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Looking at Canada, Brazil, Germany, Mexico, Nigeria, Pakistan, South Africa and Switzerland, Federalism and Decentralization in Health Care examines the overall organization of the health system.
Debating federalism in Canada.
This book is an outcome of the round table conference held in 1984 in Switzerland. It deals with decision of decentralization, structure of decentralized units, external power of decentralized unit, financial autonomy and decentralization and the protection of the basic rights.
This collection of essays assesses the efforts of African governments to constitutionalise decentralisation, be it in the form of federalism, local government or traditional authorities. Since the end of the Cold War jurisdictions across Africa have witnessed an ostensible return to multi-party democracy within the paradigm of constitutionalism and the rule of law. Linked to the democratisation process, many countries took steps to decentralize power by departing from the heavily centralized systems inherited from colonial regimes. The centralization of power, typically characterized by the personalization and concentration of power in the hands of leaders and privileged elites in capital cities, mostly resulted in repressive regimes and fragile states. As decentralisation is a response to these challenges, this volume analyses the dynamic relationship between the efforts to implement decentralization and presence or absence of constitutionalism. This volume examines a variety of forms and degrees of decentralization found across Africa. It advances a new understanding of trends and patterns and facilitates the exchange of ideas among African governments and scholars about the critical role that decentralisation may play in democratization of and constitutionalism in Africa.
The book investigates why a country facing issues that needed to be tackled nationwide chose to decentralize when it moved from authoritarianism to democracy. It discusses the events of the Brazilian constituent assembly and investigates the results of decentralization at the subnational sphere. The results suggest that there was a lack of social consensus on what was to be achieved by decentralization. They suggest that political and economic factors influence the outcomes of decentralization, thus exposing the limits of decentralization on policy results.
While health system decentralization is often associated with federations, there has been limited study on the connection between federalism and the organization of publicly financed or mandated health services. Federalism and Decentralization in Health Care examines eight federations that differ in terms of their geography, history and constitutional and political development. Looking at Canada, Brazil, Germany, Mexico, Nigeria, Pakistan, South Africa and Switzerland, Federalism and Decentralization in Health Care examines constitutional responsibility for health care, the national laws establishing a right to health care, the predominant sources and organization of public revenues directed to health care, and the overall organization of the health system. In additional to these structural features, each country case study is subjected to a "decision space analysis" to determine the actual degree of health system decentralization. This involves determining whether national and subnational governments have narrow, moderate or broad discretion in their decisions on governance, access, human resources, health system organization and financing. This comparative approach highlights the similarities and differences among these federations. Offering reflections on recent trends in centralization or decentralizations for the health system as a whole, Federalism and Decentralization in Health Care, is a valuable resource for those studying health care policy in federal systems and especially those interested in comparative aspects of the topic.
Master's Thesis from the year 2015 in the subject Business economics - Economic Policy, grade: -, , language: English, abstract: A large number of countries are trying to improve their ability to serve their inhabitants more efficiently and more effectively. To accomplish this ambition, a reawakening of interest in the practices and in the principles and of fiscal federalism is mandatory. Questions arise such as: - How many taxes are necessary to provide an efficient amount of local public goods? - How should the taxes be allocated most reasonable between the different levels of governments? - Which level of government should have how much freedom of choice concerning tax revenues and tax expenditures, or differently, which degree of decentralisation is most constructive? Generally, two conflicting possibilities to provide an efficient level of local public goods are existing: The first one proposes a high degree of centralisation of the tax system which would lead, if the government is totally benevolent, to an efficient output of local public goods. An argument against centralisation is that a centralised system cannot serve the different needs and preferences of the inhabitants of unequal regions. The second perception states that an efficient level of local public can be provided if the system is decentralised. A possible disadvantage of decentralisation is the appearance of tax competition which may lead to an inefficient low level of local public goods. The discrepancy between these two conflictive systems is going to be discussed in this thesis. Furthermore, politico-economic mechanisms, which are supposed to explain the correlation between degree of centralisation and size of government are introduced which leads to the research question of this thesis: Does a decentralised tax system lead to a smaller size of government compared to a centralised tax system? Which politico-economic mechanisms are responsible for this correlation? In relation to these questions, different approaches are discussed, underlined by theoretical and empirical models. The first one, a public choice approach, states that central governments operate like monopolists, or leviathans, extracting as much tax revenues from the citizens as possible. The aim is not to maximise social welfare, but to increase their control over the resources of the economy. This approach was formulated by Brennan’s and Buchnan’s Leviathan hypothesis (1980), stating, subject to the above mentioned conditions, that a higher degree of decentralisation leads to a smaller size of government. [...]
This is the first book to examine the processes of territorial federalization and decentralization of health systems in Europe drawing from an interdisciplinary economics, public policy and political science approach. It contains key theoretical and empirical features that allow an understanding of when health care decentralization is successful.
Fiscal Federalism 2022 surveys recent trends and policies in intergovernmental fiscal relations and subnational government. Accessible and easy-to-read chapters provide insight into: good practices in fiscal federalism; the design of fiscal equalisation systems; measuring subnational tax and spending autonomy; promoting public sector performance across levels of government; digitalisation challenges and opportunities; the role of subnational accounting and insolvency frameworks; funding and financing of local government public investment; and early lessons from the COVID-19 crisis for intergovernmental fiscal relations.
The 1990s were marked by democratic reforms throughout Africa, which went in tandem with decentralization reforms. The chapters of the volume all highlight the gradual changes that have taken place since. Long-term structural uncodified factors – be it societal, economic, geographic, demographic – seem to have interacted with the constitutional clauses introduced during the reforms. Some chapters look at how decentralization slowly gave way to recentralization because none of the new subnational entities were politically and economically strong enough to balance off the center; some look at how inherent deficiencies in infrastructure and personnel at the subnational level brought the central government back in; some look at how different subnational units ended up working differently due to differences in demographic and social factors; some look at how uncodified factors came to determine how national politics functioned; some look at how decentralization created new conflicts between ethnic groups competing for the control of the new entities; some look at how decentralization blew new life into traditional authorities. This book was original published as a special issue of Regional and Federal Studies.