New councils countrywide are grappling with bigger constituencies and more responsibilities, all ushered in by last month’€™s local elections.

Healthcare delivery is one of the key areas of added responsibility for municipalities.

This is in line with the Constitutional requirement that local government should have executive powers to administer “municipal health services”.

Addressing a meeting of key health officials this week, UK health policy expert Dr Charles Collins said he supported decentralised healthcare as “it is not viable for a central bureaucracy to run the health care system”.

However, Collins warned that decentralisation was both “complex and problematic”.

It was open to political manipulation and, if poorly implemented, could increase the gaps between the rich and the poor, he said.

Collins, from Leeds University’€™s Nuffield Institute for Health, said that decentralisation was often taken to mean a “weakening of the centre”, or provincial and national government.

However, he stressed that while central government would loose certain operational functions, it was essential that it remained strong enough to provide strategic direction for a national health plan, and support and regulate decentralised healthcare delivery to ensure that “standards were met and maintained”.

Collins warned that in some countries, central government had used decentralisation to cut healthcare funding, passing the buck to municipalities, to raise their own cash.

This had been used to take the heat off national government, as municipalities could be blamed by communities for a decline in services, warned Collins.

At present, local authorities have virtually no influence over the allocation of finances, which are handled through the Department of Finance’€™s Budget Council, consisting of provincial and national representatives, and at meetings between national ministers and their provincial MECs (MinMEC meetings).

Collins also warned that decentralisation often demoralised staff as they felt that they no longer had a clear career path, progressing from local to provincial and national government. ‘€“ Health-e News Service.