This paper examines how organization and financing of maternal health services influence health-seeking behavior in Bosomtwe district, Ghana. It contributes in furthering the discussions on maternal health-seeking behavior and health outcomes from a health system perspective in sub-Saharan Africa. From a health system standpoint, the paper first presents the resources, organization and financing of maternal health service in Ghana, and later uses case study examples to explain how Ghana's health system has shaped maternal health-seeking behavior of women in the district. The paper employs a qualitative case study technique to build a complex and holistic picture, and report detailed views of the women in their natural setting. A purposeful sampling technique is applied to select 16 women in the district for this study. Through face-to-face interviews and group discussions with the selected women, comprehensive and in-depth information on health- seeking behavior and health outcomes are elicited for the analysis. The study highlights that characteristics embedded in decentralization and provision of free maternal health care influence health-seeking behavior. Particularly, the use of antenatal care has increased after the delivery exemption policy in Ghana. Interestingly, the study also reveals certain social structures, which influence women's attitude towards their decisions and choices of health facilities.
Honoratha Mushi, K. Mullei, J. Macha, Francis Wafula · 7 authors
Health worker training is a key component of the integrated management of childhood illness (IMCI). However, training coverage remains low in many countries. We conducted in-depth case studies in two East African countries to examine the factors underlying low training coverage 10 years after IMCI had been adopted as policy. A document review and in-depth semi-structured interviews with stakeholders at facility, district, regional/provincial and national levels in two districts in Kenya (Homa Bay and Malindi) and Tanzania (Bunda and Tarime) were carried out in 2007-08. Bunda and Malindi achieved higher levels of training coverage (44% and 25%) compared with Tarime and Homa Bay (5% and 13%). Key factors allowing the first two districts to perform better were: strong district leadership and personal commitment to IMCI, which facilitated access to external funding and encouraged local-level policy adaptation; sensitization and training of district health managers; and lower staff turnover. However, IMCI training coverage remained well below target levels across all sites. The main barrier to expanding coverage was the cost of training due to its duration, the number of facilitators and its residential nature. Mechanisms for financing IMCI also restricted district capacity to raise funds. In Tanzania, districts could not spend more than 10% of their budgets on training. In Kenya, limited financial decentralization meant that district managers had to rely on donors for financial support. Critically, the low priority given to IMCI at national and international levels also limited the expansion of training. Levels of domestic and donor support for IMCI have diminished over time in favour of vertical programmes, partly due to the difficulty in monitoring and measuring the impact of an integrated intervention like IMCI. Alternative, lower cost methods of IMCI training need to be promoted, and greater advocacy for IMCI is needed both nationally and internationally.
In Niger the decentralization of the education system and the implication of local communities in the management and financing of education services is the dominant logic of national education policy promoted by international donors. In the article I examine the mobilization of local actors in public education provision. I do this using an ethnographic study of the daily management of a newly established public primary school in peri-urban Niamey. The case study illustrates the diversity of actors, from traditional chiefs to district advisors and international development projects that are implicated in the provision of public education as well as the different logics and stakes at play. It is also revelatory of the limited room for manoeuvre of the ‘local community’ organized in school committees in ensuring the day-to-day functioning of the school. Finally it is argued that at the same time as education provision is in part taken over by local actors the idea of the state as the ideal provider of public education remains strong.
The purpose of this study is to explore what governance structures and leadership styles enhance community participation in school governance. The study specifically explored community participation and democratic leadership in improving school governance and management. Qualitative research approach was applied and twenty three (23) informants were interviewed for this study. The study sample comprises of Ministry of Education officials, School Management Committee (SMC) and Parent Teachers Association (PTA) members who represent the parents and the community, Head teachers, and teachers. Interviews, documents evidence, and general observation have been employed as a means of data collection methods. This use of interviews is to allow the informant express his or her views based on the subjective school of though. The data collected was analysed inductively. Educational decentralization is the common way through which community can participate in the governance and management of the schools in Sub-Saharan Africa. Governance and community participation, and organization theories which comprises of critical organization theory, bureaucratic theory, stakeholders theory, and Role theory form the bedrock of the study. The study reveals that the schools have formal structures (SMC and PTA) that promotes community participation in school governance, and that these formal structures are an expression of democratic governance that allow the community to participate in the governance and management of the school through democratic practices and democratic leadership that allows broader participation of the stakeholders in the governance and management of the school. The research findings reveal that community through the SMC and the PTA participate in the governance and management of the schools as the community is engaged in resources mobilization, planning, budgeting, school development, policy formulation, administration and financing of the school, but policies on the curriculum and exams is under the government and that the community is also limited with lacks training, and skills. As such the roles played by the community are underperformed and financed. The study concludes that community participation and democratic leadership enhance school governance and management, as educational providers are hold accountable by the community in this democratic school governance and management.
