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Decentralization and public services : the case of immunization

Author

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  • Khaleghian, Peyvand

Abstract

The 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.

Suggested Citation

  • Khaleghian, Peyvand, 2003. "Decentralization and public services : the case of immunization," Policy Research Working Paper Series 2989, The World Bank.
  • Handle: RePEc:wbk:wbrwps:2989
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    References listed on IDEAS

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    Citations

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    Cited by:

    1. Grégoire ROTA-GRAZIOSI & Emilie CALDEIRA, 2014. "La décentralisation dans les pays en développement : une revue de la littérature - Decentralization in developing countries: A literature review," Working Papers 201411, CERDI.
    2. 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.
    3. 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.
    4. Independent Evaluation Group, 2008. "Decentralization in Client Countries : An Evaluation of World Bank Support, 1990-2007," World Bank Publications, The World Bank, number 6543, April.
    5. Antonis Adam & Manthos Delis & Pantelis Kammas, 2014. "Fiscal decentralization and public sector efficiency: evidence from OECD countries," Economics of Governance, Springer, vol. 15(1), pages 17-49, February.
    6. Dolores Jimenez & Peter C Smith, "undated". "Decentralisation of health care and its impact on health outcomes," Discussion Papers 05/10, Department of Economics, University of York.
    7. Khaleghian, Peyvand & Das Gupta Monica, 2004. "Public management and essential public health functions," Policy Research Working Paper Series 3220, The World Bank.
    8. Montero-Granados, Roberto & de Dios Jiménez, Juan & Martín, José, 2007. "Decentralisation and convergence in health among the provinces of Spain (1980-2001)," Social Science & Medicine, Elsevier, vol. 64(6), pages 1253-1264, March.
    9. repec:nwe:eajour:y:2017:i:2:p:293-306 is not listed on IDEAS
    10. Axel Dreher, 2006. "Power to the People? The Impact of Decentralization on Governance," KOF Working papers 06-121, KOF Swiss Economic Institute, ETH Zurich.
    11. World Bank, 2008. "Immunization Resource Tracking Exercise : Case Study on the Republic of Tajikistan," World Bank Other Operational Studies 8116, The World Bank.

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