The objective of this research is to analyze the effect of fiscal decentralization on the provision of health services at the level of Decentralized Territorial Collectivities (CTDs) in Cameroon. To this end, econometric modeling using generalized least squares (GLS), the Driscoll and Kraay estimator, and Lewbel’s instrumental variables estimator will be employed. Is being called upon in a panel of 107 municipalities for the period 2010-2020, the investigations revealed that fiscal decentralization significantly and positively improves the delivery of public health services in Cameroon. An increase of one unit in fiscal decentralization leads to a significant increase in the number of integrated health centers (IHCs) as well as the number of buildings constructed in Cameroonian municipalities. It is therefore desirable that public authorities continue to promote fiscal decentralization, while emphasizing the health expenditures necessary for human capital development.
KeywordsCameroonHealthFiscal Decentralization
Adam, A., Delis, M. D., & Kammas, P. (2014). Fiscal Decentralization and Public Sector Efficiency: Evidence from OECD Countries. Economics of Governance, 15, 17-49. https://doi.org/10.1007/s10101-013-0131-4
Amoussouga, F. G., & Dedehouanou, G. M. A. (2015). Essay on Financial Decentralization and Access to Basic Social Services in Benin. Review of Economic and Financial Policy Analysis, 1, 7-40.
Antón, J., Muñoz de Bustillo, R., Fernández Macías, E., & Rivera, J. (2014). Effects of Health Care Decentralization in Spain from a Citizens’ Perspective. The European Journal of Health Economics, 15, 411-431. https://doi.org/10.1007/s10198-013-0485-0
Baltagi, B. H. (2008). Econometric Analysis of Panel Data. Rohn Wiley.
Barankay, I., & Lockwood, B. (2007). Decentralization and the Productive Efficiency of Government: Evidence from Swiss Cantons. Journal of Public Economics, 91, 1197-1218. https://doi.org/10.1016/j.jpubeco.2006.11.006
Baum, C. F., Lewbel, A., Schaffer, M. E., & Talavera, O. (2012). Instrumental Variables Estimation Using Heteroskedasticity-Based Instruments. In United Kingdom Stata User’s Group Meetings (Vol. 7, pp. 1-56). Stata Users Group.
Baum, C. F., Schaffer, M. E., & Stillman, S. (2007). Enhanced Routines for Instrumental Variables/Generalized Method of Moments Estimation and Testing. The Stata Journal: Promoting Communications on Statistics and Stata, 7, 465-506. https://doi.org/10.1177/1536867x0800700402
Bird, R., & Rodriguez, E. R. (1999). Decentralization and Poverty Alleviation. International Experience and the Case of the Philippines. Public Administration and Development, 19, 299-319. https://doi.org/10.1002/(sici)1099-162x(199908)19:3<299::aid-pad82>3.0.co;2-l
Bird, R., & Wallich, C. (1993). Fiscal Decentralization and Intergovernmental Relations in Transition Economics: Toward a Systematic Framework of Analysis (No. 1122). The World Bank.
Cadil, J., Petkovová, L., & Blatná, D. (2014). Human Capital, Economic Structure and Growth. Procedia Economics and Finance, 12 , 85-92. https://doi.org/10.1016/S2212-5671(14)00323-2
Caldeira, É. (2011). Essays on Decentralization in Developing Cou ntries. Ph.D. Thesis, University of Auvergne Clermont-Ferrand I.
Castelló-Climent, A., & Doménech, R. (2014). Human Capital and Income Inequality: Some Facts and Some Puzzles. BBVA Research.
Channa, A., & Faguet, J. (2016). Decentralization of Health and Education in Developing Countries: A Quality-Adjusted Review of the Empirical Literature. The World Bank Research Observer, 31, 199-241. https://doi.org/10.1093/wbro/lkw001
Chani, M. I., Jan, S. A., Pervaiz, Z., & Chaudhary, A. R. (2014). Human Capital Inequality and Income Inequality: Testing for Causality. Quality & Quantity, 48, 149-156. https://doi.org/10.1007/s11135-012-9755-7
Chattopadhyay, R., & Duflo, E. (2004). Women as Policy Makers: Evidence from a Randomized Policy Experiment in India. Econometrica, 72, 1409-1443. https://doi.org/10.1111/j.1468-0262.2004.00539.x
Cox, G. W., & McCubbins, M. D. (1986). Electoral Politics as a Redistributive Game. The Journal of Politics, 48, 370-389. https://doi.org/10.2307/2131098
Dada, E. A. (2015). Fiscal Decentralization and Social Services in Nigeria (No. RP_291). African Economic Research Consortium.
