Does Decentralization of Health Systems Improve Maternal and Child Health? Evidence From Rural Honduras

Elisabeth D. Root , The Ohio State University
Jane Menken, University of Colorado Boulder
Krister Andersson, University of Colorado Boulder
Alan Zarychta, University of Chicago
Bertha Bermudez Tapia, University of Colorado Boulder
Tara Grillos, Perdue University

One of the greatest challenges to improving health in low resource settings is the quality and effectiveness of the health system. Decentralization reforms, premised on the idea that local institutions better provide public services, are an ubiquitous response to this problem. The Honduran Ministry of Health (MOH) began implementing decentralized health service delivery models at the regional and local levels in 2005. The objective of this study is to explain how the local context of decentralization affects variation in health system performance and, ultimately, impacts child and reproductive health and access to care. We use difference-in-difference regression models with data from the 2005 DHS and a survey we conducted in 2016 (ENSAGO) to examine whether decentralized municipalities had greater improvements in key maternal and child health outcomes than centralized municipalities. We find few differences in across outcomes, with the exception of maternal health services, which appear to improve in decentralized areas relative to centralized ones.

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 Presented in Session 53. Fertility, Family Planning, and Reproductive Health: Policy and Government Intervention