Public output and private decisions : conceptual issues in the evaluation of Government activities and their implications for fiscal policy

In this essay, the author explores theoretical concepts behind the current debate on government growth, public sector inefficiency, and the role of fiscal policy with a view to raising the most important issues relevant for fiscal policy. He examines theories of public sector growth, the evaluation of benefits from government spending, and the response of the private sector to government activities. Three principal reasons have been suggested to explain public sector growth: conscious government choices, political pressure from interest groups, and the self-interest of bureaucracies. One may ask: is the growth of the public sector a response to public demand or the result of government waste and inefficiency? In terms of the agent-principal theory, bureaucrats who are supposed to serve as agents for citizens may not necessarily do so - which is where waste comes in. If bureaucrats are interested in the nonpecuniary benefits of their bureaus, they will have an incentive to maximize their activities and budgetary allocation rather than their operating efficiency. In discussing the evaluation of public programs, the author focuses on the"true"benefits, as perceived by citizens. Would a well-to-do citizen, who could afford private security guards, make the same evaluation about public security that a poor citizen would make? In general, what considerations affect a person's desire for a given amount of public spending, and what are the important parameters that analysts should take into account in their investigation? The author also explores the issues behind the private sector's response to government activities and argues against a mechanistic approach to the interaction between the private and public sector. Unless decisionmakers are relatively certain about how citizens evaluate government actions, citizens may respond in a way that nullifies the government action. The author concludes that more empirical work is needed on measuring citizens's response to public sector activities. And fiscal policy, especially on expenditures, should be modeled on a disaggregated basis to isolate hypotheses about potential private sector responses to individual public programs.National Governance,Economic Stabilization,Economic Theory&Research,Environmental Economics&Policies,Banks&Banking Reform

Government expenditures as a citizens'evaluation of public output : public choice and the benefit principle of taxation

Combining elements from the theories of public choice and benefit taxation, the author develops a framework in which private citizens can evaluate public activities. Why, and under what circumstances, do bureaucrats increase the size of the public sector and the amount of public spending in their own self interest? What does the private sector think public output should be, what is actual public output, and how does the private sector evaluate that output? The author applies the theoretical results of an attempt to answer these questions in four Central European countries (Czechoslovakia, Hungary, Poland, and Slovenia), using actual data for 1989-91 and projections for 1992. Interpreting indirect evidence, he shows that the private sector would prefer less government activity in all countries, from a low of 5 percent less public spending (in Poland) to a high of one-third less (in Slovenia). If those governments were to follow those guidelines, their spending-to-GDP ratios would more closely resemble the 1987-89 average for a selected group of European market economies. The author also introduces a more rigorous, if not necessarily more objective, approach to determining optimal government spending. This approach requires little information, but uses a static model and requires faith in the direction of causality for some key variables. To the extent that one can accept those limitations, the model may be a useful operational tool in public spending evaluation.Public Sector Economics&Finance,National Governance,Economic Theory&Research,Environmental Economics&Policies,Fiscal&Monetary Policy

The consistency of government deficits with macroeconomic adjustment : an application to Kenya and Ghana

Sustainable medium-term debt strategies are essential to adjustment programs committed to high growth and should be integrated into a consistent macroeconomic framework that encompasses debt, growth and strategies. This paper develops an analytical model that takes 2 steps. Its purpose is to analyze the relationship between the fiscal deficit, the real interest rate, the real growth rate and the real exchange rate - and to indicate what conditions would be necessary to stabilize a country's debt-to-GDP ratio in the long run. The authors analyze three fundamental concepts of deficit: cash (or observed), primary and operational. Applying the model to the empirical data for Kenya and Ghana, the author's reach the following conclusions. First, the fiscal effort in Kenya should have been somewhat stronger between 1980 and 1987. For the period 1988-91, the projected fiscal balance is broadly consistent with stabilization, and the same goal can be achieved with a lower inflation or growth rate. Secondly, in Ghana the average fiscal performance between 1980 and 1987 was only slightly weaker than it should have been. Projections for 1988-91 suggest that the government has substantial room to maneuver in its stabilization.Economic Stabilization,Economic Theory&Research,Environmental Economics&Policies,Macroeconomic Management,Banks&Banking Reform