Dafflon, B., & Madiès, T. (2008). Decentralisation: Some Principles from the Theory of Financial Federa lism. Notes and documents n°42. French Development Agency Research Department.
De Tocqueville, A. (1968). Democracy in America. Gallimard.
Dick-Sagoe, C. (2020). Decentralization for Improving the Provision of Public Services in Developing Countries: A Critical Review. Cogent Economics & Finance, 8, Article 1804036. https://doi.org/10.1080/23322039.2020.1804036
Driscoll, J. C., & Kraay, A. C. (1998). Consistent Covariance Matrix Estimation with Spatially Dependent Panel Data. Review of Economics and Statistics, 80, 549-560. https://doi.org/10.1162/003465398557825
El Khider, A., & Imichoui, H. (2020). Regionalization, a New Mode of Governance for the Health System: An Overview of the Situation in the Case of Morocco. European Scientific Journal, ESJ, 16, 154-171. https://doi.org/10.19044/esj.2020.v16n16p154
Eliot, E., Lucas-Gabrielli, V., & Mangeney, C. (2017). Health Territorialization and Decentralization: Current Situation and Challenges Based on the French Case. Francophone Journal on Health and Territories .
Faguet, J. (2014). Can Subnational Autonomy Strengthen Democracy in Bolivia? Publius: The Journal of Federalism, 44, 51-81. https://doi.org/10.1093/publius/pjt020
Faguet, J., & Sánchez, F. (2014). Decentralization and Access to Social Services in Colombia. Public Choice, 160, 227-249. https://doi.org/10.1007/s11127-013-0077-7
Farooq, N. (2023). Fiscal Decentralization and Socioeconomic Implications in Pakistan: Focus on Pre & Post 7th NFC Award. Open Journal of Social Sciences, 11, 471-492. https://doi.org/10.4236/jss.2023.119031
Fouopi Djiogap, C., Manga, J. R. A., Onana, S. P., & Bitoto, F. E. (2024). Does Fiscal Decentralization Improve People’s Access to Health and Education Services in Cameroon? African Development Review, 36, 457-470. https://doi.org/10.1111/1467-8268.12770
Galiani, S., Gertler, P., & Schargrodsky, E. (2008). School Decentralization: Helping the Good Get Better, but Leaving the Poor Behind. Journal of Public Economics, 92, 2106-2120. https://doi.org/10.1016/j.jpubeco.2008.05.004
Hababa, H. Chakiri, L. Ouakhzan, B. and Nairi, N. (2021). The Challenges of Training and Human Capital Development in the Context of Regionalization. International Social Sciences and Management Journal, No. 4 , 1-33.
Habibi, N., Huang, C., Miranda, D., Murillo, V., Ranis, G., Sarkar, M. et al. (2003). Decentralization and Human Development in Argentina. Journal of Human Development, 4, 73-101. https://doi.org/10.1080/1464988032000051496
Hansen, L. P. (1982). Large Sample Properties of Generalized Method of Moments Estimators. Econometrica, 50, 1029-1054. https://doi.org/10.2307/1912775
Hanushek, E. A., Link, S., & Woessmann, L. (2013). Does School Autonomy Make Sense Everywhere? Panel Estimates from Pisa. Journal of Development Economics, 104, 212-232. https://doi.org/10.1016/j.jdeveco.2012.08.002
Hayek, F. A. (1945). The Use of Knowledge in Society. In Individualism and economic order. The American Economic Review, 35, 519-530.
Hayek, F. A. (1948). Free Enterprise and the Competitive Order. In F. A. Hayek, (Ed.), Individualism and Economic Order (pp. 107-118). University of Chicago Press.
Hoechle, D. (2007). Robust Standard Errors for Panel Regressions with Cross‐Sectional Dependence. The Stata Journal: Promoting Communications on Statistics and Stata, 7, 281-312.
Hounsounon, D. (2016). Decentralization and the Quality of Socio-Public Service Provision in Sub-Saharan A frica . Afrobarometer Working Paper No. 165.
