The objective of this study was to examine whether decentralization has improved health system performance in the State of Ceará, north-east Brazil. A survey across 45 local (município) health systems collected data on performance and formal organization, including decentralization, informal management and local political culture. The indicators for informal management and local political culture were based on prior ethnographic research. Data were analysed using analysis of variance, Duncan's post-hoc test and multiple regression.
Bulletin of the World Health Organization, 2004, 82(11), 811-890 pp.