identified. The indicators used in this study could be
the basis of such a monitoring process.
Conclusion
The case study demonstrates that decentralisation
can give health service managers more control over
managing their staff. In some cases this may lead to
improved HR outcomes and ultimately better
health service provision. However, this is not always
the case and in fact decentralisation may actually
lead to worse health service provision through the
inappropriate use of HRM actions.
Several lessons for increasing the chances of
decentralisation leading to improved HRM and
better health service provisions can be derived from
this case study that will have relevance to other
parts of China and other countries. First, effective
capacity building is needed to prepare and support
managers for their new roles. Second, there needs to
be a general appreciation that decentralisation is not
a simple clear-cut intervention. Third, there are
many external influences that may affect choices of
HRM actions to the extent that they may not be
aligned with broader health service needs. And
fourth, in some situations—competition for labour
between devolved health institutions can exacerbate
inequities in health service provision.
Although HRM is usually part of a wider
package of managerial decentralisation, the consequences for HR outcomes need to be considered
before the policy is adopted. If subsequently it is
adopted, because of the unpredictability of decentralisation regular monitoring of the impact on HR
outcomes is needed and actions taken accordingly.
Only then will there be a chance that decentralisation brings overall improvements to human resource management in the health sector.
Acknowledgements
The study was funded by the UK Department for
International Development (ESCOR R7641). The
views expressed in this article are those of the
authors and do not necessarily reflect opinions or
policies of the UK government. Dr Baojun Pan
from the CDC in Fujian Province and Dr Qiyan
Chen from Women and Children’s Hospital in
Fujian province participated in the study design and
data collection and analysis. The authors would also
like to thank Dr Charles Collins and the two
anonymous referees for their comments on various
drafts.