Thapa Bishnu Bahadur, Rahman Momotazur, Were Lawrence, Wamai Richard, Galárraga Omar
Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, United States of America.
Department of Health Sciences, School of Public Health, Boston University, Boston, United States of America.
Health Res Policy Syst. 2024 Dec 20;22(1):172. doi: 10.1186/s12961-024-01272-x.
As envisioned by the 2010 Constitution, Kenya implemented a devolved system of government in March 2013, setting up 47 counties and a corresponding number of local governments. These counties differed in their levels of development. While counties such as Nairobi and Kiambu led in social and economic indicators, others such as Turkana, Mandera and Wajir were at the bottom of the list. Keeping the between-country disparities and the need to remedy those disparities in mind, the national government used formula-based criteria to determine counties' eligibility for the receipt of financial resources. On the basis of these criteria, counties were classified into marginalized and nonmarginalized counties. The marginalized counties were the 14 (of the 47) most socially and economically disadvantaged counties. These counties receive additional financial resources, which we call targeted intergovernmental fiscal transfers (i.e. fiscal transfers from the national government to county governments).
We used the difference-in-differences (DID) technique and fixed effects models to estimate the effects of these targeted intergovernmental fiscal transfers on human immunodeficiency virus (HIV) incidence and diarrhoea incidence.
The results revealed that the counties receiving those transfers experienced a statistically significant decline in the incidence of diarrhoea but had no impact on the incidence of HIV. Our study fills a major gap in causal evidence linking intergovernmental fiscal transfers to health outcomes, especially in the context of low-middle-income countries in a newly decentralized setting.
Our results imply that targeted intergovernmental fiscal transfers may be effective at improving some subnational health outcomes, and therefore in reducing within-country health inequalities.
根据2010年宪法的设想，肯尼亚于2013年3月实施了权力下放的政府体制，设立了47个县及相应数量的地方政府。这些县的发展水平各不相同。内罗毕和基安布等县在社会和经济指标方面领先，而图尔卡纳、曼德拉和瓦吉尔等县则处于榜单末尾。考虑到各县之间的差距以及弥补这些差距的必要性，国家政府采用基于公式的标准来确定各县获得财政资源的资格。根据这些标准，各县被划分为边缘化县和非边缘化县。边缘化县是47个县中社会和经济最弱势的14个县。这些县获得额外的财政资源，我们称之为有针对性的政府间财政转移支付（即从国家政府向县政府的财政转移支付）。
我们使用双重差分（DID）技术和固定效应模型来估计这些有针对性的政府间财政转移支付对人类免疫缺陷病毒（HIV）发病率和腹泻发病率的影响。
结果显示，接受这些转移支付的县腹泻发病率在统计学上显著下降，但对HIV发病率没有影响。我们的研究填补了将政府间财政转移支付与健康结果联系起来的因果证据方面的一个主要空白，特别是在新分权背景下的中低收入国家。
我们的结果表明，有针对性的政府间财政转移支付可能在改善一些次国家层面的健康结果方面有效，因此在减少国内健康不平等方面也有效。
