higher share of health, on average, but this is only marginally significant. Lame-duck mayors are associated with lower share of health spending on average, a result that is consistent with the pattern observed in Table 2b of reduced health services and poorer outcomes at the village-level.

As indicated at the outset, a critical problem with the interpretation of the correlations between vote buying and access to health services is whether each is impacted independently by another set of variables such that there is little direct connection between the politics of clientelism and poor delivery of services. We argue that these concerns are attenuated by the wide array of results reported above which control for several variables—poverty, population, barangay location, household social capital, other indicators of municipal political competition— that could, potentially, be independently correlated with both vote buying and health services.

Additional results are available using household-level data to support the main results of the paper. Surveyed household respondents—who are young mothers—reported whether they received folic acid and iron supplements during pregnancy, and whether their children received iron supplements. In contrast to these supplements, whose supply can depend on actions of other politicians outside the municipality, the household survey also provides respondent-reported information on access to birthing assistance, a key health service provided by municipal health personnel (midwives and barangay health workers). Nutritional supplements are, however, also distributed by municipal health personnel, and are typically affordable within municipal budgets (as is evidenced by their showing-up as some of the village health projects financed by the municipal government).

The distribution of nutritional supplements might be compatible with or complementary to clientelist political strategies, as in the findings of Nichter (2011) in Brazil, and therefore not exhibit a negative association with vote buying.<sup>29</sup> Furthermore, household-level access to birthing assistance might also be potentially subject to clientelist targeting, with assistance provided conditional upon political support. Nichter (2011) suggests that in Brazil access to female sterilization, and generally to receiving attention from public health providers, can be subject to political manipulation rather than being broadly delivered. Could household-level measures of access to health services show a different association with vote buying than the measures obtained from government-records, and emphasized as the main results of the paper? Additionally, does access to birthing assistance exhibit a different or more robust correlation with vote buying than access to nutrition supplements, which might be relatively more amenable to clientelist targeting, and to influence from higher tier politicians?

To address these questions, we estimate the following specification with household data: HouseholdAccessijkl = δ0 + δ1VoteBuyingjkl + XijklBδh � + Wjklδb + Zklδm + θl + ωijkl (4) The dependent variables for access to health services reported by household _i_ , living in barangay _j_ , of municipality _k_ , in congressional district _l_ , consists in turn of the percentage of pregnancies for which the respondent reports receiving assistance from a trained municipal

> 29 On the other hand, political strategies that provide clientelist benefits in between elections might be traded-off against vote buying at the time of elections.

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