Organizations matter in local governance
Evidence from health sector decentralization in Honduras
Bibliographic Data
| ID | 11490802 |
|---|---|
| Authors | Elisabeth D Root (0000-0002-9566-4031, The Ohio State University, corresponding author), Alan Zarychta (0000-0002-4342-2356, University of Chicago), Bertha A Bermúdez Tapia (0000-0002-8711-2253, University of Colorado Boulder), Bertha Bermudez Tapia (University of Colorado Boulder), Tara Grillos (0000-0001-5743-3825, Department of Political Science, Purdue University, 100 N University St, West Lafayette, IN 47907, USA), Krister Andersson (0000-0002-9320-8155, University of Colorado Boulder), Jane Menken (0000-0002-0008-0325, University of Colorado Boulder) |
| Year | 2020 |
| Volume | 35 |
| Issue | 9 |
| Pages | 1168-1179 |
| Publication date | 2020-11-20 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Health Policy and Planning (JOURNAL) |
| Journal identifiers | ISSN: 0268-1080 • E-ISSN: 1460-2237 |
| Publisher | Oxford University Press (PUBLISHER • GB) |
| DOI | 10.1093/heapol/czaa084 |
| PMID | 33026429 |
| OpenAlex | W3091904347 |
| Language | EN |
| Citations received | 6 |
| References cited | 33 |
Health systems strengthening is at the forefront of the global health agenda. Many health systems in low-resource settings face profound challenges, and robust causal evidence on the effects of health systems reforms is lacking. Decentralization has been one of the most prominent reforms, and after more than 50 years of implementation and hundreds of studies, we still know little about whether these policies improve, harm or are inconsequential for the performance of health systems in less-developed countries. A persistent problem in existing studies is the inability to isolate the effect of decentralization on health outcomes, struggling with heterogeneous meanings of decentralization and missing counterfactuals. We address these shortcomings with a quasi-experimental, longitudinal research design that takes advantage of a unique staggered reform process in Honduras. Using three waves of household survey data over 10 years for a matched sample of 65 municipalities in Honduras, we estimated difference-in-difference models comparing changes in outcomes over time between local health systems that were decentralized using one of three types of organizations [municipal governments, associations of mayors or non-governmental organization (NGOs)] and those that remained centrally administered. We find evidence of overall improvements between 2005 and 2016 in several service delivery-related outcomes, and additional improvements in decentralized municipalities governed by NGOs. NGO-led municipalities saw a 15% decrease in home delivery relative to centralized municipalities in 2016, a 12.5% increase in MCH facility delivery and a 7% increase in the use of a skilled birth attendant. There were no detectable positive treatment effects for vaccination, and a slight decline in the weight-for-length z-scores in NGO municipalities, but we find no systematic evidence of decentralization negatively impacting any maternal and child health outcomes. These findings highlight the importance of considering implementation context, namely organization type, when assessing the effects of decentralization reform
Business · Corporate governance · Decentralization · Economic growth · Economics · Health care · Political science · Public economics · Service (business) · Service delivery framework · Global Health Care Issues · Global Maternal and Child Health · Healthcare Systems and Reforms · Marketing · Health Policy
Decentralization and Equitable Service Delivery
Decentralization and resource contributions within local governance networks
Decentralization and Corruption in Public Service Delivery
Decentralization Can Increase Cooperation among Public Officials
A realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes
Health Sector Reform in Honduras
The Economics of nonprofit institutions
Accountability in Street-Level Organizations
Buying results? Contracting for health service delivery in developing countries
Effectiveness of strategies to improve health-care provider practices in low-income and middle-income countries
Methods for Evaluating Changes in Health Care Policy
Generalizing Observational Study Results
Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance
High-quality health systems in the Sustainable Development Goals era
The perils of polycentric governance of infectious disease in South Africa
NGOs and international development
Alternatives to randomisation in the evaluation of public health interventions
Using natural experiments to evaluate population health interventions
Public Sector Governance Reform and the Motivation of Street‐Level Bureaucrats in Developing Countries
Hybrid Regimes for Local Public Goods Provision
Governing the Hollow State
Relational Contracting and Network Management
Policy Work
Decentralization of health care systems and health outcomes
Analyzing the decentralization of health systems in developing countries
Nonprofit Organizations, Government, and the Welfare State
Local Governments and Rural Development
Analysing Decentralization Policies in Developing Countries
| Unique citing works | 6 |
|---|---|
| Citations per year | 1,5 |
| Citation span | 2022 - 2025 (4) |
| Citation velocity | recent |
| Highly cited | No |
| Citation types | Neutral: 6 |