Health Decentralization in Paraguay: Empowering Local Communities at the Expense of Better Services?

In many parts of the world, the late 1980s and 1990s saw the promotion of decentralization as a central issue in the agenda of many national governments, regional leaders and development agencies. Decentralization was seen as... [ view full abstract ]

In many parts of the world, the late 1980s and 1990s saw the promotion of decentralization as a central issue in the agenda of many national governments, regional leaders and development agencies. Decentralization was seen as key to reestablishing the democratic credentials of the State, as a way to make governments more responsive, closer to the people and transparent, as the best way to promote better governance, reduce inequalities and strengthen economic development. Decentralization was seen as key to improving governance by bringing governments closer to the people making them more transparent and accountable. The provision of basic services would be improved by local authorities in charge of their delivery.

Many countries in the Americas initialized decentralization of services such as education and health to the local governments. Paraguay, one of the latest countries to initialize its democratic transition and decentralization process, started an interesting pilot project on health decentralization at the local level. Very few studies of its effectiveness and impact have been made. This paper will look at the health decentralization process of Paraguay and the role played by key stakeholders on its approval process, the creation of local and regional health councils, and the positive impact they have had in improving community empowerment and citizen participation but, it will argue that the way the program was implemented, actually hindered the improvement of basic health indicators.