Abstract:
BACKGROUND: Decentralization ultimately involves the execution of most health care activities at
lower levels of the health system. However, when poorly implemented, decentralization can create
confusion about roles and responsibilities. Therefore, the objective of this study was to assess the
presence and use of legislative guidelines depicting the distribution of decentralized authority for
decision making in the Jimma Zone health system, Southwest Ethiopia.
METHODS: A cross sectional study employing both qualitative and quantitative methods was
undertaken from 16th January to 15th March 2007 in Jimma Zone. Health managers at relevant
departments of the Federal Ministry of Health, Oromia Regional Health Bureau (RHB), Jimma Zonal
Health Department, 13 Woreda Health Offices of Jimma Zone and the health centers and health posts in
these districts were included in the study. Data was collected using interview guides and self
administered structured questionnaires prepared for each level of the health system. Tape-recorded
qualitative data was transcribed and analyzed using thematic framework approach while SPSS for
windows version 12.0.1 was used to analyze the quantitative data obtained.
RESULTS: According to the regional guidelines, ensuring achievement of regional health service
targets is the responsibility of the RHB. This was clear to 97 (97.9%) of the health managers included in
this study. However, almost equivalent proportion of the respondents, 95 (95.9%) agreed that the FMOH
should be responsible for this. Similarly, 71 (73.9%) of the health managers knew that approval of
health budgets and efforts for local resource generation is the responsibility of the Woreda
Administrative Council while the remaining 27.1% were uncertain or disagreed about this regional
direction. Such confusions were observed in almost every functional area. Moreover, legislative
guidelines were not available in most of the district health offices and health facilities.
CONCLUSION: Legislative guidelines depicting the distribution of decentralized authority in decision
making in the health system were prepared at national and regional levels. However, the findings of this
study suggested that health managers in the Jimma Zone health system did not appear to have the right
perceptions about roles and responsibilities of the various levels. It is, therefore, very important to clarify
such confusions along with capacity building efforts to match the changing roles of each level.
