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Corruption in public health 73
Figure 1 demonstrates the relationship between governance
indices and measures of health performance and outcomes. Measles
immunization coverage provides a robust measure of public service
performance as it reflects government’s ability to perform a critical
and basic health service. Measles immunization by itself is particularly
important since when administered in infancy it sharply
reduces all causes of mortality in childhood (Koenig et al., 1991;
Aaby 1995). It is also easily measured. Child mortality is a standard
variable for measuring health outcomes, is influenced by a wide
range of factors beyond the quality and extent of health care
services, but has the advantage that it is available for a large
number of countries.
The six panels in Figure 1 show the scatter plots for both indicators
and each of the three components of the KKM governance
index: government effectiveness, control of corruption, and voice
and accountability. Of the three measures, and compared to the
aggregate governance indicator (not shown), government effectiveness
best correlates with poor outcomes and performance in health
care based on the smaller variation conveyed in the adjust R2. 1 Voice
has the least explanatory power and it is especially limited for
immunization coverage. The panel on voice and accountability
suggests why. The highly variable relationship especially among the
countries with the lowest governance scores makes any effort to
explain variation unconvincing. In higher performing countries
more convergence occurs for government effectiveness and control
of corruption but much less so for voice. Immunization programs
are typically the responsibility of central governments because it is
a preventive measure for which demand tends to be low among all
but the most educated. 2 The dispersion in the voice and accountability
panel is consistent with that fact.
Table 1 provides OLS results showing the strength of governance
measures on measles immunization coverage controlling for
other relevant factors. Of the various governance indices, government
effectiveness explains more of the differences in measles
immunization and has a slightly stronger effect than the overall