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Decentralisation of governance and maternal healthcare utilisation: Evidence from India

Author

Listed:
  • Bharti Nandwani

    (Indira Gandhi Institute of Development Research)

  • Ishita Verma

    (Indira Gandhi Institute of Development Research)

Abstract

This paper examines the impact of a decentralisation program implemented in India's Schedule Five Areas - home to 100 million indigenous people (Scheduled Tribes, or STs) - on maternal healthcare utilisation. The program institutionalised local governance councils and introduced political reservations for STs, granting these councils formal authority over the provision of public goods and services. Using three rounds of a large-scale reproductive health data and a difference-in-differences strategy exploiting staggered program implementation, we find that the policy significantly increased the use of antenatal care services, particularly from government facilities. It also reduced delivery complications and increased reliance on public services for managing such complications. Evidence suggests that these improvements were driven by increased trust in the health system when political representatives belonged to the ST community. The findings highlight how decentralisation combined with political inclusion can improve public service utilisation and health outcomes among historically marginalised population.

Suggested Citation

  • Bharti Nandwani & Ishita Verma, 2025. "Decentralisation of governance and maternal healthcare utilisation: Evidence from India," Indira Gandhi Institute of Development Research, Mumbai Working Papers 2025-014, Indira Gandhi Institute of Development Research, Mumbai, India.
    • Handle: RePEc:ind:igiwpp:2025-014
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    References listed on IDEAS

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    1. Rohini Pande, 2003. "Can Mandated Political Representation Increase Policy Influence for Disadvantaged Minorities? Theory and Evidence from India," American Economic Review, American Economic Association, vol. 93(4), pages 1132-1151, September.
    2. Itishree Pradhan & Binayak Kandapan & Jalandhar Pradhan, 2022. "Uneven burden of multidimensional poverty in India: A caste based analysis," PLOS ONE, Public Library of Science, vol. 17(7), pages 1-18, July.
    3. Clément de Chaisemartin & Xavier D'Haultfœuille, 2020. "Two-Way Fixed Effects Estimators with Heterogeneous Treatment Effects," American Economic Review, American Economic Association, vol. 110(9), pages 2964-2996, September.
    4. Canavire-Bacarreza, Gustavo & Martinez-Vazquez, Jorge & Yedgenov, Bauyrzhan, 2020. "Identifying and disentangling the impact of fiscal decentralization on economic growth," World Development, Elsevier, vol. 127(C).
    5. Qiao, Baoyun & Martinez-Vazquez, Jorge & Xu, Yongsheng, 2008. "The tradeoff between growth and equity in decentralization policy: China's experience," Journal of Development Economics, Elsevier, vol. 86(1), pages 112-128, April.
    6. Neyapti, Bilin, 2006. "Revenue decentralization and income distribution," Economics Letters, Elsevier, vol. 92(3), pages 409-416, September.
    7. Baker, Andrew C. & Larcker, David F. & Wang, Charles C.Y., 2022. "How much should we trust staggered difference-in-differences estimates?," Journal of Financial Economics, Elsevier, vol. 144(2), pages 370-395.
    8. Sonia Bhalotra & Irma Clots-Figueras, 2014. "Health and the Political Agency of Women," American Economic Journal: Economic Policy, American Economic Association, vol. 6(2), pages 164-197, May.
    9. Fabiana Rocha & Marislei Nishijima & Veronica Fernandez Orellano, 2016. "Health spending autonomy and infant mortality rates: A matter of local administrative capacity?," Journal of Developing Areas, Tennessee State University, College of Business, vol. 50(2), pages 293-309, April-Jun.
    10. Xie, Danyang & Zou, Heng-fu & Davoodi, Hamid, 1999. "Fiscal Decentralization and Economic Growth in the United States," Journal of Urban Economics, Elsevier, vol. 45(2), pages 228-239, March.
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    Keywords

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    JEL classification:

    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development
    • P16 - Political Economy and Comparative Economic Systems - - Capitalist Economies - - - Capitalist Institutions; Welfare State

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