The rapid development of digital technologies such as blockchain and distributed ledger-based systems holds transformative potential for the financial sector. Promising applications include asset management as well as peer-to-peer networks for the transparent exchange of data and information. International climate finance stands to benefit in particular ways from these new opportunities in financial technology. Distributed ledger technologies could be leveraged to support climate action, for example by facilitating transparent and standardized transactions, or by enabling more efficient monitoring and accreditation processes. In view of these promising opportunities, we focus our inquiry on the case of the Green Climate Fund to explore how distributed ledger technologies can be used for innovative climate finance. Based on our analysis of different digital system models and potential use cases, we then discuss some of the technical and political challenges that may arise, for example with regard to standards and safeguards, governance processes, country ownership, and further capitalization. Our findings show that distributed ledger-based systems could benefit the work of the fund in key areas such as multi-stakeholder coordination and impact assessment. However, our analysis also points to the concrete limitations of technology driven solutions. Digital technologies are not a standalone solution to persistent resource allocation and governance challenges in international climate finance, especially because the design and deployment of these digital systems is inherently political.
Distributed ledger technology is envisioned as one of the cornerstones of promising solutions for building the next generation of critical applications.However, there is still quite a bit of confusion and hype around the real security guarantees this technology offers.This is especially due to the fact that for the vast majority of existing blockchain-based consensus protocols it is really hard to find sufficiently detailed documentation that fully captures their behavior.A number of recent papers have formalized the behavior of Bitcoin-like protocols in order to rigorously study the security and privacy properties of their underlying structure, but surprisingly very little work has been devoted to the formalization of distributed ledger systems using BFTlike approaches.In this work, we focus on XRP Ledger, better known as Ripple, and take the first steps towards the complete formalization of its consensus protocol.To this end, we have investigated all the existing documentation and analyzed its source code.We present a formal description of its consensus protocol for every step.Furthermore, we provide an accurate view of its security guarantees in terms of safety and liveness and show how to increase the desired tolerance by changing the value of specific protocol parameters.
The current land registration process involves a lot of vulnerabilities and people uses it to cheat the common people and the government. This paper discusses about a secure land registry implemented using blockchain which works on the basis of majority consensus. By implementing the land registry in blockchain, the security issue is resolved to a great extent. The hash value calculated for each block will be unique as it is linked to the hash of the previous block. The algorithm that is used for hashing is SHA256. Along with SHA256, Proof Of Work(PoW) algorithm is also used which makes the information related to each transaction more secure. Message digest that is generated for each block is of fixed size and each hash represents a complete set of transaction within a given block. The proposed land registry blockchain network consists of 12 nodes which calculates the proof of work. Nodes are responsible for verifying a transaction, mining a new block and adding the new block to the blockchain. A total of 200 land transactions are recorded using the blockchain methodology which offers a tamper proof and updated version of land registry. Elliptic curve cryptographic algorithm is used for signature generation which is used for verifying whether the transaction is signed by the owner or not. Merkle tree is used for linking the transactions using hash and in turn reduces the disk usage. The proposed implementation of land registry using blockchain thus offers a 99% reduction in manual effort spent in record keeping.
Blockchain is a point-to-point distributed ledger technology based on cryptographic algorithms. However, the open and transparent blockchain ledger supplemented by statistical methods such as sociological mining and data mining has caused users' privacy to face major threats. Therefore, privacy protection has become a focus of current blockchain technology research. Ring signature technology is a commonly used encryption technology in the field of privacy protection. Therefore, this paper constructs a blockchain privacy protection scheme based on ring signature. This solution built a privacy data storage protocol based on the ring signature on the elliptic curve, and used the complete anonymity of the ring signature to ensure the security of data and user identity privacy in blockchain applications. The correctness and safety proof analysis of the proposed scheme were also carried out.
