Interacción de los fármacos con el sistema inmune

The normative goals of decentralisation often described in the literature include efficiency, good governance, equity, and poverty reduction (see for example, the writings of Smoke (2001 and 2003); Dele Olowu (2001); Ribot (2002) Cheema and Rondinelli (2007); and, Zhou and World Bank, (2009) amongst others). These goals are discussed briefly in the sections which follow.

2.4.1 Efficiency

The decentralisation of government administration to local governments, which are believed to have closer ties to the people, easier access to local information and privileged knowledge of the local context, is said to improve allocative efficiency. This is said to be so because it is believed that local governments are in a better position to identify the right mix and quantity of services to suit local demands (Oates, 1999, p. 1123); Abers, 2000; Blair, 2000; Heller, 2001; Kohl, 2003; Smoke, 2003; Nordholt, 2004; Wunch, 1998). In theory, the efficiency goal is most clearly set out in the Oates

decentralisation theorem (Oates 1972, p. 35; Sartori, 1987; Saltman et al., 2007). The

theory contends that it will always be more efficient for a local government to provide goods or services within its own sphere of jurisdiction than for a central government to provide such goods or services across several local authorities (Oates, 1972, p. 35) and 2006, p. 3; Saltman, et al., 2007). This is because different localities will want different bundles of goods and services. Although its focus is limited to the fiscal dimensions of decentralisation and efficiency in public service delivery, the decentralisation theorem establishes a foundation for understanding why governments decentralise their governance structures and the provision of public services. It also sheds some light on why it is common to find both decentralised and centralised arrangements for the provision of public services in most developing countries. Theories of public administration and management also stress the importance of decentralisation in terms of ‘technical efficiency’ in delivering services to the public arising from increased accountability and responsiveness (Turner & Hulme, 1997:156; Treisman, 2007). In this understanding, decentralisation leads to improved decision-making which, in turn,

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increases efficiency and effectiveness in planning, coordination, innovation and policy implementation.3

2.4.2 Good governance

The concept of governance is ill-defined but it is generally understood to refer to the whole set of actions carried out by the government, civil society, and the private sector, and the ways in which these actors collaborate to solve society’s problems. Governance is said to represent a broader and more inclusive concept than the mere notion of government. Pollitt and Bouckaert further note there is no way governance can be viewed as an alternative to government and, it should be understood that government remains ‘one of its principal constituent elements’ (Pollitt and Bouckaert, 2011, p. 21). From a governance perspective decentralisation is seen as a means to empower citizens by giving them voice, resources and a measure of self-government.

Since local governments are said to be closer to the people, it is argued that decentralisation improves governance by increasing the level of interaction between citizens and the local state and by enhancing their capacity to meaningfully influence decision making on issues relating to the delivery of public services (Smoke, 2001: 34; 2003: 9; Treisman, 2007:157). It has also been claimed that African states seeking to address institutional incapacity, weak accountability, poor service delivery and the alienation of their citizenry would benefit from the introduction of effective participatory systems (Dia, 1996;Olowu, 2001).

In theory the governance goal of decentralisation is derived from both the ideals of liberal democracy and participatory democracy. Liberal democratic political theory, stemming from the work of John Stuart Mill and others4 envisages the returns both central and local government could derive from devolution and popular participation in formal political structures at the grassroots level (Turner & Hulme, 1997). The theory puts forward political stability, political participation, accountability and responsiveness as the political benefits that can be attained from decentralisation. According to John Stuart Mill (quoted in Wilson, 2012) representative local government encourages individuality and leads people to take an active and intelligent part in the affairs of society. Participatory

3

See Turner & Hulme (1997:156-157) for a detailed account on these grounds.

4 _{Wilson, F. ( 2012) ‘John Stuart Mill’, in E. N. Zalta (ed.) The Stanford Encyclopaedia of Philosophy}

(Spring Edition). URL: http://plato.stanford.edu/archives/spr2012/entries/mill.  

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democratic theorists maintain that where citizens participate in self-government their sense of political agency and empowerment increases. Frequent participation, it is stated, transforms ordinary people into politically informed citizens, whilst the expansion of democratic participation beyond traditionally electoral processes breaks the monopoly of state power and builds equity and humanity in a society (Pateman, 1970; Bryan, 2004; Hilmer. 2010:56).

