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Decentralization and public services: the case of immunization

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  • Khaleghian, Peyvand
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    Abstract

    This study examines the impact of political decentralization on an essential public service provided in almost all countries: childhood immunization. The relationship is examined empirically using a time-series data set of 140 low- and middle-income countries from 1980 to 1997. The study finds that decentralization has different effects in low- and middle-income countries. In the low-income group, decentralized countries have higher coverage rates than centralized ones, with an average difference of 8.5 percent for the measles and DTP3 vaccines. In the middle-income group, the reverse effect is observed: decentralized countries have lower coverage rates than centralized ones, with an average difference of 5.2 percent for the same vaccines. Both results are significant at the 99 percent level. Modifiers of the decentralization-immunization relationship also differ in the two groups. In the low-income group, development assistance reduces the gains from decentralization. In the middle-income group, democratic government mitigates the negative effects of decentralization, and decentralization reverses the negative effects of ethnic tension and ethno-linguistic fractionalization, but institutional quality and literacy rates have no interactive effect either way. Similar results are obtained whether decentralization is measured with a dichotomous categorical variable or with more specific measures of fiscal decentralization. The study confirms predictions in the theoretical literature about the negative impact of local political control on services that have public goods characteristics and inter-jurisdictional externalities. Reasons for the difference between low- and middle-income countries are discussed.

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    Bibliographic Info

    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 59 (2004)
    Issue (Month): 1 (July)
    Pages: 163-183

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    Handle: RePEc:eee:socmed:v:59:y:2004:i:1:p:163-183

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    Keywords: Decentralization Immunization Public administration Health reform Developing countries Public health;

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    Cited by:
    1. Kis-Katos, Krisztina & Sjahrir, Bambang Suharnoko, 2014. "The Impact of Fiscal and Political Decentralization on Local Public Investments in Indonesia," IZA Discussion Papers 7884, Institute for the Study of Labor (IZA).
    2. Malesky, Edmund & Nguyen, Cuong & Tran, Anh, 2013. "The Impact of Recentralization on Public Services: A Difference-in-Differences Analysis of the Abolition of Elected Councils in Vietnam," MPRA Paper 54187, University Library of Munich, Germany.
    3. Jiménez-Rubio, Dolores, 2011. "The impact of fiscal decentralization on infant mortality rates: Evidence from OECD countries," Social Science & Medicine, Elsevier, vol. 73(9), pages 1401-1407.
    4. Anila Channa & Jean-Paul Faguet, 2012. "Decentralization of Health and Education in Developing Countries: A Quality-Adjusted Review of the Empirical Literature," STICERD - Economic Organisation and Public Policy Discussion Papers Series 038, Suntory and Toyota International Centres for Economics and Related Disciplines, LSE.
    5. World Bank, 2008. "Serbia : Decentralization and Local Service Delivery," World Bank Other Operational Studies 8099, The World Bank.
    6. Denis Drechsler & Johannes Jütting, 2005. "Is There a Role for Private Health Insurance in Developing Countries?," Discussion Papers of DIW Berlin 517, DIW Berlin, German Institute for Economic Research.
    7. Khaleghian, Peyvand & Gupta, Monica Das, 2005. "Public management and the essential public health functions," World Development, Elsevier, vol. 33(7), pages 1083-1099, July.

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