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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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    1. Alberto Alesina & Eliana La Ferrara, 2000. "Participation in Heterogeneous Communities," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 115(3), pages 847-904.
    2. Edwine W Barasa & Anthony M Manyara & Sassy Molyneux & Benjamin Tsofa, 2017. "Recentralization within decentralization: County hospital autonomy under devolution in Kenya," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-18, August.
    3. Yann Algan & Camille Hémet & David D. Laitin, 2016. "The Social Effects of Ethnic Diversity at the Local Level: A Natural Experiment with Exogenous Residential Allocation," Journal of Political Economy, University of Chicago Press, vol. 124(3), pages 696-733.
    4. Desmet, Klaus & Gomes, Joseph Flavian & Ortuño-Ortín, Ignacio, 2020. "The geography of linguistic diversity and the provision of public goods," Journal of Development Economics, Elsevier, vol. 143(C).
    5. Metin M. Coşgel & Thomas J. Miceli & Sadullah Yıldırım, 2023. "Religion, rulers, and conflict," Journal of Economic Growth, Springer, vol. 28(3), pages 439-480, September.
    6. Algan, Yann & Hémet, Camille & Laitin, David D., 2011. "Diversity and Public Goods: A Natural Experiment with Exogenous Residential Allocation," IZA Discussion Papers 6053, Institute of Labor Economics (IZA).
    7. Seidel, André, 2023. "A global map of amenities: Public goods, ethnic divisions and decentralization," Journal of Development Economics, Elsevier, vol. 164(C).
    8. repec:hal:spmain:info:hdl:2441/4rm8ji0nae9elbggr366la3786 is not listed on IDEAS
    9. Alberto Alesina & Reza Baqir & William Easterly, 1999. "Public Goods and Ethnic Divisions," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 114(4), pages 1243-1284.
    10. Dahis, Ricardo & Szerman, Christiane, 2024. "Decentralizing Development: Evidence from Government Splits," Research Department working papers 2297, CAF Development Bank Of Latinamerica.
    11. Nicola Bianchi & Michela Giorcelli & Enrica Maria Martino, 2023. "The Effects of Fiscal Decentralisation on Publicly Provided Services and Labour Markets," The Economic Journal, Royal Economic Society, vol. 133(653), pages 1738-1772.
    12. Joseph Flavian Gomes, 2020. "The health costs of ethnic distance: evidence from sub-Saharan Africa," Journal of Economic Growth, Springer, vol. 25(2), pages 195-226, June.
    13. Erzo F. P. Luttmer, 2001. "Group Loyalty and the Taste for Redistribution," Journal of Political Economy, University of Chicago Press, vol. 109(3), pages 500-528, June.
    14. Benjamin Marx & Vincent Pons & Tavneet Suri, 2021. "Voter Mobilisation and Trust in Electoral Institutions: Evidence from Kenya," The Economic Journal, Royal Economic Society, vol. 131(638), pages 2585-2612.
    15. José G. Montalvo & Marta Reynal-Querol, 2021. "Ethnic Diversity and Growth: Revisiting the Evidence," The Review of Economics and Statistics, MIT Press, vol. 103(3), pages 521-532, July.
    16. Samuel Bazzi & Arya Gaduh & Alexander D. Rothenberg & Maisy Wong, 2019. "Unity in Diversity? How Intergroup Contact Can Foster Nation Building," American Economic Review, American Economic Association, vol. 109(11), pages 3978-4025, November.
    17. repec:hal:spmain:info:hdl:2441/6lcb7ovms687vbos73r9r0is5g is not listed on IDEAS
    18. Khwaja, Asim Ijaz, 2009. "Can good projects succeed in bad communities?," Journal of Public Economics, Elsevier, vol. 93(7-8), pages 899-916, August.
    19. Fearon, James D, 2003. "Ethnic and Cultural Diversity by Country," Journal of Economic Growth, Springer, vol. 8(2), pages 195-222, June.
    20. Seabright, Paul, 1996. "Accountability and decentralisation in government: An incomplete contracts model," European Economic Review, Elsevier, vol. 40(1), pages 61-89, January.
    21. Samuel Bazzi & Matthew Gudgeon, 2021. "The Political Boundaries of Ethnic Divisions," American Economic Journal: Applied Economics, American Economic Association, vol. 13(1), pages 235-266, January.
    22. Isabelle Cohen, 2024. "Documenting Decentralization: Empirical Evidence on Administrative Unit Proliferation from Uganda," The World Bank Economic Review, World Bank, vol. 38(4), pages 772-795.
    23. Alesina, Alberto & La Ferrara, Eliana, 2002. "Who trusts others?," Journal of Public Economics, Elsevier, vol. 85(2), pages 207-234, August.
    24. J-P. Platteau & A. Abraham, 2002. "Participatory Development in the Presence of Endogenous Community Imperfections," Journal of Development Studies, Taylor & Francis Journals, vol. 39(2), pages 104-136.
    25. Alberto Alesina & Caterina Gennaioli & Stefania Lovo, 2019. "Public Goods and Ethnic Diversity: Evidence from Deforestation in Indonesia," Economica, London School of Economics and Political Science, vol. 86(341), pages 32-66, January.
    26. Malesky, Edmund J. & Nguyen, Cuong Viet & Tran, Anh, 2014. "The Impact of Recentralization on Public Services: A Difference-in-Differences Analysis of the Abolition of Elected Councils in Vietnam," American Political Science Review, Cambridge University Press, vol. 108(1), pages 144-168, February.
