In 2013, Kenya shifted to a devolved government system with 47 counties, each at varying levels of development. Nairobi and Kiambu topped the list, while Turkana, Mandera, and Wajir lagged behind. To address these disparities, the national government introduced targeted fiscal transfers. These funds went to the 14 most disadvantaged counties, dubbed "marginalized. " The goal? To boost their social and economic standing. But did these special funds truly improve health outcomes? To find out, researchers used a technique called difference-in-differences.

When Kenya decentralized, it hoped to even the playing field. The national government started sending extra money to the counties that needed it most. These transfers aimed to help the lagging counties catch up. But did they work? Researchers compared health outcomes in these counties before and after the transfers, as well as in counties that didn't receive extra funds.

The study found mixed results. While some health indicators improved, others didn't. It seems that simply sending money isn't enough. How the money is used matters too. Some counties might have struggled to spend the funds effectively.

This isn't just about Kenya. Many countries use targeted funds to help underdeveloped regions. Understanding what works and what doesn't can help improve these strategies. It's not just about the money, but also about how it's used.

Do Targeted Funds Make a Difference in Kenyan Health?

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