Improving Health System Performance in a Decentralized Health System: Capacity Building in Pakistan.

-Key policy questions on decentralization in health relate to whether and in which ways health sector decentralization can improve health outcomes. Focusing on a maternal, neonatal, and child health program in Pakistan, this study examines relationships between three dimensions of decentralization: the degree of local decision-making choice ("decision space"), individual and institutional capacities, and local accountability. Additionally, these relationships are examined at two points in time to assess whether "capacity building" interventions, as well as any changes in decision space, are related to improvements in health sector performance as measured by improved administrative processes and indicators of health coverage in important primary care services.

Health sector decentralization and local decision-making: Decision space, institutional capacities and accountability in Pakistan.

Health sector decentralization has been widely adopted to improve delivery of health services. While many argue that institutional capacities and mechanisms of accountability required to transform decentralized decision-making into improvements in local health systems are lacking, few empirical studies exist which measure or relate together these concepts. Based on research instruments administered to a sample of 91 health sector decision-makers in 17 districts of Pakistan, this study analyzes relationships between three dimensions of decentralization: decentralized authority (referred to as "decision space"), institutional capacities, and accountability to local officials.

Measuring dimensions of social capital: evidence from surveys in poor communities in Nicaragua.

A dominant perspective in social capital research emphasizes a "structural" dimension of social capital, consisting of network connections, and a "cognitive" dimension, consisting of attitudes toward trust. Correspondingly, membership in organizations (i.e.