Improving a Mother to Child HIV Transmission Programme through Health System Redesign: Quality Improvement, Protocol Adjustment and Resource Addition

Health systems that deliver prevention of mother to child transmission (PMTCT) services in low and middle income countries continue to underperform, resulting in thousands of unnecessary HIV infections of newborns each year. We used a combination of approaches to health systems strengthening to reduce transmission of HIV from mother to infant in a multi-facility public health system in South Africa.All primary care sites and specialized birthing centers in a resource constrained sub-district of Cape Metro District, South Africa, were enrolled in a quality improvement (QI) programme. All pregnant women receiving antenatal, intrapartum and postnatal infant care in the sub-district between January 2006 and March 2009 were included in the intervention that had a prototype-innovation phase and a rapid spread phase. System changes were introduced to help frontline healthcare workers to identify and improve performance gaps at each step of the PMTCT pathway. Improvement was facilitated and spread through the use of a Breakthrough Series Collaborative that accelerated learning and the spread of successful changes. Protocol changes and additional resources were introduced by provincial and municipal government. The proportion of HIV-exposed infants testing positive declined from 7.6% to 5%. Key intermediate PMTCT processes improved (antenatal AZT increased from 74% to 86%, PMTCT clients on HAART at the time of labour increased from 10% to 25%, intrapartum AZT increased from 43% to 84%, and postnatal HIV testing from 79% to 95%) compared to baseline.System improvement methods, protocol changes and addition/reallocation of resources contributed to improved PMTCT processes and outcomes in a resource constrained setting. The intervention requires a clear design, leadership buy-in, building local capacity to use systems improvement methods, and a reliable data system. A systems improvement approach offers a much needed approach to rapidly improve under-performing PMTCT implementation programmes at scale in sub-Saharan Africa

What is the value and impact of quality and safety teams? A scoping review

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to conduct a scoping review of the literature about the establishment and impact of quality and safety team initiatives in acute care.</p> <p>Methods</p> <p>Studies were identified through electronic searches of Medline, Embase, CINAHL, PsycINFO, ABI Inform, Cochrane databases. Grey literature and bibliographies were also searched. Qualitative or quantitative studies that occurred in acute care, describing how quality and safety teams were established or implemented, the impact of teams, or the barriers and/or facilitators of teams were included. Two reviewers independently extracted data on study design, sample, interventions, and outcomes. Quality assessment of full text articles was done independently by two reviewers. Studies were categorized according to dimensions of quality.</p> <p>Results</p> <p>Of 6,674 articles identified, 99 were included in the study. The heterogeneity of studies and results reported precluded quantitative data analyses. Findings revealed limited information about attributes of successful and unsuccessful team initiatives, barriers and facilitators to team initiatives, unique or combined contribution of selected interventions, or how to effectively establish these teams.</p> <p>Conclusions</p> <p>Not unlike systematic reviews of quality improvement collaboratives, this broad review revealed that while teams reported a number of positive results, there are many methodological issues. This study is unique in utilizing traditional quality assessment and more novel methods of quality assessment and reporting of results (SQUIRE) to appraise studies. Rigorous design, evaluation, and reporting of quality and safety team initiatives are required.</p

EvalPartners:an international partnership to strengthen civil society’s evaluation capacities and promote equity

This is the second book in the series on Evaluation and Civil Society. This book is focused on case studies highlighting the experiences of regional and national VOPEs. They share their experiences in strengthening the capacities of individual evaluators to produce credible and useful evaluations, the institutional capacities of the VOPEs themselves, promoting equity-focused and gender-responsive evaluations, and, especially, the roles VOPEs are playing to improve the enabling environment for evaluation in their countries