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Decentralization has been associated traditionally with participation and empowerment in local decision-making. This study of four cases analyzed the role of local health boards in enhancing community participation and empowerment under a decentralized system in the Philippines. Local government units (LGUs) with functioning local health boards were compared with LGUs whose health boards were not meeting regularly as mandated by law. The study found that there were more consultations with the community, fund-raising activities, health initiatives and higher per capita health expenditure in LGUs with functioning local health boards. Only the mayors and municipal health officers felt empowered by devolution. In general, awareness of devolution and their potential roles in health decision-making was low among members of the community. These findings can be attributed to the socio-cultural and historical traditions of centralized governance with little popular participation, overall attitudes of the community and board members, perceptions of health as primarily a medical matter, economic circumstances of LGUs, and insufficient preparation for devolution. Recommendations are suggested in response to these findings.

Although developing countries can ill afford to make the wrong choice of technology, they usually find it difficult if not impossible to support an adequate technology assessment programme. Much of the available information on the efficacy of various products is valid for other countries, but factors such as epidemiology, cost-effectiveness and acceptability also have to be taken into account, and these vary considerably from one setting to another. There is therefore a strong case for developing national programmes as quickly as possible.