Table 1. Assessment of Decision Space in the Decentralised Health System .

Function area	Level of Decision Space
	Narrow	Moderate	Wide
Planning/budgeting/allocation of funds
• Local involvement in planning	District health managers mainly refer to central planning norms/targets	District health managers make some local-level adaptations to central planning norms/targets	District health managers mainly include locally defined strategies and targets
• Preparation of regular budget	Budget line items conform mainly to central norms	Local revisions made to budget line items but most allocative decisions made by higher authorities	Local revisions made to budget line items with minimal revisions made by higher authorities
• Allocation and use of funds	The central government mainly set/modify/allocate all funds	District health managers set/modify/allocate some funds	District health managers mainly set/modify/allocate funds
Human resources
• Management of human resources	All HRM functions handled centrally for permanent staff; no ability to contract non-permanent staff	Some HRM functions handled locally for permanent staff (eg, posting, promotion, incentive payment); ability to contract some cadres of non-permanent staff	Most/all functions handled locally (including salary levels); ability to contract most/all cadres of non-permanent staff
Medicine and medical supplies	All medicine and medical supplies procured centrally	Some medicine and medical supplies procured locally	District health managers mainly procure medicine and medical supplies
Governance and community participation	All governance functions are determined and handled centrally	Some governance functions are determined and handled at the district level	Most governance functions are determined and handled at the district level

Abbreviation: HRM, human resource management.

Source: Modified from Bossert et al.⁹