Open access
Blockchain Technology Applications and Security
Privacy-Preserving Technologies in Data
Advanced Steganography and Watermarking Techniques
Abir El Azzaoui, Sushil Kumar Singh, Yi Pan, Jong Hyuk Park
Nowadays, 5G network is considered to be one of the main pillars of various industries, including the Internet of Things (IoT), smart cities, virtual reality, and many more. Unlike previous network generations, 5G utilizes complex digital technologies such as massive Multiple Input Multiple Output (mMIMO) and runs over higher radio frequencies. The introduction of new technologies and advanced features in the 5G network raises new challenges for network operators, and merging Artificial Intelligence (AI) is one of the effective solutions to address these complexities. However, AI-enabled 5G network engenders security concerns and requires improvement to meet the standardization and qualification of the new network generation. To mitigate these dilemmas, Blockchain must be integrated. Blockchain, as a decentralized methodology provides a secure sharing of information and resources among various nodes of 5G environments. Blockchain can support other technologies, such as AI-based 5G, to create smarter, more efficient, and secure cellular networks. In this article, we present a comprehensive intelligence and secure data analytics framework for 5G networks based on the convergence of Blockchain and AI named “Block5GIntell”. We depict the applications of Blockchain and AI on 5G networks separately and we argue on the support that Blockchain can provide for AI to create smart and secure 5G networks relying on our proposed framework. To support our proposition, we present an energy-saving case study using Blockchain for AI-enabled 5G. The simulation shows an overall 20% decrease in energy consumption at the RAN level.
A supply chain consists of many stakeholders such as suppliers, carriers and customers. It is often complex due to the rapid development of economic globalization and the intense competition pressure in the market which resulted in information sharing within a supply chain to be fragmented. Blockchain technology can solve this problem by having only a “one trusted ledger” that could reshape the element of data trust. The goal of this paper is to identify and understand the impact of blockchain technology for information sharing within a supply chain. The decentralized nature of blockchain technology offers a high level of transparency and has gained the attention from various sectors to deploy this technology. A systematic literature review in the academic literature was conducted using different databases. Blockchain-enabled information sharing can add value to enhance collaborative work in different types of supply chains such as health and medical, construction and smart city. From our findings, one potential impact of deploying blockchain-enabled information sharing within a supply chain is that it ensures all members in the chain can obtain verified information which enhances collaborative partnerships. Through this in-depth research, we highlighted potential barriers that could impede the development of blockchain technology in supply chain such as the lack of understanding of blockchain technology in businesses and conflict of interests. Future work such as information hiding, in parallel with information sharing, could close the gap in deploying this technology within a supply chain. Understanding the nature of different supply chain is also important to better prepare the deployment of blockchain. We acknowledge that our approach in selecting literatures in our systematic review may exclude certain literatures. Nonetheless, we tried to include as many relevant literatures as possible, to develop a roadmap on the current situation of blockchain-enabled information sharing within a supply chain.
The rapid changes in textile and clothing industry's operational environment in which apparel businesses are collaborating with their suppliers and customers have recognized interoperability of information systems as an important factor. The need to address this challenge becomes vital in the context of new paradigms such as the Internet of Things (IoT), and its ability to capture realtime information from different parts of textile and cloth manufacturing value chain by using Radio Frequency Identification (RFID) tags and sensors-based data communication networks. In this process, enterprise information system architecture plays an important role in storing, processing, and distributing data. Despite contributing to the rapid development of IoT applications, the current IoT-centric architecture has led to a myriad of isolated data silos. This paper presents a blockchain-based architecture for the IoT applications, which brings distributed data management to support transactions services within a multi-party apparel business supply chain network.
In modern healthcare systems, the ability to share electronic health records is crucial for providing quality care and for enabling a larger spectrum of health services. Health data sharing is dependent on obtaining individual consent which, in turn, is hindered by a lack of resources. To this extent, blockchain-based platforms facilitate data sharing by creating a trusted distributed network of users. These users are enabled to share their data without depending on the time and resources of specific actors (such as the health services). In blockchain-based platforms, data governance mechanisms become very important due to the need to specify and monitor data sharing and data use conditions. In this article, we present a blockchain-based data-sharing consent model for access control over individual health data. We use smart contracts to dynamically represent the individual’s consent over health data and to enable data requesters to search and access those data. The dynamic consent model extends to two ontologies: the Data Use Ontology (DUO) which models the individual consent of users and the Automatable Discovery and Access Matrix (ADA-M), which describes queries from data requesters. We deploy the model on Ethereum blockchain and evaluate different data sharing scenarios. The contribution of this article consists of the creation of an individual consent model for health data sharing platforms. Such a model guarantees that individual consent is respected and that all the participants in the data sharing platform are accountable. The evaluation of our solution indicates that such a data sharing model provides a flexible decision-making approach over data usage by data requesters. Our experimental evaluation shows that the proposed model is efficient and adapts to personalized access control policies in different data-sharing scenarios.
