There seems to be no ending to debates on how and what central governments should or should not decentralize. The question seems to revolve around what to decentralize and how to decentralize. We have over the recent past seen government centralize some of the basic services that were under the mandate of local governments such as water, local policing, and health services and to some extent primary education services. I have in the past argued that this was not a productive move within the context of global trends and more importantly the efficiency and effectiveness of service delivery by government. I still argue that centralization in the manner we have undertaken it is counterproductive and defeats the whole purpose of government efficiency and effectiveness. A few incidents may seem to support this viewpoint.
It was recently reported that a senior official of the Ministry of Health did intimate that centralization of health services may not have been the best move after all, given the myriad of operational and logistical problems currently facing the ministry as it tries to deliver health services to the nation. This is a telling submission coming from the ministry that daily faces difficult operational scenes at it tries to keep the country healthy in all respects.
One would assume that this assertion by the ministry executive is a results of reports coming from various health units, especially in the rural areas, about the effects of the centralization processes. Globally, health services have always been one of the most decentralized services whose execution and delivery is a key function of local governments. What has differed has been what aspects of health remain with the central governments and what are dispersed to the local governments. In general terms though central governments retained the broader policy direction role and this is more visibly in unitary states such as ours, although by centralizing we have somewhat digressed in that role. In those countries with more meaningful decentralization commitment and processes, local governments do also deal with policy initiation aspects of the health services, especially those that may be peculiar to their localities.
The second incidents pertains to reports that the Francistown City Council recently argued for decentralization with more devolved powers to address what are reported to be cries from members of the public on the quality and range of health services rendered to them by the central government. I her address to the full council the City Mayor is reported to have deplored the current problems facing health delivery systems and amongst those mentioned were; shortage of doctors especially at clinics that used to be under the local governments, shortage of drugs that have seemingly further deteriorated since the centralization move and lack of transport, particularly ambulances.
These problems are directly linked to the centralization process as it has undermined the operational dictates such as the management of the fleet of health vehicles and ambulances acquired from local governments. It is a process that has also not coped with the volume of resources that were now shifted to the central government and capacity wise the ministry was never ready for such wholesale changes. Amongst the resources to be managed are pool of houses, a large human resource of various health experts in the different categories, buildings such as clinics of different categories, health posts and mobile health stops. The daily operational demands of services rendered at all these cannot be easily transitioned to central government nor at any time can these effective and efficiently delivery by the central ministry without the direct involvement of districts and town councils.
It is visible that cries by citizens of Francistown to bring back services to districts is a national cry and reports that the ministry of health has recently destroyed expired medicines/drugs valued at around P60 million is in itself pointing to a very inefficient delivery system where these drugs and medicines cannot be transported on time to health facilities where they are so desperately needed by the sick and ailing citizens who visit these health facilities only to be told the drugs prescribed are not available.  A health system that has local governments directly responsible, capacitated and authorized to handle operational and logistical matters on how best to deliver health services can do much better and is what this country should be looking. Incidentally, it could be very helpful to review and evaluate the effects of the centralization process at a national level because I am convinced that such a process will point in one direction and that is the need to devolve more roles, powers and associated authority to councils for a better and effective delivery of health services.
Lastly, a week ago the Ministry of Local Government hosted a conference for the Commonwealth Local Government Forum that was to specifically dialogue on how local governments can continue to play their full part in the development process. This was crafted to look and identify a space for meaningful participation by local governments in shaping the lives of about 2.2 billion people within the Commonwealth landscape. Amongst the focus of the conference was to explore the potential to improve the vibrancy of local governance as a key factor in making both national and global governance an embodiment of grassroots citizen participation.
It was also envisage that a thorough assessment of the type and role of local governments as sustainable entities that are able to harness and direct governments’ efforts in effective service delivery. This included dialogue on necessary strategies for local governments that are truly inclusive of citizens in their varied forms and more importantly local governments that are resilient and sustainable with regard to their ability to mobilize, consolidate and invest in resources that are capable of high returns, especially the aspect of generating reliable revenue sources. These would be revenue sources that greatly reduces the dependence on central government grants and transfers by local governments and revenues that can fully fund the budgetary needs of the local governments.
All these are in my view trends that suggests that any form of centralization is antithetical to the values and intentions of this mode of decentralization. We need to walk the talk when it comes to commitment to the how and what to decentralize to our districts, city and town councils, surely centralization is not the answer to a more effective and robust service delivery system, it can only constipate the central government machinery.    
*Molaodi teaches Public Administration at the university of Botswana
