13 MCNs provide some of the benefits of centralisation, but also strive to maintain equity and ease of access to services by keeping lower care level and lower volume neonatal units open, with provision for transfer to higher care level or higher volume units, if required.
But instead of becoming an instrument of centralisation and tyranny, it led to just the opposite: the democratisation of access to information and the decentralisation of politics.
Knowledge of how centralisation of obstetric services affects availability and access to obstetric institutions is lacking in high-income countries.
Methodological aspects have been debated as well [ 12- 16] with particular focus on statistical adjustment procedures and on how minimum volumes effect the geographically equal access to care by causing centralisation of care [ 17- 21] as well as accessibility of providers from the patients' perspective [ 22].
It seems that patients from more socioeconomically deprived areas could be further disadvantaged if centralisation of services increased their travel time to access them.
More detailed studies are needed to understand the impact of centralisation of RP services and the association with access issues for minority populations.
The research findings highlight four significant governance gaps: lack of coherence among civil society organisations (CSOs); limited civil society access to communities and the deliberate centralisation of oil governance; industry-driven interaction at the local level; and weak local government capacity.
Other factors including centralisation of services, while practical, may also exacerbate inequalities in access where, for example, remoteness to treatment centres [ 22] are likely to have a differential impact on population groups with fewer resources to offset the often significant economic [ 40] and social costs [ 41, 42] of cancer care.
Centralisation of services was therefore proposed as the ideal means of improving access to care and sharing of skills, but it was recognised that for most centres, such an intervention would not be possible within the constraints of the NHS.
This centralisation of electrical power, means that the economic and political power is centralised too.