Kessing, S. G., Lipatov, V., & Zoubek, J. M. (2020). Optimal Taxation under Regional Inequality. European Economic Review, 126, Article 103439. https://doi.org/10.1016/j.euroecorev.2020.103439
Khaleghian, P. (2004). Decentralization and Public Services: The Case of Immunization. Social Science & Medicine, 59, 163-183. https://doi.org/10.1016/j.socscimed.2003.10.013
Kleibergen, F., & Paap, R. (2006). Generalized Reduced Rank Tests Using the Sigular Value Decomposition. Journal of Econometrics, 133, 97-126. https://doi.org/10.1016/j.jeconom.2005.02.011
Kosycarz, E., Dędys, M., Ekes, M., & Wranik, W. D. (2023). The Effects of Provider Contract Types and Fiscal Decentralization on the Efficiency of the Polish Hospital Sector: A Data Envelopment Analysis across 16 Health Regions. Health Policy, 129, Article 104714. https://doi.org/10.1016/j.healthpol.2023.104714
Learmonth, A., & Curtis, S. (2013). Place Shaping to Create Health and Wellbeing Using Health Impact Assessment: Health Geography Applied to Develop Evidence-Based Practice. Health & Place, 24, 20-22. https://doi.org/10.1016/j.healthplace.2013.07.011
Lewbel, A. (2012). Using Heteroscedasticity to Identify and Estimate Mismeasured and Endogenous Regressor Models. Journal of Business & Economic Statistics, 30, 67-80. https://doi.org/10.1080/07350015.2012.643126
Lewis, B. D., & Smoke, P. (2017). Intergovernmental Fiscal Transfers and Local Incentives and Responses: The Case of Indonesia. Fiscal Studies, 38, 111-139. https://doi.org/10.1111/1475-5890.12080
Lewis, B. D., Nguyen, H. T. M., & Hendrawan, A. (2020). Political Accountability and Public Service Delivery in Decentralized Indonesia: Incumbency Advantage and the Performance of Second Term Mayors. European Journal of Political Economy, 64, Article 101910. https://doi.org/10.1016/j.ejpoleco.2020.101910
Litvack, J., & Seddon, J. (2000) Decentralization Briefing Notes. World Bank Institute. WBI Working Papers. Washington, DC.
Lovan, W. R., Murray, M., & Shaffer, R. (2017). Participatory Governance: Planning, Conflict Mediation and Public Decision-Making in Civil Society. Routledge.
Marlow, M. L. (1988). Fiscal Decentralization and Government Size. Public Choice, 56, 259-269. https://doi.org/10.1007/bf00130275
Martinez‐Vazquez, J., Lago‐Peñas, S., & Sacchi, A. (2017). The Impact of Fiscal Decentralization: A Survey. Journal of Economic Surveys, 31, 1095-1129. https://doi.org/10.1111/joes.12182
Miguel, E., & Zaidi, F. (2003). Do Politicians Reward Their Supporters? Public Spending and Incumbency Advantage in Ghana. Manuscript, University of California.
Maynard, A. (2003). Econometric Theory, by James Davidson, Blackwell Publishers, 2000. Econometric Theory, 19, 665-674. https://doi.org/10.1017/S0266466603004092
Musgrave, R. A. (1959). The Theory of Public Finance: A Study in Public Economy. McGraw-Hill.
Nchofoung, T., Asongu, S., Njamen Kengdo, A., & Achuo, E. (2022). Linear and Non-Linear Effects of Infrastructures on Inclusive Human Development in Africa. African Development Review, 34 , 81-96. https://doi.org/10.2139/ssrn.3866445
Ngounou, B. A., Tekam Oumbe, H., Ongo Nkoa, B. E., & Noubissi Domguia, E. (2024). Inclusive Growth in the Face of Increasing Urbanization: What Experience for African Countries? Review of Development Economics, 28, 34-70. https://doi.org/10.1111/rode.13026
Oates, W. E. (1972). Fiscal Federalism. Harcourt Brace Jovanovich, New York. Polity IV Dataset.
OATES, W. E. (1993). Fiscal Decentralization and Economic Development. National Tax Journal, 46, 237-243. https://doi.org/10.1086/ntj41789013
Olatona, J. B., & Olomola, P. A. (2015). Analysis of Fiscal Decentralization and Public Service Delivery in Nigeria. Journal of Economics and Sustainable Development, 6 , 107-119.
