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Decentralisation and government provision of public goods: The public health sector in Uganda

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  • John Akin
  • Paul Hutchinson
  • Koleman Strumpf

Abstract

While many developing countries have devolved health care responsibilities to local governments in recent years, no study has examined whether decentralisation actually leads to greater health sector allocative efficiency. This paper approaches this question by modeling local government budgeting decisions under decentralisation. The model leads to conclusions not all favourable to decentralisation and produces several testable hypotheses concerning local government spending choices. For a brief empirical test of the model we look at data from Uganda. The data are of a type seldom available to researchers-actual local government budgets for the health sector in a developing country. The health budgets are disaggregated into specific types of activities based on a subjective characterisation of each activity's 'publicness'. The empirical results provide preliminary evidence that local government health planners are allocating declining proportions of their budgets to public goods activities.

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Bibliographic Info

Article provided by Taylor & Francis Journals in its journal Journal of Development Studies.

Volume (Year): 41 (2005)
Issue (Month): 8 ()
Pages: 1417-1443

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Handle: RePEc:taf:jdevst:v:41:y:2005:i:8:p:1417-1443

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References

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  1. Pranab Bardhan & Dilip Mookherjee, 1998. "Expenditure Decentralization and the Delivery of Public Services in Developing Countries," Boston University - Institute for Economic Development 90, Boston University, Institute for Economic Development.
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Citations

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Cited by:
  1. Jean-Paul Faguet & Zulfiqar Ali, 2007. "A tale of two Upazilas : local governance and social development in Bangladesh," LSE Research Online Documents on Economics 2396, London School of Economics and Political Science, LSE Library.
  2. Emilie Caldeira, 2011. "Yardstick competition in a Federation: Theory and Evidence from China," Working Papers halshs-00552242, HAL.
  3. Paula Salinas & Albert Solé-Ollé, 2009. "Evaluating the effects of decentralization on educational outcomes in Spain," Working Papers 2009/10, Institut d'Economia de Barcelona (IEB).
  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. Karima Saleh, 2012. "World Bank study : A Health Sector in Transition to Universal Coverage in Ghana," World Bank Other Operational Studies 2728, The World Bank.
  6. Wielgosz, Benjamin & Mangheni, Margaret Najjingo & Tsegai, Daniel & Ringler, Claudia, 2012. "Malaria and agriculture: A global review of the literature with a focus on the application of integrated pest and vector management in East Africa and Uganda," IFPRI discussion papers 1232, International Food Policy Research Institute (IFPRI).
  7. Antón, José-Ignacio & Muñoz de Bustillo, Rafael & Fernández-Macías, Enrique & Rivera, Jesús, 2012. "Effects of health care decentralization in Spain from a citizens’ perspective," MPRA Paper 39423, University Library of Munich, Germany.
  8. Khaleghian, Peyvand & Gupta, Monica Das, 2005. "Public management and the essential public health functions," World Development, Elsevier, vol. 33(7), pages 1083-1099, July.
  9. Grégoire ROTA-GRAZIOSI & Emilie CALDEIRA & Martial FOUCAULT, 2010. "Decentralization in Africa and the nature of local governments' competition: evidence from Benin," Working Papers 201019, CERDI.
  10. Ahmad, Junaid & Devarajan, Shantayanan & Khemani, Stuti & Shah, Shekhar, 2005. "Decentralization and service delivery," Policy Research Working Paper Series 3603, The World Bank.
  11. Bernard F. Couttolenc, 2012. "Decentralization and Governance in the Ghana Health Sector," World Bank Publications, The World Bank, number 9376, October.
  12. Abdul Jalil, Ahmad Zafarullah, 2009. "Decentralization, Subnational Governments' Behaviour and Macroeconomic Instability: The Case of Malaysia," MPRA Paper 19071, University Library of Munich, Germany.
  13. Bashaasha, Bernard & Mangheni, Margaret Najjingo & Nkonya, Ephraim, 2011. "Decentralization and rural service delivery in Uganda:," IFPRI discussion papers 1063, International Food Policy Research Institute (IFPRI).
  14. Hai Zhong, 2010. "The impact of decentralization of health care administration on equity in health and health care in Canada," International Journal of Health Care Finance and Economics, Springer, vol. 10(3), pages 219-237, September.
  15. Dolores Jimenez & Peter C Smith, . "Decentralisation of health care and its impact on health outcomes," Discussion Papers 05/10, Department of Economics, University of York.
  16. Faguet, Jean-Paul & Ali, Zulfiqar, 2009. "Making Reform Work: Institutions, Dispositions, and the Improving Health of Bangladesh," World Development, Elsevier, vol. 37(1), pages 208-218, January.
  17. Khaleghian, Peyvand & Das Gupta Monica, 2004. "Public management and essential public health functions," Policy Research Working Paper Series 3220, The World Bank.
  18. André Martínez & Carolina Rodríguez-Zamora, 2011. "An Evaluation of the 1997 Fiscal Decentralization Reform in Mexico: The Case of the Health Sector," Working Papers 2011-16, Banco de México.
  19. José-Ignacio Antón & Rafael Muñoz de Bustillo & Enrique Fernández Macías & Jesús Rivera, 2014. "Effects of health care decentralization in Spain from a citizens’ perspective," The European Journal of Health Economics, Springer, vol. 15(4), pages 411-431, May.
  20. Khaleghian, Peyvand, 2003. "Decentralization and public services : the case of immunization," Policy Research Working Paper Series 2989, The World Bank.

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