Public choice and decentralised healthcare service delivery in Lesotho: Assessing improvement and efficiency in service delivery

Abstract

Providing efficient decentralised local public services such as healthcare in hard to reach and remote areas has been the recent concern of public finance experts. Thus public finance theory, the public choice, has been devoted to explain the link between decentralised local public service delivery and efficiency. The theory argues that efficient delivery of decentralised local public service is achieved through the proximity advantage of local management boards, which enables them (that is the local management boards) to provide services tailored to the needs of their respective local communities. Using the public choice’s decentralised local service provision, this study adopted a qualitative design, and accidentally selected and interviewed 40 health service users (HUs) and 10 Health professions (HP) in the rural areas of Lesotho. The results show improvement and efficiency in healthcare service accessibility, utilisation and affordability in the study communities. Again, it emerged that decentralised healthcare delivery helped healthcare service providers to gain an in-depth knowledge of the healthcare needs of the local people, thereby enabling them to adjust services to the healthcare needs of the community through innovative healthcare delivery strategies, like mobile healthcare delivery service and the mobilisation of trained assistant nurses deployed to serve in remote and hard-to-reach communities. Results further show that these innovative healthcare strategies meet the health needs and preferences of the local people. The study recommends local and central governments to prioritize and scale up decentralised healthcare delivery across the country, particularly in vulnerable and poor communities, in addition to the provision of state-of-the-art healthcare facilities and intensified human resource training for the healthcare sector.

Keywords

• public choice
• health service
• efficient health service
• health service utilisation
• decentralisation
• local governments