Decentralization and public services : the case of immunization
AbstractThe author studies the impact of political decentralization on childhood immunization, an essential public service provided in almost all countries. He examines the relationship empirically using a time-series data set of 140 low- and middle-income countries from 1980 to 1997. The author 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 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. The author discusses reasons for the difference between low- and middle-income countries.
Download InfoIf you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
Bibliographic InfoPaper provided by The World Bank in its series Policy Research Working Paper Series with number 2989.
Date of creation: 31 Mar 2003
Date of revision:
Public Health Promotion; Banks&Banking Reform; Health Monitoring&Evaluation; Decentralization; Municipal Financial Management; National Governance; Banks&Banking Reform; Municipal Financial Management; Health Monitoring&Evaluation; Governance Indicators;
This paper has been announced in the following NEP Reports:
- NEP-ALL-2004-08-16 (All new papers)
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Collins, Charles & Araujo, Jose & Barbosa, Jarbas, 2000. "Decentralising the health sector: issues in Brazil," Health Policy, Elsevier, vol. 52(2), pages 113-127, June.
- Prud'homme, Remy, 1995. "The Dangers of Decentralization," World Bank Research Observer, World Bank Group, vol. 10(2), pages 201-20, August.
- Gilson, Lucy & Mills, Anne, 1995. "Health sector reforms in sub-Saharan Africa: lessons of the last 10 years," Health Policy, Elsevier, vol. 32(1-3), pages 215-243.
- Tendler, Judith & Freedheim, Sara, 1994. "Trust in a rent-seeking world: Health and government transformed in Northeast Brazil," World Development, Elsevier, vol. 22(12), pages 1771-1791, December.
- Rafael LaPorta & Florencio Lopez-de-Silanes & Andrei Shleifer & Robert Vishny, .
"The Quality of Government,"
19452, Harvard University OpenScholar.
- Andrei Shleifer & Robert W. Vishny, 1998. "The Quality of Government," Harvard Institute of Economic Research Working Papers 1847, Harvard - Institute of Economic Research.
- Rafael La Porta & Florencio Lopez-de-Silanes & Andrei Shleifer & Robert Vishny, 1998. "The Quality of Goverment," NBER Working Papers 6727, National Bureau of Economic Research, Inc.
- Brinkerhoff, Derick W., 2000. "Democratic Governance and Sectoral Policy Reform: Tracing Linkages and Exploring Synergies," World Development, Elsevier, vol. 28(4), pages 601-615, April.
- Ebel, Robert D. & Yilmaz, Serdar, 2002. "On the measurement and impact of fiscal decentralization," Policy Research Working Paper Series 2809, The World Bank.
- Dilip Mookherjee, 2001. "Combating the Crisis in Government Accountability: A Review of Recent International Experience," Boston University - Department of Economics - The Institute for Economic Development Working Papers Series dp-117, Boston University - Department of Economics.
- Beck, Thorsten & Clarke, George & Groff, Alberto & Keefer, Philip & Walsh, Patrick, 2000. "New tools and new tests in comparative political economy - the database of political institutions," Policy Research Working Paper Series 2283, The World Bank.
- Gauri, Varun & Khaleghian, Peyvand, 2002.
"Immunization in developing countries : its political and organizational determinants,"
Policy Research Working Paper Series
2769, The World Bank.
- Gauri, Varun & Khaleghian, Peyvand, 2002. "Immunization in Developing Countries: Its Political and Organizational Determinants," World Development, Elsevier, vol. 30(12), pages 2109-2132, December.
- Robalino, David A. & Picazo, Oscar F. & Voetberg, Albertus, 2001. "Does fiscal decentralization improve health outcomes? - evidence from a cross-country analysis," Policy Research Working Paper Series 2565, The World Bank.
- Jonathan Isham & Satu Kahkonen, 2002. "Institutional Determinants of the Impact Community-Based Water Services: Evidence from Sri Lanka and India," Middlebury College Working Paper Series 0220, Middlebury College, Department of Economics.
- John Akin & Paul Hutchinson & Koleman Strumpf, 2005. "Decentralisation and government provision of public goods: The public health sector in Uganda," Journal of Development Studies, Taylor & Francis Journals, vol. 41(8), pages 1417-1443.
- 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.
- Campos-Outcalt, Doug & Kewa, Kelly & Thomason, Jane, 1995. "Decentralization of health services in Western Highlands Province, Papua New Guinea: An attempt to administer health service at the subdistrict level," Social Science & Medicine, Elsevier, vol. 40(8), pages 1091-1098, April.
- Faguet, Jean-Paul, 2001. "Does decentralization increase responsiveness to local needs? - evidence from Bolivia," Policy Research Working Paper Series 2516, The World Bank.
- Khaleghian, Peyvand & Das Gupta Monica, 2004. "Public management and essential public health functions," Policy Research Working Paper Series 3220, The World Bank.
- Llanto, Gilberto M. & Kelekar, Uma, 2013. "Perspectives on Health Decentralization and Interjurisdictional Competition among Local Governments in the Philippines," Discussion Papers DP 2013-20, Philippine Institute for Development Studies.
- World Bank, 2008. "Immunization Resource Tracking Exercise : Case Study on the Republic of Tajikistan," World Bank Other Operational Studies 8116, The World Bank.
- Antonis Adam & Manthos D. Delis & Pantelis Kammas, 2008.
"Fiscal Decentralization and Public Sector Efficiency: Evidence from OECD Countries,"
CESifo Working Paper Series
2364, CESifo Group Munich.
- Adam, Antonis & Delis, Manthos D & Kammas, Pantelis, 2012. "Fiscal decentralization and public sector efficiency: Evidence from OECD countries," MPRA Paper 36889, University Library of Munich, Germany.
- 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.
- Independent Evaluation Group, 2008. "Decentralization in Client Countries : An Evaluation of World Bank Support, 1990-2007," World Bank Publications, The World Bank, number 6543, March.
- Axel Dreher, 2006. "Power to the People? The Impact of Decentralization on Governance," KOF Working papers 06-121, KOF Swiss Economic Institute, ETH Zurich.
- Andreas Kyriacou & Oriol Roca sagalés, 2009. "Fiscal descentralization and the quality of government: evidence from panel data," Hacienda Pública Española, IEF, vol. 189(2), pages 131-155, June.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Roula I. Yazigi).
If references are entirely missing, you can add them using this form.