Decentralization, ethnic fractionalization, and public services : evidence from Kenyan healthcare

Author / Creator

Hémet, Camille, author

Available as

Online

Summary

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 serv...

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.

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