Date of Award

Spring 1-1-2013

Document Type


Degree Name

Master of Arts (MA)


Political Science

First Advisor

Krister Andersson

Second Advisor

Andy Baker

Third Advisor

Anand Sokhey


Poor, rural citizens in developing countries have access to fewer health services and experience worse health outcomes than their richer, urban counterparts. While numerous governments have decentralized their health systems in response to this disparity, we have little evidence on whether these systems are producing healthier citizens. In this paper I investigate the effectiveness of decentralized health service delivery models in the department of Intibucá, Honduras. I implement a difference-in-differences research design at the sub-regional level, creating a new longitudinal dataset that links quantitative health outcome data with original survey data as well as socio-economic and institutional information. My analysis shows that the average effect of decentralization on the decentralized health centers is an annual increase of 1,205 family planning consultations, 2,407 prenatal consultations, and 662 postpartum consultations, and that information, accountability, and connectedness may be key causal mechanisms. These results are robust to specifications including covariates, excluding compositional differences, and using weighted estimation; they also pass falsification tests using placebo treatments, placebo dependent variables, and outcome randomization. Most importantly, this analysis suggests that health sector governance reforms can generate positive incremental improvements in health outcomes for women, and thus possibly lead to wider change with respect to household well-being and economic development across rural communities.