The Case of Immunization

Khaleghian studies the Impact of political the two groups. In the low-income group, development decentralization on childhood immunization, an essential assistance reduces the gains from decentralization. In the public service provided in almost all countries. He middle-income group, democratic government mitigates examines the relationship empirically using a time-series the negative effects of decentralization, and data set of 140 lowand middle-income countries from decentralization reverses the negative effects of ethnic 1980 to 1997. The author finds that decentralization has tension and ethno-linguistic fractionalization, but different effects in lowand middle-income countries. In institutional quality and literacy rates have no interactive the low-income group, decentralized countries have effect either way. Similar results are obtained whether higher coverage rates than centralized ones, with an decentralization is measured with a dichotomous average difference of 8.5 percent for measles and DTP3 categorical variable or with more specific measures of vaccines. In the middle-income group, the reverse effect fiscal decentralization. The study confirms predictions in is observed: decentralized countries have lower coverage the theoretical literature about the negative impact of rates than centralized ones, with an average difference of local political control on services that have public goods 5.2 percent for the same vaccines. Both results are characteristics and inter-jurisdictional externalities. The significant at the 99 percent level. Modifiers of the author discusses reasons for the difference between lowdecentralization-immunization relationship also differ in and middle-income countries. This paper-a product of Public Services, Development Research Group-is part of a larger effort in the group to study the delivery of essential health services. Copies of the paper are available free from the World Bank, 1818 H Street NW, Washington, DC 20433. Please contact Hedy Sladovich, room MC3-607, telephone 202-473-7698, fax 202-522-1154, email address [email protected]. Policy Research Working Papers are also posted on the Web at http:// econ.worldbank.org. The author may be contacted at [email protected]. March 2003. (43 pages) The Policy Research Workig Paper Seres dissemPiates the fRdengs of work in progress to encourage the exchange of adeas about develop"ieitt Issues An objective of the series Is to get the findings ouit quicikly, even If the presentations are less than fully polisbed. The papers carry the names of the authors and should be cited accordingly. The findings, interpretations, and conicluisions expressed in this paper are entirely those of the auithors. They do not necessarily represent the view of the World Bank, Its Execuitive Directors, or the countries they represent Produced by the Research Advisory Staff Decentralization and Public Services: The Case of Immunization