What Local Governments Can Learn from Participatory Budgeting in Kenya
Participatory budgeting is widely promoted as a way to strengthen local democracy, but evidence on its effects on concrete development outcomes – especially health – remains limited.
This policy brief summarises findings from a randomised controlled trial in rural Kenya that tested three forms of citizen participation – consultation, voting, and deliberation – in decisions over local health investments. The results are striking. Villages that used participatory budgeting experienced reductions in infant mortality relative to villages using standard top-down decision-making. More structured forms of participation, especially voting and deliberation, produced the deepest eductions. These approaches also increased citizens’ sense of fairness, trust in local government, and willingness to contribute time and
effort to maintaining public goods.
The central lesson is clear: participation works, but how it is designed matters. Moving beyond token consultation toward structured, inclusive participation can save lives while strengthening democratic governance.