Saleh, Omar S., Ghazali, Osman, Rana, Muhammad Ehsan
Document verification is a complex domain that involves various challenging and tedious processes to authenticate. Moreover various types of documents for instance banking documents, government documents, transaction documents, educational certificates etc. might involve customized verification and authentication practices. The content for each type vary significantly, hence requires to be dealt in a distinct manner. For students, educational certificates are the most important documents issued by their universities. However, as the issuing process is not that transparent and verifiable, fake certificates can be easily created. A skil fully generated fake certificate is always hard to detect and can be treated as the original. With the increase of forged documents, credibility of both the document holder and the issuing authority is jeopardized. Blockchain technology has recently emerged as a potential mean for authenticating the document verification process and a significant tool to combat document fraud and misuse. This research aimed to enhance the document verification process using blockchain technology. In this research, authors have identified the security themes required for document verification in the blockchain. This research also identifies the gaps and loopholes in the current blockchain based educational certificate verification solutions. At the end, a blockchain based framework for verifying educational certificates focusing on themes including authentication, authorization, confidentiality, privacy and ownership is proposed using the Hyperledger Fabric Framework.
The exponential growth of the blockchain size has become a major contributing factor that hinders the decentralisation of blockchain and its potential implementations in data-heavy applications. In this paper, we propose segment blockchain, an approach that segmentises blockchain and enables nodes to only store a copy of one blockchain segment. We use \emph{PoW} as a membership threshold to limit the number of nodes taken by an Adversary---the Adversary can only gain at most $n/2$ of nodes in a network of $n$ nodes when it has $50\%$ of the calculation power in the system (the Nakamoto blockchain security threshold). A segment blockchain system fails when an Adversary stores all copies of a segment, because the Adversary can then leave the system, causing a permanent loss of the segment. We theoretically prove that segment blockchain can sustain a $(AD/n)^m$ failure probability when the Adversary has no more than $AD$ number of nodes and every segment is stored by $m$ number of nodes. The storage requirement is mostly shrunken compared to the traditional design and therefore making the blockchain more suitable for data-heavy applications.
Abstract We make a distinction between centralized, decentralized, and distributed payment mechanisms. A centralized payment mechanism processes a transaction using a trusted third party. A decentralized payment mechanism processes a transaction between the parties to the transaction. A distributed payment mechanism relies on the network of users to process a transaction on a shared ledger. We maintain that bitcoin is neither a centralized nor a decentralized payment mechanism. It is, instead, a distributed payment mechanism. We then consider decentralized and centralized aspects of the broader bitcoin payment space.
Bitcoin is the oldest and most widely established cryptocurrency network with the highest market capitalization among all cryptocurrencies. Although bitcoin (with lowercase b) is increasingly viewed as a digital asset belonging to a new asset class, the Bitcoin network (with uppercase B) is a decentralized financial market infrastructure (“dFMI”) that clears and settles transactions in its native asset without relying on the conventional financial market infrastructures (“FMIs”). To be a reliable asset class as well as a dFMI, however, Bitcoin needs to have robust governance arrangements; whether such arrangements are built into the protocol (i.e., on-chain governance mechanisms) or relegated to the participants in the Bitcoin network (i.e., off-chain governance mechanisms), or are composed of a combination of both mechanisms (i.e., a hybrid form of governance). This paper studies Bitcoin governance with a focus on its alleged shortcomings. In so doing, after defining Bitcoin governance and its objectives, the paper puts forward an idiosyncratic governance model whose main objective is to preserve and maximize the main value proposition of Bitcoin, i.e., its censorship-resistant property, which allows participants to transact in an environment with minimum social trust. Therefore Bitcoin governance, including the processes through which Bitcoin governance crises have been resolved and the standards against which the Bitcoin Improvement Proposals (“BIPs”) are examined, should be analyzed in light of the prevailing narrative of Bitcoin as a censorship-resistant store of value and payment infrastructure. Within such a special governance model, this paper seeks to identify the potential shortcomings in Bitcoin governance by reference to the major governance crises that have posed serious threats to Bitcoin in the last decade. It concludes that the existing governance arrangements in the Bitcoin network have been largely successful in dealing with Bitcoin’s major crises that would have otherwise become existential threats to the network.
