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Abstract Decentralization reform has both advantages and risks. Bringing service delivery “closer to the people” can improve information flows and strengthen accountability, but it may also leave systems vulnerable to elite capture and corruption by municipal government officials. While past research has acknowledged the possibility of corruption under decentralization, relatively little work has connected those risks to features of these reforms or specific local institutional arrangements. To explore the conditions that can help mitigate the risks of corruption under decentralization, we study the case of health sector reform in Honduras where municipal governments, associations, and NGOs each serve as intermediary-managing organizations under a common decentralized health service delivery model. We argue that three types of institutional arrangements reflecting local accountability practices serve as checks on the authority granted through decentralization and can help guard against corruption: external supervision, civil society engagement, and public participation. Empirically, we draw on data from more than 600 street-level bureaucrats, valuable but under-utilized informants about municipal corruption, across a matched sample of 65 municipalities with contrasting forms of administration. We find that reported corruption is highest under decentralization led by municipal governments, as compared to association- or NGO-led varieties. Both external supervision and civil society engagement help attenuate the positive association between decentralization and corruption, but public participation does not. Overall, this research highlights the importance of considering reform features and local conditions when designing policies to help manage risks and support effective social sector decentralization. 

Abstract Scholars and practitioners often promote direct engagement between policymakers, health workers and researchers as a strategy for overcoming barriers to utilizing scientific knowledge in health policy. However, in many settings public health officials rarely have opportunities to interact with researchers, which is a problem further exacerbated by the coronavirus disease 2019 pandemic. One prominent theory argues that policy actors will trust and utilize research findings when they perceive them to be salient, credible and legitimate. We draw on this theory to examine the conditions facilitating greater uptake of new knowledge among health officials when engagement is out of reach and they are instead exposed to new ideas through written mass communication. Using data from a survey experiment with about 260 health workers and administrators in Honduras, we find that messages from a technocratic sender based on statistical evidence improved perceptions of salience, credibility and legitimacy (SCL). Additionally, perceptions of SCL are three contextual features that operate as joint mediators between knowledge and action, and several individual characteristics also influence whether officials trust research findings enough to apply them when formulating and implementing health policies. This research can help inform the design of context-sensitive knowledge translation and exchange strategies to advance the goals of evidence-based public health, particularly in settings where direct engagement is difficult to achieve. 

Governance reforms like decentralization and performance-based management aim to improve public services by increasing accountability among street-level bureaucrats: bureaucrats may be held to account by communities, supervisors, intermediary organizations, or all of these. To assess the relationship between accountability and bureaucratic effort, we utilize data from a lab-in-the-field behavioral experiment conducted with Honduran health workers across decentralized and centrally administered municipalities. We presented health workers with an incentivized effort task that included instructions that were neutral, had a bottom-up political accountability prompt, or a top-down bureaucratic accountability prompt. Our results show that administrative context moderates the accountability-to-effort relationship. With neutral instructions, civil servants in decentralized systems exert greater quality effort than their counterparts under centralized administration. Importantly, both accountability prompts increase quality effort in centrally administered settings to levels comparable with those in decentralized settings. These findings support multiple accountability as a potentially important mechanism linking decentralization reform to improved service delivery. 

Abstract Collective action among public officials is necessary for the effective delivery of many social services, but relatively little is known about how it can be fostered through policy reforms. In this article, we compare cooperation among public officials within decentralized versus centrally‐administered municipalities in Honduras. Leveraging a quasi‐experiment in health sector reform, coupled with behavioral games and social network surveys, we find that decentralization is associated with greater cooperation. When they are able to communicate, health sector workers in decentralized municipalities contribute more to a public good than their centrally‐administered counterparts. This increase in cooperative behavior results in part from the decentralization reform engendering greater numbers of interactions and stronger ties across different levels of government. These findings indicate that institutional reforms like decentralization can favorably reconfigure patterns of social interactions across public organizations, which is an important component of administrative capacity in developing countries.