Many countries are currently undergoing or have recently undergone decentralization of the health sector, whereby decision-making and management functions are shifted to lower levels of government (e.g., states, provinces, and municipalities).
Background
The goals of this decentralization might be to ensure that health services are more responsive to local needs by encouraging community participation; to improve efficiency and equality of health services; and to increase the equity of health services.
In such cases, the decentralization process does not often make clear how RH commodities are to be financed, procured, or managed. Under centralized management, a budget line item for FP supplies may exist; however, at the decentralized level, budget line items for contraceptives often do not exist.
If the procurement of commodities becomes the responsibility of subnational governments, it can be difficult to achieve competitive commodity prices due to a lack of economies of scale.
Central governments do not always take a stewardship approach to assisting lower levels of government with defining new roles and responsibilities and ensuring transfer of technical skills and resources for the management of and decision-making around health services.
Additionally, limited commitment to or awareness of FP/RH issues may exist at local levels. Thus, the challenge under decentralization is to at least maintain the level of capacity that existed under centralized management; this would require explicitly addressing issues related to policy, planning, finance, procurement, and delivery of contraceptives during the decentralization process (see "Capacity Building at the Decentralized Level for Contraceptive Security Planning and Implementation in Indonesia").