Abstract This paper studies a large number of bitcoin (BTC) options traded on the options exchange Deribit. We use the trades to calculate implied volatility (IV) and analyze if volatility forecasts can be improved using such information. IV is less accurate than AutoRegressive–Moving‐Average or Heterogeneous Auto‐Regressive model forecasts in predicting short‐term BTC volatility (1 day ahead), but superior in predicting long‐term volatility (7, 10, 15 days ahead). Furthermore, a combination of IV and model‐based forecasts provides the highest accuracy for all forecasting horizons revealing that the BTC options market contains unique information.
Latif U. Khan, Ibrar Yaqoob, Muhammad Imran, Zhu Han · 5 authors
Internet of everything (IoE)-based smart services are expected to gain immense popularity in the future, which raises the need for next-generation wireless networks. Although fifth-generation (5G) networks can support various IoE services, they might not be able to completely fulfill the requirements of novel applications. Sixth-generation (6G) wireless systems are envisioned to overcome 5G network limitations. In this article, we explore recent advances made toward enabling 6G systems. We devise a taxonomy based on key enabling technologies, use cases, emerging machine learning schemes, communication technologies, networking technologies, and computing technologies. Furthermore, we identify and discuss open research challenges, such as artificial-intelligence-based adaptive transceivers, intelligent wireless energy harvesting, decentralized and secure business models, intelligent cell-less architecture, and distributed security models. We propose practical guidelines including deep Q-learning and federated learning-based transceivers, blockchain-based secure business models, homomorphic encryption, and distributed-ledger-based authentication schemes to cope with these challenges. Finally, we outline and recommend several future directions.
Anichur Rahman, Mostofa Kamal Nasir, Ziaur Rahman, Amir Mosavi · 6 authors
Security, privacy, and transparency aspects of the Internet of Things (IoT) sensors have recently raised significant concerns among the public and policymakers. The distributed ledger and Blockchain technologies had brought solutions through transparently bridging two or multiple untrusted parties. In this research, a novel architecture for a smart building system, including a control system and automatic approaches, is proposed. An efficient cluster head selection algorithm is proposed to select the desired cluster head with the consideration of low energy consumption and fast head selection. An enhanced combination of IoT forwarding devices and Software-Defined Networking (SDN) technology is further advanced. Furthermore, the proposed “DistBlockBuilding” architecture is implemented for managing a safe and secure data transfer from one surface to another surface. Besides, Blockchain technology is performed for transferring data within the smart building. Finally, the performance of IoT-SDN based secured networks is evaluated.
Mohammad Zarour, Md Tarique Jamal Ansari, Mamdouh Alenezi, Amal Krishna Sarkar · 8 authors
Blockchain technology is among the most significant developments and revolutionary innovations of the Information Technology industry. It corners a crucial space in the present digital era and has already made significant differences in human life. Moreover, it is anticipated that the Blockchain technology will improvise the existing IT facilities in the next several years in many domains. Recent technological developments are allowing for a major advancement in Healthcare sectors. Information security and accessibility are critical considerations for the integration and communication with Electronic Healthcare Record (EHR) systems when sharing private medical information. In this context, selecting the most effective blockchain model for secure and trustworthy EHRs in the healthcare sector requires an accurate mechanism for evaluating the impact of different available blockchain models for its features. The present study uses a scientifically proven approach for evaluating the impact of blockchain technology and provides a novel idea and path to the future researchers. This research analysis garnered the feedback of 56 domain experts in the healthcare management for assessing the impact of different blockchain models. To eliminate the ambiguities that arose due to multiple opinions of these experts and for the externalization and organization of information about the selection context of the blockchain model, the study used a decision model. Fuzzy Analytic Analytical Network Process (F-ANP) method was used to calculate the weights of the criteria as well as the Fuzzy-Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) technique was used to evaluate the effect of alternative solutions. Further, the results obtained through this empirical investigation will be an instrumental reference for choosing the most appropriate Blockchain model for maintaining breach-free EHRs.
