Assessing the Public Health Impacts of Decentralization Reform: a Participatory, Quasi-experimental, and Multi- Method Approach

Over the last thirty years, international organizations have invested heavily in efforts aimed at increasing the provision and improving the efficacy of public services within developing countries. Health sector decentralization have been one of the most common manifestations of this effort to reform governance. However, generalizing about appropriate methodology for evaluating and identifying the effects of such reforms proves difficult. For example, evaluations of governance reforms are often hampered by problems of establishing counterfactuals, endogeneity, as well as accounting for selection effects with respect to the reform interventions. Additionally, robust policy evaluations need to address heterogeneity in treatment, staggered timing, and the theoretical underpinnings about expected effects. Nonetheless, the increased popularity as well as the substantial financial investments in efforts to augment health-sector governance demand systematic and rigorous empirical evaluation strategies. In this paper we present a participatory, quasi-experimental, and multi-method approach for evaluating the public health effects of decentralization reforms, illustrating such an approach with and example from our research on decentralized health service delivery models in Honduras.