Only for the recipients of foreign aid is something akin to central planning seen as a way to achieve prosperity. The end of poverty is achieved with free markets and democracy—where decentralized “searchers” look for ways to meet individual needs—not Poverty Reduction Strategy Papers (PRSPs) to achieve Millennium Development Goals (MDGs). The PRSPs and MDGs create lots of bureaucracy but hold no one specific agency in foreign aid accountable for any one specific task. Planners in foreign aid use the old failed models of the past—the “Financing Gap”, the “poverty trap”, the government-to-government aid model; and the “expenditures = outcomes” mentality. Searchers in foreign aid would imitate the feedback and accountability of markets and democracy to provide goods and services to individuals until homegrown markets and democracy end poverty in the society as a whole. An example of the more promising “searchers” approach in foreign aid is 2006 Nobel Peace Laureate Mohammad Yunus and Grameen Bank.
What is best strategy to reach the Millennium Development Goal of basic education for all will depend on the specific country context.This paper introduces an input-output method to estimate the financial inputs required to achieve the MDG for primary education and an additional target of enhancing access to secondary education. 1As such the approach followed here is not new, but the innovative element is combining educational demand and supply variables considering both cost dimensions and quality of services as measured among others through test scores (outcomes), quality of school inputs and the nature of delivery of services (privatepublic, centralized or decentralized).We take the following analytical steps: (i) define a production function for specific education outputs (enrolment), (ii) isolate the main determinants of such output (considering both demand and supply factors); (iii) estimate costs per unit of producing such output, and -based on estimated elasticity's and unit costs ensuing from the education production function -(iv) calculate the financing needs of reaching key education goals.We find that determinants of access to schooling are significantly different for urban and rural and for poor and non-poor children.Furthermore, the determinants also differ when referring to access to primary or secondary education.Quality of school inputs does matter in all cases though to varying degree.Particularly, class size, shares of trained teachers and greater school autonomy (in hiring teachers and managing schools) are relevant.Quality of education outcomes, i.e. test scores, while very poor in Ecuador does not seem to influence school enrolment.The upshot is that with a more cost-effective use of resources for primary education, the MDG target of 100% of net primary school enrolment in urban areas is within reach in a period of 4 to 5 years at virtually no additional budgetary cost.Meeting the target for the rural population seems more complicated.In secondary education, important progress can be made to reach a target of 70% net enrolment (with important expected positive externalities for economic growth) by enhancing the share of trained teachers, expand coverage of school demand subsidies and improve class infrastructure.This target is within reach for the poor and non-poor urban population by 2007 at an estimated additional cost of 1 Vos is with the Institute of Social Studies (ISS), The Hague and the Free University Amsterdam.Ponce is with FLACSO-Ecuador and is also a PhD candidate at ISS.
The term "development finance \n institutions" (DFI) encompasses no only government \n development banks, but also nongovernmental micro-finance \n organizations, that match grants to attempt to promote \n community development, decentralization of power, and local \n empowerment. Measures of the social cost of DFIs that \n receive public funds, help to check whether DFIs are good \n uses of public funds, i.e., if the social benefit of a DFI \n exceeds the social cost, then public funds are indeed \n well-spent, further improving social welfare. This report \n describes the measurement of costs but not of benefits; but \n even without knowledge of benefits, knowledge of costs can \n help to adequately spend funds. Two measures of social cost \n are presented: first, the Subsidy Dependence Index (SDI) - \n the ratio of subsidy received to revenue from loans; and, \n subsidy is the social cost of the public funds used to run a \n DFI - which does not discount flows, rather it works in \n short time frames, or when the rate of time preference is \n low; second, the Net Present Cost to Society (NPCs) - like \n standard present-value measures, it discounts cash flows, \n and works in any time frame. Both SDI and NPCs are tools, to \n help establish benchmarks, chart trends, and compare a DFI \n with identical clients, and services. It is stipulated that \n measurement of the social cost of public DFIs matters \n because funds earmarked for development are scarce, while \n subsidies for DFIs could be adequate, provided social \n welfare improves in a broader scale.
