Place-Sensitive Policies in the Provision of Subnational Public Goods in Colombia

Abstract

What causes stark differences in living standards between subnational units? What can countries do to lessen such variations? This article argues that there is an aspect of national policy frameworks that impacts subnational provision of social services: the sensitivity of policy to the particularities of place. Place-sensitive policies make adaptations to the way social services are organized and provided across a country, so that they are better equipped to deal with the different characteristics of places and better support their well-being. When policies are place-sensitive, subnational provision is facilitated in poor, rural, and marginal locations in a country. In contrast, place-blind policies employ a one-size-fits-all approach that excludes people in vulnerable areas and aggravates inequalities in social service provision and social outcomes. By studying the Colombian case, this article demonstrates that a key placeblind feature of its healthcare model disproportionately affects small localities.

Territorial Inequality in Health Service Delivery: Lessons from Latin America’s Federations

“…In other words, these works do not account for cross-national differences in territorial healthcare inequality. Otero-Bahamón (2016, 2019) is, to our knowledge, the only scholar who has directly tackled the puzzle of cross-national variation in (subnational) territorial inequality. She argues that territorial equalization in the provision of public goods is a result of a dyad of autonomous technocrats and weakened subnational political elites.…”

“…Equalization flows from this dyad in the form of two mechanisms: place-sensitive policy formation and controlled decentralization 7 . Drawing on evidence from Colombia’s education sector and Peru’s healthcare system, Otero-Bahamón (2016, 2019) shows that both countries have reduced territorial inequalities when national technocrats became autonomous and subnational political elites weakened.…”

“…According to Otero-Bahamón (2016, 2019), controlled decentralization is key for explaining increases and decreases in territorial inequality. Specifically, she contends that the ability of national technocrats to control the process of decentralization or to recentralize functions, so that the central administration controls a policy area (i.e., healthcare or education), reduces territorial inequalities.…”

“…The study tests this explanation in Argentina, Brazil, and Mexico, the region’s three largest federal countries. It uses Otero-Bahamón’s operationalization (2016, 2019) to calculate a measure of territorial healthcare inequality and to assess and compare long-term trajectories of change. The analysis shows that Brazil’s bottomup decentralizing coalition generated a political commitment to reducing territorial inequality in health.…”

“…It also discusses and rules out potential alternative explanations. Then it presents the argument about the determinants of trajectories of territorial healthcare inequality and discusses the need to develop measures of territorial inequality, presenting an operationalization proposed by Otero-Bahamón (2016, 2019). The analysis examines change in that measure across time in Argentina, Brazil, and Mexico.…”