Decentralization and public services : the case of immunization

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.Public Health Promotion,Banks&Banking Reform,Health Monitoring&Evaluation,Decentralization,Municipal Financial Management,National Governance,Banks&Banking Reform,Municipal Financial Management,Health Monitoring&Evaluation,Governance Indicators

Immunization in developing countries : its political and organizational determinants

The authors use cross-national social, political, economic, and institutional data to explain why some countries have stronger immunization programs than others, as measured by diphtheria-tetanus-pertussis (DTP) and measles vaccine coverage rates and the adoption of the hepatitis B vaccine. After reveiwing the existing literature on demand- and supply-side side factors that affect immunization programs, the authors find that the elements that most affect immunization programs in low- and middle-income countries involve broad changes in the global policy environment and contact with international agencies. Democracies tend to have lower coverage rates than autocracies, perhaps because bureaucratic elites have an affinity for immunization programs and are granted more autonomy in autocracies, althought this effect is not visible in low-income countries. The authors also find that the quality of a nation's institutions and its level of development are strongly related to immunization rate coverage and vaccine adoption, and that coverage rates are in general more a function of supply-side than demand effects. there is no evidence that epidemics or polio eradication campaigns affect immunization rates one way or another, or that average immunization rates increase following outbreaks of diphtheria, pertussis, or measles.Health Monitoring&Evaluation,Disease Control&Prevention,Insurance&Risk Mitigation,Public Health Promotion,Early Child and Children's Health,Health Monitoring&Evaluation,Early Child and Children's Health,Insurance&Risk Mitigation,ICT Policy and Strategies,Health Economics&Finance

Public management and essential public health functions

The authors provide an overview of how different approaches to improving public sector management relate to so-called core or essential public health functions, such as disease surveillance, health education, monitoring and evaluation, workforce development, enforcement of public health laws and regulations, public health research, and health policy development. The authors summarize key themes in the public management literature and draw lessons for their application to these core functions.Decentralization,Health Monitoring&Evaluation,Health Systems Development&Reform,Public Health Promotion,Enterprise Development&Reform,Health Monitoring&Evaluation,National Governance,Agricultural Knowledge&Information Systems,Banks&Banking Reform,Health Economics&Finance

Governance of communicable disease control services : a case study and lessons from India

The authors study the impact of governance and administrative factors on communicable disease prevention in the Indian state of Karnataka using survey data from administrators, frontline workers, and elected local representatives. They identify a number of key constraints to the effective management of disease control in India, in misaligned incentives, and the institutional arrangements for service delivery. The authors discuss these under five headings: administrative issues; human resource management; horizontal coordination; decentralization, community involvement, and public accountability; and implementation of public health laws and regulations. They find that India's public health system is configured to be highly effective at top-down reactive work, such as bringing disease outbreaks under control, but not for the more routine collaborations required for proactive disease prevention. The authors conclude with policy recommendations that take into account the complexity of India's system of public administration and the need for simple reforms that can be easily implemented.Health Monitoring&Evaluation,Health Systems Development&Reform,Agricultural Knowledge&Information Systems,Public Health Promotion,Disease Control&Prevention,Health Systems Development&Reform,Health Monitoring&Evaluation,National Governance,Agricultural Knowledge&Information Systems,Health Economics&Finance

Decentralization and public services: the case of immunization

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.Decentralization Immunization Public administration Health reform Developing countries Public health