While there is considerable documented experience of decentralising health services in rural areas of developing countries, the decentralisation of health services in the urban context is rarely analysed. Urban development literature usually fails to address health issues, while the literature on the decentralisation of health services tends to ignore the urban sector. This article addresses the relationship between a Ministry of Health and a City Council, and identifies key issues to consider in the decentralisation of urban health activities: roles and responsibilities; legislation; coordination and communication; and resource constraints. The case-study from Maseru, Lesotho, highlights aspects of planning which need to be considered by national and local governments which are trying to strengthen urban health activities by decentralisation.
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