Other financing challenges encountered include rationalization of public funding, which in the case of Utopia could lead to services being centralized to larger rural centers and undermining the Aboriginal governance and design of Utopia's presently decentralized program.
Even when all programs are decentralized, old program allegiances of staff create tension and potential conflict between the supervisees and the new local health manager.
The urban site in Western Cape and the rural site in Kwa-Zulu Natal are considered to have decentralized ART programs, whereas the other two have highly-centralized ART programs.
Previous research by the authors examined the political consequences of internationally funded, decentralized development programs that target local nongovernmental organizations (NGOs).
Although there are numerous studies describing decentralized ART programs in sub-Saharan African countries [ 5, 6, 9, 10, 23– 27], few have described the state of national ART roll-out at the lowest level of decentralized primary service delivery.
Uganda also had the commitment, and the ability to mobilize and decentralize the program, and to develop the management capacity to implement the IEC program at this broad and high level of effort.
Each U.S. state represents a unique health care environment with unique and decentralized cancer control programs and state-specific insurance and practitioner regulations.
In the past, the special setting of this tertiary health care facility made it possible to start decentralized HBV vaccination programs in HCWs supported by donations.
Implementing the PHRN has contributed to valuable experience for establishing and sustaining a people's network, in close collaboration with the government, towards the end objective of building capacity to improve decentralized planning and programming.
Admission to graduate programs is decentralized; applicants apply directly to the department or degree program.
