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User fees and abuser fees

Shanta's picture

If user fees for health have been so vilified (including in comments on this blog), why are we bringing the subject up again?  Because new evidence calls into question the prevailing view, namely that removing user fees leads to: (i) increased use of health services and hence to (ii) improved health outcomes.  Confirming (i), the recent literature shows that (ii) does not always follow.

Principles

Raising the price of a good or service has two effects: it reduces demand and increases supply.  In the case of user fees for health, it was thought that paying for a service also makes people use it more appropriately (you don’t go to the doctor for minor ailments) and value it more than if they obtained it for free. 

Is Tanzania strong enough to resist temptation?

Jacques Morisset's picture

Speaking about the often unruly behavior of his talented young players, Arsene Wenger, the famous Arsenal coach, said: "Some are wrong because they are not strong enough to fight temptation and some are wrong because they don't know."

Youth in Tanzania: a growing uneducated labor force

Jacques Morisset's picture

Let's think together: Every Sunday the World Bank in Tanzania in collaboration with The Citizen wants to stimulate your thinking by sharing data from recent official surveys in Tanzania and ask you a few questions.

"The youth of today are the leaders of tomorrow", so the old adage goes. All countries, including Tanzania, need to invest in and build a strong, healthy, well educated, dynamic and innovative youth.  In Africa, the number of youths (aged 14 to 25 years) have grown significantly  over the past decades, contributing to the bulk of the labor force.

Mortal Combat in the Public Sphere

Sina Odugbemi's picture

The nature of the relationship between (elected) political leaders and the elite reporters dedicated to reporting on their activities is insufficiently studied, and its importance is inadequately appreciated. Yet that relationship says a lot about a political community, particularly:

  • the public political culture;
  • the nature of press/government relations generally;
  • some of the strengths of the governance system in that country;
  • some of the pathologies bedeviling governance in that country, and so on.

Weekly Wire: the Global Forum

Kalliope Kokolis's picture

These are some of the views and reports relevant to our readers that caught our attention this week.

Washington Post 
New apps transforming remote parts of Africa

“For generations, breeding cows in the rural highlands of Kenya has hinged on knowledge and experience passed down from parents to children. But Mercy Wanjiku is unlike most farmers. Her most powerful tool is her cellphone, and a text messaging service called iCow.

The service informs her when her cows are in heat, which feed might boost their milk output and what their fair market price is. And when she needed a veterinarian recently, she relied on the service’s extensive database. “Otherwise, it would have been hard to find someone qualified in my area,” said Wanjiku, a 29-year-old farmer in Mweru, a village about 100 miles north of the Kenyan capital, Nairobi.” READ MORE

Ending Open Defecation, Not by Evidence Alone

Jaehyang So's picture

Open defecation – going outside without using a toilet or latrine – is one of the most important threats to child health and human capital, period; ending it must be a policy priority.

How can public service providers do better? Pay versus ‘prosocial motivation’

Willy McCourt's picture

 BEYOND PAY AS MOTIVATOR

Pay reform has been a mainstay of our public sector practice over many years.  We have encouraged governments to ‘decompress’ pay, paying more to senior staff whose relative contribution to the public service, we have argued, is not reflected in their pay packets.  We have sponsored job evaluation exercises, so that pay is aligned more closely with duties.  We have tried to link pay to some measure of performance. 

Will Rising Temperatures Derail Africa’s Rise?

Tom Bundervoet's picture

Africa is on the move. After two decades of decline, fortunes reversed by the end of the 1990s, resulting in a decade of strong economic growth and sizable improvements in sanitation, education and health. Real incomes per capita in Sub-Saharan Africa grew by more than 30 percent over the last ten years, and six countries from the continent made it on the list of the ten fastest-growing economies in the world. Big men, although still around in some parts of the continent, have become less common, elections have become more frequent, and many civil wars have finally ended. All this has produced a narrative of “Africa Rising” and a widespread optimism that Africa is finally on the right track. Indeed, the 21st century may well turn out to be Africa’s century.

Or not. Ted Miguel’s keynote address at the annual conference of the Center for the Study of African Economies (CSAE) in Oxford highlighted a potentially important concern. Applying a common statistical framework to a large number of studies on the link between temperatures and human violence, Miguel and his co-authors find a remarkably consistent and strong correlation between exceptionally high temperatures and manifestations of violence. Drawing on detailed data from a variety of countries and studies, they show that exceptionally high temperatures are correlated with significant increases in witch killings (Tanzania), rapes (USA), murders (USA), aggressive behavior of baseball players (USA) and more frequent and more aggressive horn-honking.

Toilets missing in action

Waly Wane's picture

Let's think together: Every Sunday the World Bank in Tanzania in collaboration with The Citizen wants to stimulate your thinking by sharing data from recent official surveys in Tanzania and ask you a few questions.

Tanzania is ranked the second lowest in terms of access to improved sanitation worldwide out of 171 countries that reported statistics for 2010. The details read as follows:
- Only 1 in 10 Tanzanians has access to an improved sanitation facility, such as a flush toilet connected to a sewage system or septic tank or a covered pit latrine not shared with other households.
- The above access to improved sanitation for Tanzania is well below the average for sub-Saharan Africa (31 percent), and also much lower than in Kenya (32 per cent), Uganda (34 per cent) and Malawi (51 per cent).
- Urban residents are three times more likely to use an improved toilet facility than their rural counterparts (20 per cent vs. 7 per cent).
- A staggering 5.4 million Tanzanians do not have access to any toilet facility, and answer nature’s call in the open. This burden falls most heavily on the poorest quintile.

