Democracy is not enough: Accountability, international organizations, and the politics social good distribution

Katie Anne Cahill, Purdue University


Why are some developing states more successful at distributing necessary goods and services to their population than others? Using a large- N multi-level dataset on childhood immunization of over 200,000 children across 50-countries and extensive fieldwork, I examine the role and importance of accountability in distributional decision-making and programmatic successes. For this study, I conducted over nine months of fieldwork in three Indian states (Uttar Pradesh, Maharashtra, and West Bengal), and in Dhaka, the capitol of Bangladesh. My field interviews with national, sub-national, and international actors in these locations illustrated the variation in the nature and structure of accountability partnerships. These analyses point to the minor influence of democratic institutions and the overarching importance of international involvement; a stark departure from much of the research on this topic. Using a nested analysis and mixed methods research design, I find that the presence of internal accountability, or democratic elections, is not a sufficient explanation for social good distribution. The minor effect of regime type in my preliminary and secondary statistical analyses, and in my qualitative field research, suggest that whether or not a country is a democracy is unlikely to predict the likelihood that a child is fully immunized. Instead, the presence of external accountability, vis-à-vis mechanisms tied to funding and monitoring by international organizations, may be a sufficient condition for ensuring that 80% of children are reached with child immunizations; the general standard for herd immunity and the level of coverage committed to by every country in the world. In addition, an examination of the impact of foreign aid on outcomes shows that external involvement can be “trump card” that can help a country to overcome the lack of accountability, capability, and any feasibility challenges. Contrary to much of the literature on this topic, my research suggests that democracy is not enough to ensure that social goods are distributed to those in most need of them.




Boling, Purdue University.

Subject Area

Public health|Political science|Public policy

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