Onana, S. P., & Tchitchoua, J. (2020). Decentralization and Access to Basic Social Services in Cameroon. Annals of the University d’Alger, 34, 929-946.
Pal, S., & Roy, J. (2010). Fiscal Decentralization and Development: How Crucial Is Local Politics? (No. 5286). IZA Discussion Papers. No. 5286, Institute for the Study of Labor (IZA), Bonn. https://doi.org/10.2139/ssrn.1700455
Pasichnyi, M., Kaneva, T., Ruban, M., & Nepytaliuk, A. (2019). The Impact of Fiscal Decentralization on Economic Development. Investment Management and Financial Innovations, 16, 29-39. https://doi.org/10.21511/imfi.16(3).2019.04
Pasquier, R., Guigner, S., & Cole, A. (2020). Dictionary of Territorial Policies. Presses de Sciences Po.
Pesaran, M. H. (2015). Testing Weak Cross-Sectional Dependence in Large Panels. Econometric Reviews, 34, 1089-1117. https://doi.org/10.1080/07474938.2014.956623
Prud’homme, R. (1995). The Dangers of Decentralization. The World Bank Research Observer, 10, 201-220. https://doi.org/10.1093/wbro/10.2.201
Ramey, V. A. (2020). The Macroeconomic Consequences of Infrastructure Investment (No.cl4366). National Bureau of Economics Research.
Ramos, R., Surinach, J., & Artís, M. (2012). Regional Economic Growth and Human Capital: The Role of Over-Education. Regional Studies, 46 , 1389-1400. https://doi.org/10.1080/00343404.2012.675140
Republic of Cameroon, & United Nations Development Programme (2020). National Human Development Report 2019: Inclusive Growth, Inequalities and Exclusion .
Rodden, J. (2002). The Dilemma of Fiscal Federalism: Grants and Fiscal Performance around the World. American Journal of Political Science, 46, 670-687. https://doi.org/10.2307/3088407
Salmon, P. (1987). Decentralisation as an Incentive Scheme. Oxford Review of Economic Policy, 3, 24-43. https://doi.org/10.1093/oxrep/3.2.24
Saltman, R. B., & Bankauskaite, V. (2006). Conceptualizing Decentralization in European Health Systems: A Functional Perspective. Health Economics, Policy and Law, 1, 127-147. https://doi.org/10.1017/s1744133105001209
Sanogo, T. (2018). Budgetary Policy and Inclusive Development: What Contribution of Decentralization in Côte d’Ivoire? Doctoral Dissertation, Clermont Auvergne University.
Seabright, P. (1996). Accountability and Decentralisation in Government: An Incomplete Contracts Model. European Economic Review, 40, 61-89. https://doi.org/10.1016/0014-2921(95)00055-0
Soura, B. D., & Coulibaly, S. S. (2014). Analysis of the Healthcare Service Decentralization Process in Côte d’ivoire. Médecine et Santé Tropicales, 24, 151-156. https://doi.org/10.1684/mst.2013.0255
Sumah, A. M., Baatiema, L., & Abimbola, S. (2016). The Impacts of Decentralisation on Health-Related Equity: A Systematic Review of the Evidence. Health Policy, 120, 1183-1192. https://doi.org/10.1016/j.healthpol.2016.09.003
Thanh, S. D., & Canh, N. P. (2020). Fiscal Decentralization and Economic Growth of Vietnamese Provinces: The Role of Local Public Governance. Annals of Public and Cooperative Economics, 91, 119-149. https://doi.org/10.1111/apce.12255
Tiebout, C. M. (1956). A Pure Theory of Local Expenditures. Journal of Political Economy, 64, 416-424. https://doi.org/10.1086/257839
Winchester, M. S., & King, B. (2018). Decentralization, Healthcare Access, and Inequality in Mpumalanga, South Africa. Health & Place, 51, 200-207. https://doi.org/10.1016/j.healthplace.2018.02.009
Wooldridge, J. M. (2013) Introductory Econometrics: A Modern Approach (5th Edition). South-Western/Cengage Learning.
World Bank (2013). World Development Indicators 2013 (English) . World Bank Group. http://documents.worldbank.org/curated/en/449421468331173478/Worlddevelopmentindicators2013