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

Camille Hémet (), Liam Wren-Lewis () and Jessica Mahoney
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Camille Hémet: PSE - Paris School of Economics - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement - ENPC - École nationale des ponts et chaussées - IP Paris - Institut Polytechnique de Paris, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement - ENPC - École nationale des ponts et chaussées - IP Paris - Institut Polytechnique de Paris
Liam Wren-Lewis: IC Migrations - Institut Convergences Migrations - French Collaborative Institute on Migration [Aubervilliers], INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement, PSE - Paris School of Economics - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement - ENPC - École nationale des ponts et chaussées - IP Paris - Institut Polytechnique de Paris, PJSE - Paris Jourdan Sciences Economiques - UP1 - Université Paris 1 Panthéon-Sorbonne - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres - EHESS - École des hautes études en sciences sociales - CNRS - Centre National de la Recherche Scientifique - INRAE - Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement - ENPC - École nationale des ponts et chaussées - IP Paris - Institut Polytechnique de Paris
Jessica Mahoney: CEPREMAP - Centre pour la recherche économique et ses applications - ECO ENS-PSL - Département d'économie de l'ENS-PSL - ENS-PSL - École normale supérieure - Paris - PSL - Université Paris Sciences et Lettres

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Abstract: This article examines the impact of ethnic fractionalization on public service use by exploiting a major constitutional reform in Kenya. Following an important period of inter-ethnic conflict, responsibility for local health services was decentralized to forty-seven newly created county governments across the country. Crucially, this changed the ethnic composition of the administrative area responsible for healthcare, while leaving the composition of the local population unchanged. Using an event-study design, we find that the use of public clinics for births increased significantly more in counties that were relatively ethnically homogeneous after the reform. We also find a significant increase in the correlation between county ethnic fractionalization and a range of other measures of public health service use. Using within-county variation to investigate mechanisms, we find healthcare use increases were concentrated among individuals of the same ethnicity as members of the new county government executives. Overall, the results suggest that more ethnically homogeneous subnational jurisdictions can lead to more public service use relative to more fractionalized ones.

Keywords: Kenya; Local public goods; Public health; Ethnic fractionalization; Decentralization (search for similar items in EconPapers)
Date: 2026-07-29
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Published in Journal of Economic Geography, 2026, ⟨10.1093/jeg/lbag043⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:pseptp:hal-05770661

DOI: 10.1093/jeg/lbag043

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