An evaluation of three decades of health system decentralisation in Oman

Background: In 1990, the Omani Ministry of Health initiated a decentralisation of its health system, transferring authority to the regional health administrations, in line with the global drive to improve the efficiency, equity, accessibility, and quality of health service delivery. Aim: To evaluate health system decentralisation in Oman over the past 30 years, including its strengths, weaknesses and areas for improvement. Methods: We reviewed reports, ministerial decrees, legislations and other documents relating to the health system decentralisation policy in Oman and interviewed 35 key informants among those responsible for its implementation. This review was guided by the health systems framework of the World Health Organization, which focuses on leadership, governance, finance, service delivery, workforce, information, and medical products. Results: Respondents expressed varying levels of satisfaction with the decentralisation across the health system. They said decentralisation has helped improve service quality, timing of procedures, resource management, and responsiveness to community needs. They highlighted the need to evaluate the current model and improve it, expand delegation of authority, strengthen legal and accountability frameworks, invest in leadership development, restructure in accordance with the decentralisation principles, and improve communication and use of technology. Conclusion: Our findings show that decentralisation has helped improve health care at the hospital level in Oman, particularly service delivery and governance. Strengthening leadership skills of health workers and managers, clarifying roles, and improving accountability would help make the system more responsive and more efficient.