Evidence and Experience of Procurement in Health Sector Decentralisation

24th May 2017
Author: Kerry Millington, Mina Bhardwaj

Improving the efficiency, effectiveness, equity and responsiveness of supply chains and procurement processes for pharmaceuticals, vaccines and other health products, which make up a large share of total health expenditure in low and middle-income countries (LMICs), has important implications for health system performance and population health. Decentralised governance of health services provides greater autonomy in planning, management and decision making from national to sub-national level and has occurred in many LMICs largely as a response to the primary healthcare approach promoted by international agencies. Evidence suggests that procurement is more efficient when centralised because of economies of scale and improved purchasing power whilst other health system functions such as financing and planning/budgeting benefit more from local context-specific implementation. Nepal is embarking on a process of decentralisation after adopting a federal approach to local governance. This helpdesk report looks at other countries to summarise key findings and lessons learnt from decentralised procurement.

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Suggested Citation

Millington K. A. and Bhardwaj M. (2017). Evidence and experience of health procurement in
health sector decentralisation. K4D Helpdesk Report 108. Liverpool, UK: Liverpool School of
Tropical Medicine.


24th May 2017


Continent: Global