Decentralisation’s Effects On Health: Theory And Evidence From Balochistan, Pakistan

Theme/Relevant Ministry:

M/o IPC; M/o PDSI; M/o Health; P&D Board and Health department Balochistan

Project Brief:

The paper aims to investigate the impacts of decentralisation on health in Balochistan: How decentralisation has been [in]effective in improving (worsening) the overall healthcare services in the province. Decentralisation is seen through the National Finance Commission (NFC) Award – the 7th NFC Award – and the 18th Amendment to the Constitution, both initiatives provide fiscal and administrative decentralisation to the provinces in Pakistan. Healthcare service in Pakistan is a provincial subject, and any step that helps improving the capacity of the provinces should supposedly translate into better services of healthcare. After the 7th NFC Award and the 18th Amendment, Balochistan has gained bigger fiscal space and provincial autonomy to improve social services including health. The paper uses a long time series dataset from 1975 to 2020 from federal/provincial/district sources to provide micro-level evidence of static (or otherwise) outcomes in health corresponding to decentralisation. The empirical analysis is discussed and analysed in a rigorous theoretical framework. The framework compares the public health provision by provincial/subnational government with centralised government to assess which tier is more effective (or otherwise) in health care provision considering various institutional types in both decentralised and decentralised regimes. The empirical evidence is based on the autoregressive distributed lag (ARDL) regression approach. The findings show that decentralisation has no effect on improving health outcomes in terms of life expectancy, infant mortality rate and child immunization. Instead, it causes an increase in infant mortality in Balochistan. The paper concludes that health outcomes have not improved in post decentralisation despite bigger fiscal space and provincial autonomy, and the province has not been able to increase healthcare services with qualitatively better outcomes.

Public Policy Relevance:

This study explores to what extend Balochistan has/has not been able to improve the healthcare services. The study also explores the underlining political and economic factors and provide policy guidelines to remove bottlenecks for better healthcare services for all in the province.

In progress 90%

Unedited Working Paper and Policy Brief prepared for the Second RASTA Conference can be downloaded from the link:

CGP 02-034
Manzoor Ahmed
Professor, Lasbela University (PI)
08 months
Rs. 2,000,000/-