The Politics of Health Service Delivery in Developing Countries

Session Submission Type: Full Paper Panel

Session Description

Delivery of high-quality and equitable public services is a fundamental governance challenge in developing countries. Health service delivery is of particular interest, given the substantial burdens of premature mortality and morbidity that most developing countries face. The papers in this panel examine these challenges using diverse methods, and across a wide range of settings. Hiroi and Schober present a global perspective, developing theory about the relationship between governance and mortality prevention. They exploit cross-country governance and mortality data to generate empirical analysis of the relationship between governance and treatable, preventable, and non-amenable mortality. These findings push us to consider the working of health systems in developing countries, which is where the remaining 3 papers focus. Croke examines primary health care programs in two countries (Nigeria and Ethiopia) which together account for a substantial fraction of the under-5 mortality globally. The paper uses comparative case study methods to highlight the interplay between individuals, institutions, and underlying political settlements as they affect state capacity to implement health programs. Camacho and Dionne consider both the supply side (state capacity) and the demand side (citizen mobilization to demand accountability) for health services in the DRC, using an RCT to estimate the impact of interventions designed to strengthen both processes. Zarychta, Carson and Mora examine a common strategy to strengthen service delivery capacity, decentralization, and its effect on “street level bureaucrats” in Honduras. In their mixed method study, they generate insights into both the attitudes of health workers towards these reforms, as well as the relative efficacy of local service delivery implemented by non-state versus state actors. Taken together, these papers provide a rich set of analyses which shed light on critical issues of state capacity, accountability, mobilization, and implementation of health services in developing countries.

Sub Unit

• Division 48: Health Politics & Health Policy

Cosponsor

• Division 12: Comparative Politics of Developing Countries

Individual Presentations

• The Health Impact of Capacity and Community Building Interventions in DRC - Kim Yi Dionne, University of California, Riverside; Luis A. Camacho, NORC at the University of Chicago

• The Politics of Primary Health Programs in Ethiopia and Nigeria - Kevin Croke, Harvard School of Public Health

• Governance and Amenable Mortality in Developing Countries - Taeko Hiroi, The University of Texas at El Paso; Gregory Schober, University of Texas at El Paso

• Understanding Street-level Bureaucrats’ Attitudes under Public Sector Reform - Alan Zarychta, University of Chicago

Chair

• Scott L. Greer University of Michigan

Discussants

• Carmen Jacqueline Ho University of Guelph

• Claudio A. Méndez Universidad Austral de Chile