User fees and abuser fees
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.

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."
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:
BEYOND PAY AS MOTIVATOR
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
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.
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:

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 