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Decentralization, Ethnic Fractionalization, and Public Services: Evidence from Kenyan Healthcare

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  • Hémet, Camille
  • Wren-Lewis, Liam
  • Mahoney, Jessica

Abstract

This paper examines how use of public services changed following a major constitutional reform in Kenya. Following an important period of inter-ethnic conflict, responsibility for local health services was decentralized to 47 newly created county governments. Using an event-study design, we find that use of public clinics for births increased significantly after the reform, but only in counties that were relatively ethnically homogeneous. We also find a significant increase in the correlation between county ethnic fractionalization and a range of other measures of public health service use. Results suggest that services in these counties are less likely to require payments after devolution. Additionally, using within-county variation, we find an increase in public service use among individuals that are of the same ethnicity as the members of the county government executive.

Suggested Citation

  • Hémet, Camille & Wren-Lewis, Liam & Mahoney, Jessica, 2023. "Decentralization, Ethnic Fractionalization, and Public Services: Evidence from Kenyan Healthcare," SocArXiv em3js, Center for Open Science.
  • Handle: RePEc:osf:socarx:em3js
    DOI: 10.31219/osf.io/em3js
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    More about this item

    JEL classification:

    • D72 - Microeconomics - - Analysis of Collective Decision-Making - - - Political Processes: Rent-seeking, Lobbying, Elections, Legislatures, and Voting Behavior
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • H77 - Public Economics - - State and Local Government; Intergovernmental Relations - - - Intergovernmental Relations; Federalism
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • J15 - Labor and Demographic Economics - - Demographic Economics - - - Economics of Minorities, Races, Indigenous Peoples, and Immigrants; Non-labor Discrimination

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