    27. Benjamin Marx & Vincent Pons & Tavneet Suri, 2021. "Diversity and Team Performance in a Kenyan Organization," Post-Print hal-03873741, HAL.
    28. Walter Bossert & Conchita D'Ambrosio & Eliana La Ferrara, 2011. "A Generalized Index of Fractionalization," Economica, London School of Economics and Political Science, vol. 78(312), pages 723-750, October.
    29. Yann Algan & Camille Hémet & David D. Laitin, 2016. "The Social Effects of Ethnic Diversity at the Local Level: A Natural Experiment with Exogenous Residential Allocation," Journal of Political Economy, University of Chicago Press, vol. 124(3), pages 696-733.
    30. Mergele, Lukas & Weber, Michael, 2020. "Public employment services under decentralization: Evidence from a natural experiment," Journal of Public Economics, Elsevier, vol. 182(C).
    31. Miguel, Edward & Gugerty, Mary Kay, 2005. "Ethnic diversity, social sanctions, and public goods in Kenya," Journal of Public Economics, Elsevier, vol. 89(11-12), pages 2325-2368, December.
    32. Christopher J. Waller & Thierry Verdier & Roy Gardner, 2002. "Corruption: Top Down or Bottom Up?," Economic Inquiry, Western Economic Association International, vol. 40(4), pages 688-703, October.
    33. Dunning, Thad & Harrison, Lauren, 2010. "Cross-cutting Cleavages and Ethnic Voting: An Experimental Study of Cousinage in Mali," American Political Science Review, Cambridge University Press, vol. 104(1), pages 21-39, February.
    34. Frey, Bruno S & Stutzer, Alois, 2000. "Happiness, Economy and Institutions," Economic Journal, Royal Economic Society, vol. 110(466), pages 918-938, October.
    35. Posner, Daniel N., 2004. "The Political Salience of Cultural Difference: Why Chewas and Tumbukas Are Allies in Zambia and Adversaries in Malawi," American Political Science Review, Cambridge University Press, vol. 98(4), pages 529-545, November.
    36. José Garcia Montalvo & Marta Reynal-Querol, 2004. "Ethnic polarization, potential conflict and civil wars," Economics Working Papers 770, Department of Economics and Business, Universitat Pompeu Fabra, revised Mar 2005.
    37. José G. Montalvo & Marta Reynal-Querol, 2005. "Ethnic Polarization, Potential Conflict, and Civil Wars," American Economic Review, American Economic Association, vol. 95(3), pages 796-816, June.
    38. Oliver Vanden Eynde & Patrick M. Kuhn & Alexander Moradi, 2018. "Trickle-Down Ethnic Politics: Drunk and Absent in the Kenya Police Force (1957-1970)," American Economic Journal: Economic Policy, American Economic Association, vol. 10(3), pages 388-417, August.
    39. William Easterly & Ross Levine, 1997. "Africa's Growth Tragedy: Policies and Ethnic Divisions," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 112(4), pages 1203-1250.
    40. Stacey Orangi & Angela Kairu & Joanne Ondera & Boniface Mbuthia & Augustina Koduah & Boniface Oyugi & Nirmala Ravishankar & Edwine Barasa, 2021. "Examining the implementation of the Linda Mama free maternity program in Kenya," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(6), pages 2277-2296, November.
    41. Rachel Glennerster & Edward Miguel & Alexander D. Rothenberg, 2013. "Collective Action in Diverse Sierra Leone Communities," Economic Journal, Royal Economic Society, vol. 0, pages 285-316, May.
    42. Marcella Alsan & Owen Garrick & Grant Graziani, 2019. "Does Diversity Matter for Health? Experimental Evidence from Oakland," American Economic Review, American Economic Association, vol. 109(12), pages 4071-4111, December.
    43. Pranab Bardhan & Dilip Mookherjee, 2006. "Decentralisation and Accountability in Infrastructure Delivery in Developing Countries," Economic Journal, Royal Economic Society, vol. 116(508), pages 101-127, January.
    44. Swee, Eik Leong, 2015. "Together or separate? Post-conflict partition, ethnic homogenization, and the provision of public schooling," Journal of Public Economics, Elsevier, vol. 128(C), pages 1-15.
    45. Besley, Timothy & Coate, Stephen, 2003. "Centralized versus decentralized provision of local public goods: a political economy approach," Journal of Public Economics, Elsevier, vol. 87(12), pages 2611-2637, December.
    46. Ricardo Dahis & Christiane Szerman, 2023. "Decentralizing Development: Evidence from Government Splits," Monash Economics Working Papers 2023-18, Monash University, Department of Economics.
    47. Cagla Okten & Una Okonkwo Osili, 2004. "Contributions in heterogeneous communities: Evidence from Indonesia," Journal of Population Economics, Springer;European Society for Population Economics, vol. 17(4), pages 603-626, December.
    48. Marx, Benjamin & Pons, Vincent & Suri, Tavneet, 2021. "Diversity and team performance in a Kenyan organization☆," Journal of Public Economics, Elsevier, vol. 197(C).
    49. Fumihiko Saito, 2008. "Decentralization and Local Governance: Introduction and Overview," Springer Books, in: Fumihiko Saito (ed.), Foundations for Local Governance, chapter 1, pages 1-24, Springer.
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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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