Paper short abstract:

This paper discusses local health officials' decision-making space and room to manoeuvre in public emergencies. Insights from Rwanda and Ghana help analyze local autonomy, a central promise in decentralization projects.

Paper long abstract:

This paper examines the decision autonomy of local health authorities in decentralized structures under public health emergencies. A dominant view is that local health agents in liberal regimes gain policing powers to derive and enforce pandemic containment measures while their counterparts in authoritarian systems face an even stricter decision space as top-down decision-making intensifies. The need for efficient governance structures to police containment measures regardless of the regime time is a helpful reconciliation point. Investment in efficiency-oriented projects (e.g., technology and expertise) ensure total central control but might create at once a leeway for autonomous action by local officials. With Covid-19 in focus, this preliminary analysis draws on data from district arenas in Rwanda and Ghana, two good examples of an efficient administration. The perspectives of local health officials are discussed, particularly their room to manoeuvre despite increasing restrictions on their decision spaces. Again as Covid-19 containment efforts opened up the local arenas to very different marginal actors and rationalities, the question of the effectiveness of the policies in Rwanda and Ghana is crucial. The cases divulge at least one instance of the latent consequences of state regulation of different local arenas.