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Decentralization and equitable service delivery: Access and satisfaction under health sector governance reform

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  • Zarychta, Alan
  • Bermudez Tapia, Bertha
  • Root, Elisabeth Dowling
  • Freake, Dominic
  • Grillos, Tara
  • Andersson, Krister
  • Menken, Jane

Abstract

Administrative reforms implemented in the Global South are often designed to improve health service delivery for rural communities. Decentralization is one of the most popular strategies, with contemporary versions combining devolution and performance-based management. Our study draws on the experience of health sector reform in Honduras where the government decentralized health service delivery in a third of its municipalities.

Suggested Citation

  • Zarychta, Alan & Bermudez Tapia, Bertha & Root, Elisabeth Dowling & Freake, Dominic & Grillos, Tara & Andersson, Krister & Menken, Jane, 2026. "Decentralization and equitable service delivery: Access and satisfaction under health sector governance reform," Social Science & Medicine, Elsevier, vol. 388(C).
    • Handle: RePEc:eee:socmed:v:388:y:2026:i:c:s0277953625010810
    DOI: 10.1016/j.socscimed.2025.118750
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    References listed on IDEAS

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    1. Christian Lessmann, 2012. "Regional Inequality and Decentralization: An Empirical Analysis," Environment and Planning A, , vol. 44(6), pages 1363-1388, June.
    2. Anila Channa & Jean-Paul Faguet, 2016. "Decentralization of Health and Education in Developing Countries: A Quality-Adjusted Review of the Empirical Literature," The World Bank Research Observer, World Bank, vol. 31(2), pages 199-241.
    3. Daniel Cobos Muñoz & Paloma Merino Amador & Laura Monzon Llamas & David Martinez Hernandez & Juana Maria Santos Sancho, 2017. "Decentralization of health systems in low and middle income countries: a systematic review," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 62(2), pages 219-229, March.
    4. Christian Lessmann, 2012. "Regional inequality and decentralization: an empirical analysis," Environment and Planning A, Pion Ltd, London, vol. 44(6), pages 1363-1388, June.
    5. Braveman, Paula & Tarimo, Eleuther, 2002. "Social inequalities in health within countries: not only an issue for affluent nations," Social Science & Medicine, Elsevier, vol. 54(11), pages 1621-1635, June.
    6. Kruk, Margaret Elizabeth & Freedman, Lynn P., 2008. "Assessing health system performance in developing countries: A review of the literature," Health Policy, Elsevier, vol. 85(3), pages 263-276, March.
    7. Zarychta, Alan, 2020. "Making social services work better for the poor: Evidence from a natural experiment with health sector decentralization in Honduras," World Development, Elsevier, vol. 133(C).
    8. Faguet, Jean-Paul, 2014. "Decentralization and Governance," World Development, Elsevier, vol. 53(C), pages 2-13.
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