lacking, by contrast, decentralization is bound to fail because it has not really happened in the first place.
Keywords: Decentralization, Democracy, Local Government, Good Governance, Civil Society, Fiji
Copyright: © 2016 by Kerman University of Medical Sciences
Citation: Faguet JP. Low decision space means no decentralization in Fiji; Comment on “Decentralisation of health
services in Fiji: a decision space analysis.” Int J Health Policy Manag. 2016;5(x):x–x. doi:10.15171/ijhpm.2016.82
*Correspondence to:
Jean-Paul Faguet
Email: j.p.faguet@lse.ac.uk
Article History:
Received: 20 April 2016
Accepted: 14 June 2016
ePublished: 22 June 2016
Commentary
Department of International Development & STICERD, London School of Economics, London, UK
hp://ijhpm.com
Int J Health Policy Manag 2016, 5(x), 1–3 doi 10.15171/ijhpm.2016.82
Introduction
This interesting paper examines two periods of the
decentralization of healthcare in Fiji, and an intervening
recentralization in between. It focuses particularly on the
period 2008-2014, comprising the second wave of reform, and
asks the question, to what extent were different health functions
actually decentralized? The paper employs the ‘Decision
Space’ approach pioneered by Bossert,1 which defines decision
space as the local discretion allowed by central government
for functions and sub-functions about financing, service
delivery, human resources, and governance exercised by local
governments. Carefully operationalized for empirical analysis,
measures of decision space allow researchers to investigate
the extent to which local authorities have policy discretion,
or central authorities effectively circumscribe local choice
through rules and incentives that promote central objectives.
Developing these ideas further, Bossert2 argues that the decision
space approach has several advantages. It puts the focus
squarely on the extent to which authority over public choices
is shifted from central to local authorities. And it stresses that
the choices in question are neither simple not monolithic, but
rather involve a range of discretion over different functions
and types of decisions. Therefore, we should expect a given
decentralization reform to permit more local choice over
budgets and financing in some areas (eg, primary education),
and hiring and firing in others (eg, public infrastructure). This
is a more realistic way of analysing the complexity of real-
world experience than the simple decentralized-centralized
dichotomies that dominate the literature, concealing more
than they reveal. In all these ways, ‘decision space’ is similar
to the concept of ‘residual authority’ developed in Faguet.3
The empirical operationalizations of decision space, however,
constitute an important and original empirical dimension.
The paper finds that although workloads have shifted from
tertiary hospitals to peripheral health centres, there has been
little transfer of administrative authority from the centre.
Decision-making in five functional areas analysed remains
highly centralized. Hence – and this in my view is the most
important point – the benefits of decentralization for citizens
in terms of service provision and real outcomes are likely to
be quite limited. The authors rightly stress, however, that the
question of real health outcomes is beyond their remit.
Mohammed, North, and Ashton4 end their analysis there. The
objective of this comment is to push the analysis further. I
wish to provide theoretical underpinnings for their final, most
powerful conclusion – given more as a speculation – and so
show why it is likely true not only for Fiji, but indeed for any
country that decentralises in a similar fashion.
Why would decentralization improve government
responsiveness to citizen needs in the first place? How,
additionally, might it make public services more efficient?
The most important thing to understand is that citizen needs,
unit costs, and the feasibility of realistic options vary across
space. In any field of public policy, different places simply need
different things, and have different realistic options available
to them. What advantages might local governments have been
over central government in such a context?
In comparison to central government, local government is said
to benefit from: (i) more and/or better information regarding
local preferences and conditions; (ii) louder citizen voice and
participation in the government process; and (iii) superior
accountability, and, hence, responsiveness of public servants to
citizens. All of these effects, it is claimed, come about as a result
of the creation of functionally independent local governments
that are physically closer to their electorates (than central
government), and whose political fortunes are in the hands of
Faguet
International Journal of Health Policy and Management, 2016, 5(x), 1–32
those who benefit – or suffer – from the local services they
provide. If “bringing government closer to the people” leads to
improved information, voice, participation and accountability
in public decision-making, then local public services should
improve as a result. Services can improve in two broad ways:
(a) lower costs through greater productive efficiency and
less corruption; and (b) higher quality, interpreted to include
services better-suited to local needs and conditions. Improved
services, in turn, should lead to more intensive use by local
citizens, and thence to better substantive outcomes. Examples
of better substantive outcomes include lower infant mortality
rates or higher rates of vaccination.
In practice, will decentralised governments benefit from better
information, greater citizen voice, and superior accountability?
Or will they be crippled by corruption, elite capture, and low
capacity? Literally thousands of studies have attempted to
answer this question, with results so mixed that the debate has
rumbled on, increasingly fruitlessly, for decades (Faguet and
Pöschl 2015; Channa and Faguet Forthcoming).5,6 An entire
literature has marched into this dead-end, failing to realize that
the basic question it posits is misconstrued.3 The simplest way
to explain it is as follows: The question, “Does decentralization
improve service delivery?” has two obvious answers:
(1) Yes. Of course services will improve. In at least some
localities, resources will be spent and decisions taken
in such a way that education, health, and other services
improve compared to what central government provided.
(2) No. Of course services will worsen. In at least some other
localities, resources will be spent and decisions taken
in such a way that education, health, and other services
worsen compared to what central government did before.
