Impact of organizational change on the delivery of reproductive services: a review of the literature
Article first published online: 4 AUG 2005
Copyright © 2005 John Wiley & Sons, Ltd.
The International Journal of Health Planning and Management
Volume 20, Issue 3, pages 209–225, July 2005
How to Cite
Ensor, T. and Ronoh, J. (2005), Impact of organizational change on the delivery of reproductive services: a review of the literature. Int. J. Health Plann. Mgmt., 20: 209–225. doi: 10.1002/hpm.810
- Issue published online: 4 AUG 2005
- Article first published online: 4 AUG 2005
- Bill and Melinda Gates Foundation
- Department for International Development
- European Commission
- maternal health;
- reproductive health decentralization;
- sector-wide approach;
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.