The government of Cameroon like that of many Sub-S aharan African countries is \nfaced with dwindling revenues and cannot provide the required fmances for the education \nsector. Since many other developing countries are facing similar fmancial constraints, \npolicy options have been proposed for the recovery of costs as a way of revitalizing and \nimproving the quality of education in these countries. The introduction of user charges is \none of the more prominent options that applies to all levels of education. In light of the \neducational financing situation in Cameroon, this study sets out to assess the possibility \nof implementing this option. It therefore seeks to analyze how secondary schools are \nfmanced and to measure private direct costs of secondary education so as to determine \nparental willingness to spend on schooling. \nA household and a school survey were conducted in Mezam Division of the North \nWest Province of Cameroon. 335 households in urban and rural areas were involved in \nthe household survey, while 16 principals and 750 students, selected from 16 secondary \nschools, took part in the school survey. Results from these surveys indicate that in \ngovernment secondary schools, although tuition is provided free, parents are obliged to \nmeet the costs of books and uniforms. Moreover, because government funding is \ninadequate, by default, parents are obliged to contribute further towards the provision of \nadditional facilities in these schools through the Parent-Teacher Association (PTA). Thus \nparents incur substantial costs for their children's education, in relation to household \nincome and Gross National per Capita Income. The study also reveals that in the private \neducational sector, fees and other parental contributions, including PTA levies, form an \nimportant source of finance for secondary schools. Parents of government school students \nvalue the education of their children highly, and therefore indicated willingness to pay \nmore, even though they already incur substantial costs. The findings further indicate that \nwillingness to pay will be increased if the quality of education is improved. However, \nability to pay is related to family income and number of children, which have important \nimplications for equity which are discussed in the thesis. Finally the study reveals that the \nhighly centralized financing policy and practice in government secondary schools does not \ntake into account the fmancial capacity of communities and private individuals \nsufficiently. \nThe thesis argues that, in order to improve access, quality and efficiency of \neducational provision, an appropriate cost-sharing strategy needs to be developed to \nfinance government secondary schools, with provision of scholarships or other selective \nassistance to the most needy. The thesis suggests further that, efforts be made to explore \nparental willingness and the inherent self help tradition of the people, by encouraging \nlocal management and fmancing of schools. Hence support from individual users and \ncontributions from local communities through Parent-Teacher-Associations should be \nactively solicited. It also suggests that the decentralization of educational management of \nschools will go a long way towards enhancing educational quality and efficiency. This \nwill require some adjustments to the existing financing structures, and changes in the \nregulation and management of the education system. The successful implementation of \nthese recommendations require immense political will on the part of the policy makers.
Summary This article analyses the structure and organization of RDRS, one of the largest rural development NGOs in Bangladesh. RDRS's Comprehensive Project works with 120,000 households, through small groups of about 15, motivating and educating people on joint savings and investment, agricultural and off-farm income generation, primary health and family planning, literacy, social awareness, and women's development. Groups have access to credit provided by RDRS or banks. No free inputs are given. The Comprehensive Project's Community Health Unit runs 55 antenatal centres and a leprosy treatment service. The Rural Works Project plants 250,000 trees per year, and supervises construction of schools, markets and small bridges and culverts in isolated rural communities. RDRS has almost 1,700 staff. Field implementation is decentralized to area-based units, within a common policy, activity, financial and personnel framework. Six sectoral advisory units are responsible for innovation, quality control and coordination across the whole programme. Résumé Les ONG: le cas du Service rural de Rangpur Dinajpur Le présent article contient une analyse de la structure et de l'organisation du RDRS, l'une des plus importantes ONG (Organisation non gouvernementale) rurales du Bangladesh. Le Comprehensive Project du RDRS intervient auprès d'environ 120 000 ménages sous forme de petits groupes d'environ 15 personnes; le RDRS a pour rôle de motiver et d'éduquer les participants quant aux économies et investissements conjoints dans le ménage; la génération de revenus fermiers et outre-fermiers; les soins de santé primaires et le planisme familial; les campagnes d'alphabétisation; les programmes de sensibilisation sociale; et le développement des femmes dans la population. Les groupes ont accès au crédit fourni par le RDRS ou par les banques. Aucune contribution n'est gratuite. Le groupe des Soins de santé communautaires du Comprehensive Project organise 55 centres de consultation prénatale, ainsi qu'un centre pour le traitement des lépreux. Le service des prestations rurales plante environ 250 000 arbres par an et contrôle la construction des écoles, des marchés et des petits ponts et caniveaux dans les communautés rurales isolées. Le personnel du RDRS compte presque 1700 effectifs. Les antennes exécutives rurales sont décentralisées en unités à base géographique, or elles restent liées par une organisation de gestion commune des politiques, des activités, du financement, et du personnel. Six groupes de conseil sectoral se chargent des programmes d'innovation, de contrôle de la qualité et de coordination du programme au niveau de l'ensemble. Resumen Organizaciones no gubernamentales: el caso del Servicio Rural en Rangpur Dinajpar El artículo analiza la estructura y organización del RDRS, uno de los proyectos de desarrollo rural más grandes de las Organizaciones no gubernamentales en Bangladesh. Este proyecto exhaustivo comprende 120.000 familias, en grupos de quince familias, motivando y educando a la población en áreas como: ahorro colectivo e inversiones, producción de ganancias fuera de la granja, salud y planificación familiar, alfabetización, conciencia social y el desarrollo de la mujer. Los grupos tienen acceso a créditos provistos por RDRS o instituciones bancarias. No se otorga dinero gratis. La Unidad del Proyecto de Salud Comunitaria maneja 55 centros pre-natales y un servicio para el tratamiento de la lepra. El Proyecto de Trabajos Rurales planta 250.000 árboles por año, y supervisa la construcción de escuelas, mercados, puentes y alcantarillas en comunidades rurales aisladas. RDRS tiene un personal de casi 1700 empleados. La implementación de base se descentraliza en forma de unidades en cada área, que sin embargo siguen una línea común en cuanto a a criterios, actividades y estructuras financieras y de personal. Hay seis unidades consultivas responsables por las innovaciones, control de calidad y coordinación de la totalidad del programa.