Electronic health records (EHRs) are health information of patients that are saved digitally in a network. Various opportunities to enhance patient care, performance measures in clinical practice and contribute to clinical research in the future are provided by EHRs. The schemes used to store EHRs have been very insecure in the present era of smart cities and homes. The data can be easily breached by hackers and unauthorized external parties. Also, the data is not accessible to patients and care providers. These schemes are unable to create a balance between data security and data accessibility. But blockchain can resolve these issues. Blockchain creates a ledger system that is immutable and allows the transactions to take place in a decentralized manner. The three main features of blockchain technology - Security, Decentralization, and Transparency make any application built using it secure and not accessible by unauthorized parties. The manipulation of data is almost impossible to do in a blockchain network. In this project, we propose a system to implement EHRs using blockchain technology and make EHRs more secure and private. The blockchain technology will keep control over access to information using its cryptographic techniques and decentralization. It will also maintain the balance between data privacy and data accessibility. Our main objective of this project is the framing of data privacy and security issues in electronic healthcare
Recently, researchers around the world in medical institutions and pharmaceutical companies are demanding a wider access to healthcare data for secondary use in order to provide enhanced and personalized medical services. For this purpose, healthcare information exchange between health authorities can be leveraged as a fundamental concept to meet these demands and enable the discovery of new insights and cures. However, health data are highly sensitive and private information that requires strong authentication and authorization procedures to manage the access to them. In this regard, the cloud paradigm has been used in these e-healthcare solutions, but they remain inefficient due to their inability to adapt to the expanding volume of data generated from body sensors and their vulnerability against cyberattacks. Hence, collaborative and distributed data governance supported by edge computing and blockchain promises enormous potentials in improving the performance and security of the whole system. In this paper, we present a secure and efficient data management framework, named ”EdgeMediChain”, for sharing health data. The proposed architecture leverages both edge computing and blockchain to facilitate and provide the necessary requirements for a healthcare ecosystem in terms of scalability, security, as well as privacy. The Ethereum-based testbed evaluations show the effectiveness of EdgeMediChain in terms of execution time with a reduction of nearly 84.75% for 2000 concurrent transactions, higher throughput compared to a traditional blockchain, and scalable ledger storage with a linear growth rate.
Convergence of physical and digital identity and integration of various individual records, such as patient data, into a united repository remains a serious challenge. On one hand, collecting relevant data can help clinicians, specialists and healthcare service providers to facilitate care for patients. On the other hand, Self-Sovereign identity and the right to control personal data comes into question, because patients do not handle their data explicitly. Distributed Ledger Technology (DLT) is a novel method which would allow to securely record time-stamped data and enable patient-driven health and identity records. In this paper, we review the state-of-the-art in Blockchain (BC)-based self-sovereignty and patient data records in healthcare. Our motivation is to investigate the potential of BC technology for use in the patient data and identity management. As a distributed decentralized technology, BC can be very beneficial, giving patients control over their own data and self-sovereign identity. To the extent of our knowledge, there is no literature covering the same concerns. More specifically, the focus is on solutions that aim the realization of holistic BC-based Electronic Health Records (EHR) and Patient Health Records (PHR). EHR and PHR are used to record patient data, such as the doctor's notes upon a visit and radiology images. Hence, they include critical information regarding patient's privacy and identity. Therefore, development of pure decentralized Healthcare Information Systems (HIS) is a great challenge in terms of architectural and technical structure of the systems. Designing robust and reliable EHR and PHR, which represent the foundation of many other healthcare services, relies on carefully finding the balance in a trade-off between many factors, such as level of decentralization, privacy, scalability and data throughput. In this paper, we review the state-of-the-art and provide an analysis on the design trade-offs.
Aleksandr Ometov, Yulia Bardinova, Alexandra Afanasyeva, Pavel Mašek · 10 authors
The blockchain technology is currently penetrating different areas of the modern Information and Communications Technology community. Most of the devices involved in blockchain-related processes are specially designed targeting only the mining aspect, i.e., solving the computational puzzle task. At the same time, the use of wearable and mobile devices may also become a part of eCommerce blockchain operation, especially during the on-charge time. The paper considers the possibility of using a large number of constrained devices to support the operation of the blockchain with a low impact on battery consumption. The utilization of such devices is expected to improve the system efficiency as well as to attract a more substantial number of users. This paper contributes to the body of knowledge with a survey of the main applications of blockchain for smartphones along with existing mobile blockchain projects. It also proposes a novel consensus protocol based on a combination of Proof-of-Work (PoW), Proof-of-Activity (PoA), and Proof-of-Stake (PoS) algorithms for efficient and on-the-fly utilization on resource-constrained devices. The system was deployed in a worldwide testnet with more than two thousand smartphones and compared with other projects from the user-experienced metrics perspective. The results prove that the utilization of PoA systems on a smartphone does not significantly affect the lifetime of the smartphone battery while existing methods based on PoW have a tremendous negative impact. Finally, the main open challenges and future investigation directions are outlined.
