Colombian fiscal decentralisation
(2013)
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- Authors
- Supervisors
- Lorant, Vincent
- Abstract
- (en) Decentralisation is a common strategy for improving the performance of health systems. In developing countries, empirical evidence has shown that decentralisation has an overall positive effect on health-care provision. However, this effect depended on the local context in each locality. Indeed, the heterogeneity of local contexts may jeopardise the effect of decentralisation on equity in health outcomes across municipalities. This dissertation contributes to our understanding of the effect of decentralisation on equity of health outcomes across municipalities. The case of Colombian healthcare fiscal decentralisation was analysed. Colombia is an interesting case study, as health financing there has become decentralised since 1993. Infant mortality rates and vaccination coverage were used as health outcomes and health financing resources were used as a main proxy of decentralisation. Standard econometric and spatial econometric techniques were used. The results suggest that fiscal decentralisation has not tackled the differences in health outcomes across Colombian municipalities. Overall, fiscal decentralisation had a positive effect on health outcomes. However, the results were highly dependent on socio-economic conditions at the municipal level. The benefits of fiscal decentralisation were greater in well-off municipalities than in the poorest. Therefore, even when municipal governments know the needs of their localities, the level of local development could be a key condition for achieving better health outcomes and reducing inequalities across municipalities.
- Affiliations
Citations
Soto Rojas, V. E. (2013). Colombian fiscal decentralisation. https://hdl.handle.net/2078.5/204910