The development of institutions of self-governance in India, and specifically the 2005 reform - the National Rural Health Mission that introduced village health and sanitation committees - provide a unique opportunity to study the effects of the strengthening of the political agency on collective healthcare decision-making in rural areas. We use data from the District Level Household Survey and take advantage of the heterogeneity of maternal and child healthcare use, before and after the introduction of village health and sanitation committees. Specifically, we examine the effect of village health and sanitation committees on use of both public and preventive healthcare among children. Our results suggest that local democracy has increased access to preventive child healthcare services. Part of the effect is driven by an increase in the utilization of the public healthcare network. We find some evidence of an effect of village residence heads of a Panchayat on preventive healthcare use.
decentralization direct democracy India immunization maternal healthcare public healthcare