PURSUING EFFICIENCY WHILE MAINTAINING OUTREACH: BANK PRIVATIZATION IN TANZANIA

Profitability improvements after the privatization of a large state-owned bank might come at the expense of reduced access to financial services for some groups, especially the rural poor. The privatization of Tanzania's National Bank of Commerce provides a unique episode for studying this issue. The bank was split into the "new" National Bank of Commerce, a commercial bank that assumed most of the original bank's assets and liabilities, and the National Microfinance Bank, which assumed most of the branch network and the mandate to foster access to financial services. The new National Bank of Commerce's profitability and portfolio quality improved although credit growth was slow, in line with privatization experiences in other developing countries. Finding a buyer for the National Microfinance Bank proved very difficult, although after years under contract management by private banking consultants, Rabobank of the Netherlands emerged as a purchaser. Profitability has since improved and lending has slowly grown, while the share of non-performing loans remains low.access to banking; access to banking services; access to financial services; access to services; Accounting; Agricultural Bank; asset allocation; asset portfolio; ATMs

Healthy Firms: Constraints to Growth among Private Health Sector Facilities in Ghana and Kenya

Background: Health outcomes in developing countries continue to lag the developed world, and many countries are not on target to meet the Millennium Development Goals. The private health sector provides much of the care in many developing countries (e.g., approximately 50 percent in Sub-Saharan Africa), but private providers are often poorly integrated into the health system. Efforts to improve health systems performance will need to include the private sector and increase its contributions to national health goals. However, the literature on constraints private health care providers face is limited. Methodology/Principal Findings: We analyze data from a survey of private health facilities in Kenya and Ghana to evaluate growth constraints facing private providers. A significant portion of facilities (Ghana: 62 percent; Kenya: 40 percent) report limited access to finance as the most significant barrier they face; only a small minority of facilities report using formal credit institutions to finance day to day operations (Ghana: 6 percent; Kenya: 11 percent). Other important barriers include corruption, crime, limited demand for goods and services, and poor public infrastructure. Most facilities have paper-based rather than electronic systems for patient records (Ghana: 30 percent; Kenya: 22 percent), accounting (Ghana: 45 percent; Kenya: 27 percent), and inventory control (Ghana: 41 percent; Kenya: 24 percent). A majority of clinics in both countries report undertaking activities to improve provider skills and to monitor the level and quality of care they provide. However, only a minority of pharmacies report undertaking such activities

Private Sector Participation and Health System Performance in Sub-Saharan Africa

BACKGROUND: The role of the private health sector in developing countries remains a much-debated and contentious issue. Critics argue that the high prices charged in the private sector limits the use of health care among the poorest, consequently reducing access and equity in the use of health care. Supporters argue that increased private sector participation might improve access and equity by bringing in much needed resources for health care and by allowing governments to increase focus on underserved populations. However, little empirical exists for or against either side of this debate. METHODOLOGY/PRINCIPAL FINDINGS: We examine the association between private sector participation and self-reported measures of utilization and equity in deliveries and treatment of childhood respiratory disease using regression analysis, across a sample of nationally-representative Demographic and Health Surveys from 34 SSA economies. We also examine the correlation between private sector participation and key background factors (socioeconomic development, business environment and governance) and use multivariate regression to control for potential confounders. Private sector participation is positively associated with greater overall access and reduced disparities between rich and poor as well as urban and rural populations. The positive association between private sector participation and improved health system performance is robust to controlling for confounders including per capita income and maternal education. Private sector participation is positively correlated with measures of socio-economic development and favorable business environment. CONCLUSIONS/SIGNIFICANCE: Greater participation is associated with favorable intermediate outcomes in terms of access and equity. While these results do not establish a causal link between private sector participation and health system performance, they suggest that there is no deleterious link between private sector participation and health system performance in SSA

Memory Influences Visual Cognition across Multiple Functional States of Interactive Cortical Dynamics