In a third set of localities, which in many countries may be
the majority, services will continue much as before, neither
significantly better nor worse, and decentralization will
have little effect. This is true not by assumption, but by the
very definition of decentralization, which even in relatively
homogeneous countries should lead to a greater diversity
of outcomes, in both type and efficiency. The “outputs” of
decentralization are, thus, the simple aggregation of all of
the local outputs that reform produces. Each of these local
outcomes is, in turn, driven by interactions of the underlying
actors and characteristics of each place. The necessary
implication is that for much of the past four decades,
researchers have been asking the wrong sorts of questions,
of a type: ‘Is decentralization good or bad for policy variable
X?’ A far better approach is to admit from the outset that
decentralization leads to a broad heterogeneity of response,
and ask: ‘Why are the good outcomes good, and why are the bad
outcomes bad?’ To understand the effects of decentralization
on any political and administrative system, we must begin our
analysis at the grass roots. To understand decentralization, we
must first understand how local government works.
A Theory of (Local) Government Responsiveness
Why do some local governments provide better services,
and others worse ones? Consider Faguet’s model3,7 of local
governance depicted in the Figure. Our goal is to understand
the determinants of responsiveness and accountability in
local governance.[1] As the figure implies, the first-order
determinant of a responsive, accountable government is an
open, substantively competitive politics. Where politics is
open to new entrants and focuses on issues of substance, as
opposed to appearance, political competition will produce
a strong inclusive tendency in the sense of not leaving
significant groups of voters unrepresented. Political platforms
will tend to focus on the real needs of voters and firms,
rather than descending into beauty contests. Hence, the best
predictor of governments that are accountable and responsive
is open political systems where competition is substantive and
political entrepreneurialism[2] possible.
But open, competitive politics is not a fixed municipal
characteristic. Rather, it emerges endogenously through the
interaction of local economic interests and civic organizations.
Where the firms and other economic interests that comprise
the local economy are diverse and heterogeneous, and where
civil society is organized into many, active groups, and where
these two sets of actors interact with one another through
local politics, proposing needs, debating competing priorities,
and searching for avenues of mutual benefit, local politics will
tend strongly towards openness and competition as described
above.
Where, by contrast, the local economy is dominated by a
single large actor, the diversity of political forms that supports
broad representation will tend not to emerge. And where civil
society is atomized into individuals, and the intermediating
organizations that aggregate preferences and organize collective
action are missing, politics will tend to become divorced from
society’s needs.8 In either case, politics will tend to be less open
and less competitive, or competitive in dimensions orthogonal
to the needs of voters and the economy. As the figure also
implies, economic interests and civic organizations are capable
of exerting direct effects on responsiveness and accountability
too. But evidence suggests that these effects are weak, and
hence firms’ and civic organizations’ primary channel of
influence is through the political system.
Conclusion
The crucial underlying assumption necessary for this system
to work is that real power and resources lie in the hands of local
authorities. In other words, substantive decentralization has
occurred, leaving elected local officials with enough decision
space to make the costly competition for power and influence
that civic organizations and firms are presumed to engage in
worthwhile. If local officials instead have little decision space,
Figure. A Theory of (Local) Government Responsiveness. Reproduced
from Faguet,3 with permission from the University of Michigan Press.
Faguet
International Journal of Health Policy and Management, 2016, 5(x), 1–3 3
implying that power and discretion continue to reside in the
centre, then neither firms nor citizen groups will have much
incentive to support local parties, lobby officials, or otherwise
compete for power. Where public services are concerned, the
relevant power will continue to lie in the capital, far beyond the
reach of the vast majority of local actors. In such contexts, the
requirements of responsive local governments cannot be met,
and so the benefits of decentralization cannot be obtained.
This is why the question posed by Mohammed, North, and
Ashton is so important. The first step to understanding the
effects of any decentralization is to ask Did it really happen?
In Fiji, it appears, the answer is no. This is both an important
insight for future research, and a clarion call for sincere reform.
Ethical issues
Not applicable.
Competing interests
Author declares that he has no competing interests.
Author’s contribution
JPF is the single author of the paper.
Endnotes
[1] As opposed to understanding how much power or resources are
decentralized, or other systemic aspects of reform that require national-level
analysis.
[2] Political entrepreneurialism can be defined as the identification, by a new
politician or party, of a bloc of voters ill-served by existing political competition.
When she then develops proposals and messages attuned to this bloc’s
needs, and wins their votes in the following election, she is acting as a political
entrepreneur.3
References
1. Bossert T. Analyzing the decentralization of health in developing
countries: decision space, innovation and performance. Soc Sci
Med 1998;47:1513-1527. doi:10.1016/S0277-9536(98)00234-2
2. Bossert T. Empirical Studies of an Approach to Decentralization:
“Decision Space” in Decentralized Health Systems. In: Faguet
JP, Pöschl C, eds. Is Decentralization Good for Development?
Perspectives from Academics and Policy Makers. Oxford:
Oxford University Press; 2015.
3. Faguet JP. Decentralization and Popular Democracy:
Governance from Below in Bolivia. Ann Arbor: University of
Michigan Press; 2012.
4. Mohammed J, North N, Ashton T. Decentralisation of health
services in Fiji: a decision space analysis. Int J Health Policy
Manag. 2015;5(3):173-181. doi:10.15171/ijhpm.2015.199
5. Faguet JP, Pöschl C, eds. Is Decentralization Good for
Development? Perspectives from Academics and Policy Makers.
Oxford: Oxford University Press; 2015.
6. Channa A, Faguet JP. 2016. Decentralization of Health and
Education in Developing Countries: A Quality-Adjusted Review
of the Empirical Literature.” World Bank Research Observer.
2016. doi:10.1093/wbro/lkw001
7. Faguet JP. Transformation from Below in Bangladesh:
Decentralization, Local Governance, and Systemic Change.
Modern Asian Studies. Forthcoming.
8. Faguet JP. Building Democracy in Quicksand: Altruism, Empire
and the United States. Challenge: The Magazine of Economic
Affairs. 2004;47:73-93.
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