02161nas a2200337   4500000000100000008004100001260001300042653001100055653001300066653003300079653001100112653002300123653001100146653001200157653002100169653000900190653002900199653003700228653001800265653001300283653002000296100001100316700001600327245010400343856005100447300001000498490000700508050003200515520126200547022001401809       2004                            d  c2004 Mar10aBrazil10aColombia10aCommunicable Disease Control10aFemale10aHealth Care Reform10aHumans10aleprosy10aLocal Government10aMale10aNational Health Programs10aOutcome Assessment (Health Care)10aPolicy Making10aPolitics10aRisk Assessment1 aKalk A1 aFleischer K00aThe decentralization of the health system in Colombia and Brazil and its impact on leprosy control.  uhttps://leprosyreview.org/article/75/1/06-7078  a67-780 v75  aInfolep Library - available3 a<p>Decentralization policies are an integrated component of health sector reform in an increasing number of countries. The ability of such policies to improve the health system's quality and efficiency is backed up by limited scientific evidence. This study intends to evaluate the impact of decentralization on a specialized field of disease control (leprosy control) in Colombia and Brazil. It analyses the respective juridical base, epidemiological indicators and local publications. Furthermore, 39 semi-structured interviews with key informants were conducted. In both countries, the devolution of technical responsibility and financial resources to the municipalities was the implemented form of decentralization. Access to preventive and curative health care and the community participation in decision-making improved clearly only in Brazil. The decentralization to private providers in Colombia had dubious effects on service quality in general and still more on public health. The flow of finances (including finance collection through state-owned taxes instead of insurance companies) seemed to be better controlled in Brazil. Leprosy control in Brazil took advantage of the decentralization process; in Colombia, it came close to a collapse.</p>  a0305-7518