Contemporary participatory theorists define participation as a process whereby citizens, and especially marginalised ones, influence governance processes, decisions, policies and development initiatives that affect them (World Bank, 1992: 177; 1998; Brett, 2003; Sharma, 2004; Tapscott & Thomson, 2013). A central problem addressed by most participatory research is the nature of that influence and, particularly, how to devise mechanisms to enable state agencies to incorporate citizens’ opinions into government decision-making, policy formulation, planning and budgeting processes ‘directly rather than indirectly, as is the case in orthodox bureaucratic systems’ (Brett, 2003:5). Some participation scholars have classified the ways in which citizens participate as occurring in two distinct spheres in what have been termed ‘invited spaces’ and ‘invented spaces’ of state-citizen engagement (Cornwall, 2002; Mohanty, 2007: 80; Kateshumbwa, 2013: 16; Cornwall, 2002; Piper, 2010). The invited spaces are institutional spaces or platforms purposefully created by government to encourage citizens to exercise their rights by taking part in government decision-making and policy processes (Cornwall, 2002; Mohanty, 2007: 80; Kateshumbwa, 2013: 16; Cornwall, 2002; Piper, 2010). It is at this level where decentralisation is seen to link with participation as it ‘provides different kinds of institutions, politically and administratively, for participation at various local levels’ (Samaratunge, 1998: 6). The invented spaces refer to the social spaces created by the people themselves through collective action, usually in the form of social mobilisation to confront the state (Cornwall, 2002; Miraftab, 2004; Mohanty, 2007: 81; Piper, 2010; Kateshumbwa, 2013: 16). This second category of citizen engagement with the state typically occurs when the invited spaces for participation are failing to fulfil their objectives and frustrated people create their own platforms to express their views and wants.

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2.4.3 Equity

Although decentralisation has been championed by academics and practitioners as a strategy for achieving improved efficiency, responsiveness to local needs, and accountability, very few scholars have claimed that it is likely to lead to improved equity in the delivery of public services (Bossert et al., 2003). Conversely, many scholars have argued that centralized systems are more effective in redistributing resources in favour of poorer areas and poor people. It has also been argued that local governments may not have the incentive to pursue redistribution in their jurisdictions unless compelled to do so by the central government through the imposition of inclusive local political processes or centrally determined targeted interventions and conditional transfers (Smoke, 2001:34). Linked to this is the argument that the redistribution of resources from wealthier to poorer areas should be the responsibility of central governments since local governments are constrained by their internal resources (Smoke, 2003: 9). A further concern in the literature is that local governments are frequently prone to elite capture and that, in such situations, local control and local financing of service delivery will disadvantage poor communities if targeted interventions are not specifically designed by the central government to address the needs of poor people (Bossert et al., 2003; World Bank, 2004).

2.4.4 Development and/or poverty reduction

Apart from delivering basic public services, decentralised local governments are also seen to contribute to local socio-economic development. Through the provision of supportive production and distribution services, such as the provision of extension services to local firms and entrepreneurs and the creation of markets for local contractors, it is believed that local governments can stimulate economic development in local communities. Devolved local governments can also promote local economic development by legislating and creating institutional environments supportive of economic growth (Nel & Binns, 2001; Agranoff & McGuire, 2004).

In theory, decentralisation impacts poverty by making heard the voice of the poor; by improving poor peoples’ access to public services; and by reducing their vulnerability (Jütting et al., 2005). The decentralisation of power facilitates the creation of democratic institutions that encourage poor people to actively participate in decision-making and lobby for a better quality of life (Parker, 1995; Jütting et al., 2005). Due to their proximity to the people, as previously intimated, local government institutions gain insight into the

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needs of different communities and are able to match local needs and services by proper targeting (Jütting et al., 2005). In that regard, Von Braun and Grote (2000) maintain, under the right circumstances decentralisation can benefit the poor.

However, since there are multiple factors which influence local development, including macro-economic and institutional conditions over which local governments have limited control, it is evident that devolution, of itself, is a necessary but insufficient condition for local development and poverty reduction (World Bank, 2000b). In many developing states this fact has been used to justify rigid central government control over local government. It is also evident in the introduction of de-concentrated administrative programmes, so often sponsored by multilateral and bilateral donors under the banner of poverty reduction and the attainment of millennium development goals.