Impact of organizational change on the delivery of reproductive services: a review of the literature

• Published in: The International journal of health planning and management Vol. 20; no. 3; pp. 209 - 225
• Main Authors: Ensor, Tim, Ronoh, Jeptepkeny
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.07.2005; Wiley Subscription Services, Inc
• Subjects: Corporate culture; Decentralization; Delivery of Health Care - organization & administration; Developing Countries; Female; Health administration; Health care delivery; Health Planning; Humans; integration; Literature reviews; Low income countries; maternal health; Maternal health care; Models, Organizational; Obstetrics; Organizational change; Organizational Innovation; Politics; Privatization; Public Health Administration; Reproduction; Reproductive health; reproductive health decentralization; Reproductive Health Services - organization & administration; sector-wide approach; Service delivery
• ISSN: 0749-6753; 1099-1751
• DOI: 10.1002/hpm.810

In order to understand the impact of specific maternal health interventions, it is necessary to understand the likely effect of the health system structure. An important aspect of this structure is the organizational culture. Many systems in low‐income countries have been based on a centrally planned and financed system. In recent years a series of organizational changes have been introduced into many systems and these substantially alter the way in which the system operates and impacts on reproductive health care provision. The main changes reviewed in this paper are: (i) decentralization, (ii) privatization and (iii) integration and sector wide approaches. Each of these changes is seen to have important implications for reproductive health. In each case it is clear that the nature of the impact depends crucially on the way it is implemented. Quantifying the impact of these changes remains extremely difficult given the many different ways they can be introduced and the many confounding factors that affect the overall impact. The literature does, however, point to a number of key issues that impinge on the way in which change is likely to affect reproductive health initiatives. Copyright © 2005 John Wiley & Sons, Ltd.