Decentralisation and government provision of public goods: The public health sector in Uganda

While many developing countries have devolved health care responsibilities to local governments in recent years, no study has examined whether decentralisation actually leads to greater health sector allocative efficiency. This paper approaches this question by modeling local government budgeting de...

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Bibliographic Details
Published in:The Journal of development studies 2005-11, Vol.41 (8), p.1417-1443
Main Authors: Akin, John, Hutchinson, Paul, Strumpf, Koleman
Format: Article
Language:English
Subjects:
Allocative efficiency
Budgets
Decentralization
Developing countries
Health care
Health care policy
LDCs
Local Government
Public expenditure
Public goods
Public Health
Uganda
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Summary:While many developing countries have devolved health care responsibilities to local governments in recent years, no study has examined whether decentralisation actually leads to greater health sector allocative efficiency. This paper approaches this question by modeling local government budgeting decisions under decentralisation. The model leads to conclusions not all favourable to decentralisation and produces several testable hypotheses concerning local government spending choices. For a brief empirical test of the model we look at data from Uganda. The data are of a type seldom available to researchers-actual local government budgets for the health sector in a developing country. The health budgets are disaggregated into specific types of activities based on a subjective characterisation of each activity's 'publicness'. The empirical results provide preliminary evidence that local government health planners are allocating declining proportions of their budgets to public goods activities.
ISSN:0022-0388
1743-9140
DOI:10.1080/00220380500187075