No embargo requiredMemory supports a wide range of abilities from categorical perception to goal-directed behavior, such as decision-making and episodic recognition. Memory activates fast and surprisingly accurately and even when information is ambiguous or impoverished (i.e., showing object constancy). This paper proposes the multiple-state interactive (MUSI) account of object cognition that attempts to explain how sensory stimulation activates memory across multiple functional states of neural dynamics, including automatic and strategic mental simulation mechanisms that can ground cognition in modal information processing. A key novel postulate of this account is ‘multiple-function regional activity’: The same neuronal population can contribute to multiple brain states, depending upon the dominant set of inputs at that time. In state 1, the initial fast bottom-up pass through posterior neocortex happens between 95 ms and ~200 ms, with knowledge supporting categorical perception by 120 ms. In state 2, starting around 200 ms, a sustained state of iterative activation of object-sensitive cortex involves bottom-up, recurrent, and feedback interactions with frontoparietal cortex. This supports higher cognitive functions associated with decision-making even under ambiguous or impoverished conditions, phenomenological consciousness, and automatic mental simulation. In the latest state so far identified, state M, starting around 300 to 500 ms, large-scale cortical network interactions, including between multiple networks (e.g., control, salience, and especially default mode), further modulate posterior cortex. This supports elaborated cognition based on earlier processing, including episodic memory, strategic mental simulation, decision evaluation, creativity, and access consciousness. Convergent evidence is reviewed from cognitive neuroscience of object cognition, decision-making, memory, and mental imagery that support this account and define the brain regions and time course of these brain dynamics

Paris is not enough: Toward an Information Technology (IT) enabled transnational climate policy

The 2015 Paris Agreement was undoubtedly an important diplomatic achievement. Organizations and experts have rallied around it, all the more since the attack against the agreement by the current US administration. This rally has led to a collective unwillingness to acknowledge what the evidence already tells us: the Paris Agreement and the currently dominant, international approach to climate change policy will not work. Much faster and more decisive change is needed; a paradigm shift. We need a policy which provides for a realistic yet rapid transition from our dependence on cheap fossil fuels to deep decarbonization and a sustained reliance on renewable sources of energy. We argue in this paper that, thanks to advances in Information Technology (IT) and social media, viable options exist for an alternative global, transnational climate policy. Three key principles have to be followed: (i) gradual expansion across boundaries; (ii) use of economic incentives to compel behavioral change; and (iii) a close link between the price of carbon and the use of raised funds. The funds from the climate risk surcharge collected on fossil fuels at the source, a central piece of the proposal, are to be used for subsidizing adaption to and insurance against damage from climate change. The paper argues that the challenges in terms of information requirements and institutional resistance can be overcome if IT solutions are deployed within a public-private governance framework that protects the public interest.ISSN:2214-629

Pursuing efficiency while maintaining outreach: Bank privatization in Tanzania

Profitability improvements after the privatization of a large state-owned bank might come at the expense of reduced access to financial services for some groups, especially the rural poor. The privatization of Tanzania's National Bank of Commerce provides a unique episode for studying this issue. The bank was split into the "new" National Bank of Commerce, a commercial bank that assumed most of the original bank's assets and liabilities, and the National Microfinance Bank, which assumed most of the branch network and the mandate to foster access to financial services. The new National Bank of Commerce's profitability and portfolio quality improved although credit growth was slow, in line with the privatization experiences in other developing countries. Finding a buyer for the National Microfinance Bank proved very difficult, although after years under contract management by private banking consultants, Rabobank of the Netherlands emerged as a purchaser. Profitability has since improved and lending has slowly grown, while the share of non-performing loans remains low.Bank privatization Tanzania Africa Access to finance

Firm-level perspectives on public sector engagement with private healthcare providers: survey evidence from Ghana and Kenya.

BACKGROUND: Health systems in Sub-Saharan Africa (SSA) are in urgent need of improvement. The private health sector is a major provider of care in the region and it will remain a significant actor in the future. Any efforts by SSA governments to improve health systems performance therefore has to account for the private health sector. Regional and international actors increasingly recognize importance of effectively engaging with the private health sector, and initiatives to improve engagement are underway in several countries. However, there is little systematic analysis of private health providers' view and experience with engagement. METHODOLOGY/PRINCIPAL FINDINGS: In this study we surveyed private health facilities in Kenya and Ghana to understand the extent to which and how governments interact and engage with these facilities. The results suggest that government engagement with private health facilities is quite limited. The primary focus of this engagement is "command-and-control" type regulations to improve the quality of care. There is little attention paid to building the capacity of health care businesses through either technical or financial assistance. The vast majority of these facilities also receive no government assistance in meeting public health and social goals. Finally, government engagement with private pharmacies is often neglected and clinics receive a disproportionate share of government assistance. CONCLUSIONS/SIGNIFICANCE: Overall, our findings suggest that there may be considerable untapped potential for greater engagement with private health facilities--particularly pharmacies. Improving engagement will likely help governments with limited resources to better take advantage of the private sector capacity to meet access and equity objectives and to accelerate the achievement of the Millennium Development Goals