Abstract We develop an economic model to compare equilibrium security of Proof-of-Work (PoW) versus Proof-of-Stake (PoS) blockchains. We derive general conditions to determine when PoW blockchains are more secure than otherwise equivalent PoS blockchains and vice versa. Applying real-world parameter values to these conditions, we demonstrate that PoS blockchains are more secure than otherwise equivalent PoW blockchains. Furthermore, we demonstrate that PoS’s security advantage over PoW is particularly salient for high-scale blockchains.
Decentralization is a key indicator for the evaluation of public blockchains. In the past, there have been very few studies on measuring and comparing the actual level of decentralization between Proof-of-Work (PoW) blockchains and blockchains with other consensus protocols. This paper presents a new comparison study of the level of decentralization in Bitcoin and Steem, a prominent Delegated-Proof-of-Stake (DPoS) blockchain. Our study particularly focuses on analysing the power that decides the creators of blocks in the blockchain. In Bitcoin, miners with higher computational power generate more blocks. In contrast, blocks in Steem are equally generated by witnesses while witnesses are periodically elected by stakeholders with different voting power weighted by invested stake. We analyze the process of stake-weighted election of witnesses in DPoS and measure the actual stake invested by each stakeholder in Steem. We then compute the Shannon entropy of the distribution of computational power among miners in Bitcoin and the distribution of invested stake among stakeholders in Steem. Our analyses reveal that neither Bitcoin nor Steem is dominantly better than the other with respect to decentralization. Compared with Steem, Bitcoin tends to be more decentralized among top miners but less decentralized in general. Our study is designed to provide insights into the current state of the degree of decentralization in DPoS and PoW blockchains. We believe that the methodologies and findings in this paper can facilitate future studies of decentralization in other blockchain systems employing different consensus protocols.
Blockchain is widely recognized as a potential disruptive technology that has gained much popularity recently. Despite many promising results, the current blockchain landscape is fragmented, in which many blockchain systems exist in silos. Interoperability becomes a critical functionality to facilitate broad blockchain adoption and starts to attract attention in both industry and academia research. In this paper, we propose a new consensus protocol, Multi-tokens Proof of Stake (MPoS), for blockchain interoperability architecture. The MPoS protocol is able to strengthen the token network effects in a cross-chain ecosystem and grow the user base of blockchain systems dramatically. We also provide an analytical model to analyze and prove that the MPoS protocol can offer better security than traditional single-token PoS consensus protocols.
INTRODUCTION: Fiscal federalism and fiscal decentralization are distinct policy options in public services in general and healthcare in particular, with possibly opposed effects on equity, effectiveness, and efficiency. However, the pertinent discourse often reflects confusion between the concepts or conflation thereof. METHODS: This paper performs a narrative review of theoretical literature on decentralization. The study offers clear definitions of the concepts of fiscal federalism and fiscal decentralization and provides an overview of the potential implications of each policy for healthcare systems. RESULTS: The interpretation of the literature identified three different dimensions of decentralization: political, administrative, economic. Economic decentralization can be further implemented through two different policy options: fiscal federalism and fiscal decentralization. Fiscal federalism is the transfer of spending authority of a centrally pooled public health budget to local governments or authorities. Countries like the UK, Cuba, Denmark, and Brazil mostly rely on fiscal federalism mechanisms for healthcare financing. Fiscal decentralization consists of transferring both pooling and spending responsibilities from the central government to local authorities. Contrarily to fiscal federalism, the implementation of fiscal decentralization requires as a precondition the fragmentation of the national pool into many local pools. The restructuring of the pooling system may limit the cross-subsidization effect between high- and low-income groups and areas that a central pool guarantees; thus, severely affecting local equality and equity. With the limited availability of local public resources in poorer regions, the quality of services drops, increasing the disparity gap between areas. Evidence from Italy, Spain, China, and Ivory Coast -countries with a strong fiscal decentralization element in their healthcare services- suggests that fiscal decentralization has positive effects on the infant mortality rate. However, it decreases healthcare resources as well as access to services, fostering spatial inequities. CONCLUSION: If public resources are and remain adequate, allocation follows equitable criteria, and local communities are involved in the decision-making debate, fiscal federalism -rather than fiscal decentralization- appear to be an adequate policy option to improve the healthcare services and population's health nationwide and achieve health sector economic decentralization. HIPPOKRATIA 2020, 24(3): 107-113.