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Enhanced Health care services address not only one of the key Sustainable Development Goals (SDG) which is goal No 3, but also the development strategies for most developing countries. Good governance is critical to improving health care systems. Many developing countries therefore have decentralized health care systems as a way of improving good governance and as a means of attaining improved access to and delivering quality health care services to both urban and rural population. Decentralization involves the extent of planning, management and decision making from national to lower levels of government. From the 1990s the capacity of governments in developing countries to deliver public goods and services was stretched to the extent there was dire for partnerships. The Public Private Partnerships (PPP) therefore became fundamental in the provision of health services under decentralization. The nature of PPP differed from country to country and the level of decision making within each level of government. The paper has discussed the extent to which decentralized governance has facilitated the management of health care systems in the urban centres through Public Private Partnership initiatives, by conducting a comparative case study analysis of existing literature on urban health care systems under different forms of decentralized governance in Kenya, Uganda, Ghana and India, respectively. The study established that access to health care services differed with forms of decentralization. Secondly, there were more public private partnerships in devolved governments which also registered higher improvement in access to health care services in urban centres. The paper concluded that the more the involvement of public private partnership, the better health care services in terms of access was noted.

Decentralized Governance in the Management of Urban Health Care Systems in Developing Countries