Healthcare for All: Confronting Ethnic Favouritism in Access to Care

Abstract

Ethnic favouritism is a key aspect of development in Africa. Studies show that the ethno-regional homelands of prominent leaders experience stronger nighttime light illumination, reflecting increased economic activity. Access to public services, such as healthcare and roads, is also greater in areas tied to powerful political actors. This study examines Ethiopia’s 20-year health sector expansion program, aiming to provide nuanced evidence of favouritism by evaluating a national policy with well-defined objectives and timelines. To isolate the program’s effect, the study evaluates outcomes such as access to institutional delivery, skilled birth attendance, vaccination rates, antenatal care and child survival indicators. Employing a difference-in-differences empirical strategy, the findings provide strong evidence of expanding primary healthcare services in areas ethnically aligned with the government. In sum, while the entire country benefited from the program, it led to a significant divergence in access to and utilisation of healthcare services. The study attributes the disparity primarily to favouritism, with the coethnic group growing faster while marginalised ethnic groups lag behind.