¹The author is the Director of Research at The Center for Health and Gender Equity (CHANGE), Takoma Park, MD, 20912. CHANGE is a donor accountability organization that seeks to ensure that US international policies and programs promote sexual and reproductive rights and health through effective, evidence-based approaches to prevention and treatment of critical reproductive and sexual health concerns, and through increased funding for critical programs.

Abstract

Priya Nanda argues that the distance of local health care providers from decision making mean that reforms fail to ensure that local care givers can be effective agents of change. Decentralization has failed to move power from the centre to community representatives, especially women, and health care workers. She argues that core health needs, particularly of women should be visualized at the centre of concentric circles of power in order for decentralization to transfer power to community health care workers.