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Decentralization and public services: the case of immunization

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  • Khaleghian, Peyvand

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.

Suggested Citation

  • Khaleghian, Peyvand, 2004. "Decentralization and public services: the case of immunization," Social Science & Medicine, Elsevier, vol. 59(1), pages 163-183, July.
    • Handle: RePEc:eee:socmed:v:59:y:2004:i:1:p:163-183
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    Citations

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    Cited by:

    1. Youngju Kang & Wonhyuk Cho & Kwangho Jung, 2012. "Does Decentralization Matter in Health Outcomes? Evidence from 22 OECD Unbalanced Panel Data for 1995–2005," International Review of Public Administration, Taylor & Francis Journals, vol. 17(1), pages 1-32, April.
    2. Vargas Bustamante, Arturo, 2010. "The tradeoff between centralized and decentralized health services: Evidence from rural areas in Mexico," Social Science & Medicine, Elsevier, vol. 71(5), pages 925-934, September.
    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. Feldhaus, Isabelle & Chatterjee, Susmita & Clarke-Deelder, Emma & Brenzel, Logan & Resch, Stephen & Bossert, Thomas J., 2023. "Examining decentralization and managerial decision making for child immunization program performance in India," Social Science & Medicine, Elsevier, vol. 317(C).
    5. Manzoor Ahmed & Abdul Qayyum, 2023. "Decentralisation’s Effects on Health: Theory and Evidence from Balochistan, Pakistan," The Pakistan Development Review, Pakistan Institute of Development Economics, vol. 62(3), pages 331-356.
    6. Kis-Katos, Krisztina & Sjahrir, Bambang Suharnoko, 2017. "The impact of fiscal and political decentralization on local public investment in Indonesia," Journal of Comparative Economics, Elsevier, vol. 45(2), pages 344-365.
    7. 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.
    8. Jiménez-Rubio, Dolores & García-Gómez, Pilar, 2017. "Decentralization of health care systems and health outcomes: Evidence from a natural experiment," Social Science & Medicine, Elsevier, vol. 188(C), pages 69-81.
    9. repec:agg:journl:1535 is not listed on IDEAS
    10. Sarah Shair-Rosenfield, 2022. "Decentralization, intergovernmental coordination, and emergency response in East and Southeast Asia: lessons from combatting the COVID-19 pandemic," Working Papers. Collection A: Public economics, governance and decentralization 2209, Universidade de Vigo, GEN - Governance and Economics research Network.
    11. Antonio Nuzzo & Flavia Carle & Eugenio Anessi Pessina, 2018. "Processo di decentramento del SSN ed evoluzione dell?equit? interregionale nell?assistenza sanitaria nel periodo 2001-2012," MECOSAN, FrancoAngeli Editore, vol. 2018(108), pages 9-34.
    12. Britteon, Philip & Fatimah, Alfariany & Gillibrand, Stephanie & Lau, Yiu-Shing & Anselmi, Laura & Wilson, Paul & Sutton, Matt & Turner, Alex J., 2024. "The impact of devolution on local health systems: Evidence from Greater Manchester, England," Social Science & Medicine, Elsevier, vol. 348(C).
    13. Khaleghian, Peyvand & Gupta, Monica Das, 2005. "Public management and the essential public health functions," World Development, Elsevier, vol. 33(7), pages 1083-1099, July.
    14. Bossert, Thomas John & Mitchell, Andrew David, 2011. "Health sector decentralization and local decision-making: Decision space, institutional capacities and accountability in Pakistan," Social Science & Medicine, Elsevier, vol. 72(1), pages 39-48, January.
    15. Resnick, Danielle, 2018. "The devolution revolution: Implications for agricultural service delivery in Ghana:," IFPRI discussion papers 1714, International Food Policy Research Institute (IFPRI).
    16. World Bank, 2008. "Serbia : Decentralization and Local Service Delivery," World Bank Publications - Reports 8099, The World Bank Group.
    17. 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.
    18. Smith, Robert William & Jarvis, Tamika & Sandhu, Harman Singh & Pinto, Andrew D. & O'Neill, Meghan & Di Ruggiero, Erica & Pawa, Jasmine & Rosella, Laura & Allin, Sara, 2023. "Centralization and integration of public health systems: Perspectives of public health leaders on factors facilitating and impeding COVID-19 responses in three Canadian provinces," Health Policy, Elsevier, vol. 127(C), pages 19-28.
    19. Cavalieri, Marina & Ferrante, Livio, 2016. "Does fiscal decentralization improve health outcomes? Evidence from infant mortality in Italy," Social Science & Medicine, Elsevier, vol. 164(C), pages 74-88.
    20. Sanghita Bhattacharyya & Anns Issac & Bhushan Girase & Mayukhmala Guha & Joanna Schellenberg & Bilal Iqbal Avan, 2020. "“There Is No Link Between Resource Allocation and Use of Local Data”: A Qualitative Study of District-Based Health Decision-Making in West Bengal, India," IJERPH, MDPI, vol. 17(21), pages 1-14, November.
    21. 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.
    22. Liangliang Liu & Donghong Ding & Jun He, 2019. "The welfare effects of fiscal decentralization: a simple model and evidence from China," Quality & Quantity: International Journal of Methodology, Springer, vol. 53(1), pages 417-434, January.
    23. repec:agg:journl:3587 is not listed on IDEAS
    24. 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.
    25. Shun‐ichiro Bessho & Yoko Ibuka, 2019. "Interdependency in vaccination policies among Japanese municipalities," Health Economics, John Wiley & Sons, Ltd., vol. 28(2), pages 299-310, February.

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