Gauri and Khaleghian use cross-national social, political, bureaucratic elites have an affinity for immunization economic, and institutional data to explain why some programs and are granted more autonomy in autocracies, countries have stronger immunization programs than although this effect is not visible in low-income others, as measured by diptheria-tetanus-pertussis (DTP) countries. The authors also find that the quality of a and measles vaccine coverage rates and the adoption of nation's institutions and its level of development are the hepatitis B vaccine. After reviewing the existing strongly related to immunization rate coverage and literature on demand-and supply-side factors that affect vaccine adoption, and that coverage rates are in general immunization programs, the authors find that the more a function of supply-side than demand effects. elements that most affect immunization programs in low-There is no evidence that epidemics or polio eradication and middle-income countries involve broad changes in campaigns affect immunization rates one way or another, the global policy environment and contact with or that average immunization rates increase following international agencies. Democracies tend to have lower outbreaks of diphtheria, pertussis, or measles. coverage rates than autocracies, perhaps because This paper-a product of Public Services, Development Research Group-is part of a larger effort in the group to study the political economy of basic service delivery. Copies of the paper are available free from the World Bank,

Khaleghian studies the Impact of political the two groups. In the low-income group, development decentralization on childhood immunization, an essential assistance reduces the gains from decentralization. In the public service provided in almost all countries. He middle-income group, democratic government mitigates examines the relationship empirically using a time-series the negative effects of decentralization, and data set of 140 low-and middle-income countries from decentralization reverses the negative effects of ethnic 1980 to 1997. The author finds that decentralization has tension and ethno-linguistic fractionalization, but different effects in low-and middle-income countries. In institutional quality and literacy rates have no interactive the low-income group, decentralized countries have effect either way. Similar results are obtained whether higher coverage rates than centralized ones, with an decentralization is measured with a dichotomous average difference of 8.5 percent for measles and DTP3 categorical variable or with more specific measures of vaccines. In the middle-income group, the reverse effect fiscal decentralization. The study confirms predictions in is observed: decentralized countries have lower coverage the theoretical literature about the negative impact of rates than centralized ones, with an average difference of local political control on services that have public goods 5.2 percent for the same vaccines. Both results are characteristics and inter-jurisdictional externalities. The significant at the 99 percent level. Modifiers of the author discusses reasons for the difference between lowdecentralization-immunization relationship also differ in and middle-income countries.This paper-a product of Public Services, Development Research Group-is part of a larger effort in the group to study the delivery of essential health services. Copies of the paper are available free from the World Bank,

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This paper provides an overview of how different approaches to improving public sector management relate to so-called core or essential public health functions such as disease surveillance, health education, monitoring and evaluation, workforce development, enforcement of public health laws and regulations, public health research, and health policy development. The paper summarizes key themes in the public management literature and draws lessons for their application to these core functions.

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