Should Real Leaders Ignore Public Opinion?

Sina Odugbemi's picture

Many policy entrepreneurs and technocrats waving sundry blueprints dislike uncooperative public opinion. Sometimes the dislike is intense. But since you cannot go around insulting mass publics on television what they do is turn on leaders and they ask these leaders to show true leadership by ignoring public opinion…or transforming it with a feat of oratory.

We have at least two instances playing out right now. First, we have deficit slashing, austerity zealotry running amok. In country after country, governments are being asked by experts to slash budgets no matter who is hurt (but, naturally, common people bear the brunt of the hurt).  Unelected prime ministers are being used to push through painful budget cuts and then the establishment is surprised when people refuse to vote for these technocratic ‘saviors’. And we get the reaction: ‘What is wrong with the people of that country?’

How to Build Local Government Accountability in South Africa? A Conversation with Partners

Duncan Green's picture

This is what a good day visiting an Oxfam programme looks like. I skim the interwebs (and this blog) to put together some thoughts on a given issue from our experience or what others are writing (‘the literature’). Then sit down with local Oxfamistas and partner organizations (who are usually closer to the grassroots than we are) to compare these bullet points with their reality. Last Friday, it was ‘how can NGOs build the accountability of local government.’ My ten minutes covered:

Aadhaar Enabled Service Delivery to the Poor in India

Tanya Gupta's picture

The poor are nameless, faceless, and therefore, powerless.  Throughout history, the act of naming is linked to power.  In 2010, the poor of India were named.  Aadhaar is a unique 12 digit identification number that can used to get social benefits from the Central Government and the State Government by Indian citizens. 

Most importantly, perhaps, direct cash benefits are supported.  The ability of the poor to withdraw their direct cash not only empowers them, but also minimizes corruption-based leakages of entitlements from the system. Moreover, the delays in receiving the money they are entitled to will also be reduced through the use of micro ATMs.  A micro ATM is basically a mobile phone with a fingerprint device for real time authentication. 

A bank in your pocket: The mobile money revolution in Tanzania

Isis Gaddis's picture

Let's think together: Every Sunday the World Bank in Tanzania in collaboration with The Citizen wants to stimulate your thinking by sharing data from recent official surveys in Tanzania and ask you a few questions.

The mobile phone is a truly novel device. It comes in just as handy and as easily when we need to communicate about the serious things as to chat about the simpler things in life.  Mobiles are not only being used as radios and flashlights but they are also delivering banking and financial services to those who urgently need them.

Increasingly, people around the world, especially in Africa, are paying their school fees, healthcare and utility bills using mobile phones today. Businesses use mobile money phones to pay their staff and suppliers. Poor people who have never entered a bank are using mobile services to send or receive remittances and to save their money.

How Can South Africa Promote Citizenship and Accountability? A Conversation with Some State Planners

Duncan Green's picture

How can states best promote active citizenship, in particular to improve the quality and accountability of state services such as education? This was the topic of a great two hour brainstorm with half a dozen very bright sparks from the secretariat of South Africa’s National Planning Commission yesterday. The NPC, chaired by Trevor Manuel (who gave us a great plug for the South African edition of From Poverty to Power) recently brought out the National Development Plan 2030 (right), and the secretariat is involved with trying to turn it into reality.

I kicked off with some thoughts which should be familiar to regular readers of this blog: the importance of implementation gaps, the shift in working on accountability from supply side (seminars for state officials) to demand side (promote citizen watchdogs to hold the state to account) and the challenge from the ODI-led Africa Power and Politics Programme that accountability work needs to break free of such supply/demand thinking and pursue ‘collective problem-solving in fragmented societies hampered by low levels of trust’, which seems a pretty good description of South Africa, according to the NPC. I gave the example of the Tajikistan Water Supply and Sanitation Network as an example of how this can be done through ‘convening and brokering’.

Once I shut up, it got more interesting (funny how often that happens). Some of the most interesting questions (and responses from me and others).

Citizen Engagement - Seven Questions, One Conversation

Tiago Carneiro Peixoto's picture

Read this post in: Español

Citizen Voices

Calls for increased citizen empowerment are heard from across the spectrum, ranging from governments and donors to CSOs and multilateral efforts such as the Open Government Partnership.

The World Bank Group, in partnership with CIVICUS, the Government of Finland and InterAction will host a conference on citizen engagement on March 18, 2013 to highlight the value of engaging with citizens for effective development.

The Citizen Voices conference will focus on citizen engagement and feedback systems that strengthen the quality of policy making and service delivery, where the impact on the poor is most direct. The conference aims to explore how citizen engagement is essential for effective development, move from knowledge to action, and establish concrete partnerships for scaling up at global and national levels.

But while the claims for citizen engagement abound, less discussion is dedicated to how to design and implement participatory processes that deliver their expected benefits, such as increased accountability and better delivery of policies and services. As part of this problem, not enough attention is paid to the various outcomes that participatory processes may engender and what they mean for policy and development.


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