Are incentives everything? payment mechanisms for health care providers in developing countries

This paper assesses the extent to which provider payment mechanisms can help developing countries address their leading health care problems. It first identifies four key problems in the health care systems in developing countries: 1) public facilities, which provide the bulk of secondary and tertiary health care services in most countries, offer services of poor quality; 2) providers cannot be enticed to rural and urban marginal areas, leaving large segments of the population without adequate access to health care; 3) the composition of health services offered and consumed is sub-optimal; and 4) coordination in the delivery of care, including referrals, second opinions, and teamwork, is inadequate. The paper examines each problem in turn and assesses the extent to which changes in provider payments might address it.Health Economics&Finance,Health Systems Development&Reform,Public Health Promotion,Health Monitoring&Evaluation,Early Child and Children's Health,Health Monitoring&Evaluation,HealthEconomics&Finance,Health Systems Development&Reform,Environmental Economics&Policies,Housing&Human Habitats

The publicity"defect"of customary law

This paper examines the extent to which dispute resolvers in customary law systems provide widely understandable justifications for their decisions. The paper first examines the liberal-democratic reasons for the importance of publicity, understood to be wide accessibility of legal justification, by reviewing the uses of publicity in Habermas’ and Rawls’ accounts of the rule of law. Taking examples from Sierra Leone, the paper then argues that customary law systems would benefit from making the reasons for local dispute resolution practices, such as"begging"from elders, witchcraft, and openness of hearings, more widely accessible. The paper concludes that although legal pluralism is usually taken to be an analytical concept, it may have a normative thrust as well, and that publicity standards would also apply to formal courts in developing countries, which are also typically"defective"along this dimension.Legal Products,Gender and Law,Children and Youth,Public Sector Corruption&Anticorruption Measures,Parliamentary Government

Public interest litigation in India : overreaching or underachieving ?

Public interest litigation has historically been an innovative judicial procedure for enhancing the social and economic rights of disadvantaged and marginalized groups in India. In recent years, however, a number of criticisms of public interest litigation have emerged, including concerns related to separation of powers, judicial capacity, and inequality. These criticisms have tended to abstraction, and the sheer number of cases has complicated empirical assessments. This paper finds that public interest litigation cases constitute less than 1 percent of the overall case load. The paper argues that complaints related to concerns having to do with separation of powers are better understood as criticisms of the impact of judicial interventions on sector governance. On the issue of inequality, the analysis finds that win rates for fundamental rights claims are significantly higher when the claimant is from an advantaged social group than when he or she is from a marginalized group, which constitutes a social reversal, both from the original objective of public interest litigation and from the relative win rates in the 1980s.Gender and Law,Judicial System Reform,Human Rights,Information Security&Privacy,Legal Institutions of the Market Economy

Redressing grievances and complaints regarding basic service delivery

Redress procedures are important for basic fairness. In addition, they can help address principal-agent problems in the implementation of social policies and provide information to policy makers regarding policy design. To function effectively, a system of redress requires a well-designed and inter-linked supply of redress procedures as well as, especially if rights consciousness is not well-developed in a society, a set of organizations that stimulate and aggregate demand for redress. On the supply side, this paper identifies three kinds of redress procedures: administrative venues within government agencies, independent institutions outside government departments, and courts. On the demand side, the key institutions are nongovernmental organizations/civil society organizations and the news media, both of which require a receptive political and economic climate to function effectively. Overall, procedures for redressing grievances and complaints regarding basic service delivery are under-developed in many countries, and deserve further analysis, piloting, and support.Public Sector Corruption&Anticorruption Measures,Corruption&Anticorruption Law,Public Sector Regulation,Health Monitoring&Evaluation,Governance Indicators

How do local-level legal institutions promote development ?

This paper develops a framework and some hypotheses regarding the impact of local-level, informal legal institutions on three economic outcomes: aggregate growth, inequality, and human capabilities. It presents a set of stylized differences between formal and informal legal justice systems, identifies the pathways through which formal systems promote economic outcomes, reflects on what the stylized differences mean for the potential impact of informal legal institutions on economic outcomes, and looks at extant case studies to examine the plausibility of the arguments presented. The paper concludes that local-level, informal legal institutions can support social substitutes for the enforcement of contracts, although these substitutes tend to be limited in range and scale; they are flexible and could conceivably be adapted to serve the interests of the poor and marginalized if supportive organizational and social resources could be brought to support the legal claims of the disempowered; and they are more likely to support personal integrity rights than the positive liberties that are also constitutive of development as freedom.Legal Products,Children and Youth,Public Institution Analysis&Assessment,Gender and Law,Legal Institutions of the Market Economy

Do international treaties promote development ? the convention on the rights of the child and basic immunization

Little evidence is available on whether changing global rules so as to promote human rights can enhance development outcomes. The Convention on the Rights of the Child was almost universally ratified by the mid-1990s, but it is unclear whether treaty ratification was associated with better or wider protection of children’s rights. This paper uses an instrumental variable approach to investigate whether treaty ratification was associated with stronger effort at the country level on child survival, and particularly with higher rates of immunization coverage. The paper finds that ratification of the Convention on the Rights of the Child was correlated with a subsequent increase in immunization rates, but only in upper middle and high-income countries. Treaties can promote development outcomes, but require institutional support to do so.Population Policies,Labor Policies,Treaties,Human Rights,Children and Youth

Social rights and economics : claims to health care and education in developing countries

The author analyzes contemporary rights-based and economic approaches to health care and education in developing countries. He assesses the foundations and uses of social rights in development, outlines an economic approach to improving health and education services, and then highlights the differences, similarities, and the hard questions that the economic critique poses for rights. The author argues that the policy consequences of rights overlap considerably with a modern economic approach. Both the rights-based and the economic approaches are skeptical that electoral politics and de facto market rules provide sufficient accountability for the effective and equitable provision of health and education services, and that further intrasectoral reforms in governance, particularly those that strengthen the hand of service recipients, are needed. There remain differences between the two approaches. Whether procedures for service delivery are ends in themselves, the degree of disaggregation at which outcomes should be assessed, the consequences of long-term deprivation, metrics used for making tradeoffs, and the behavioral distortions that result from subsidies are all areas where the approaches diverge. Even here, however, the differences are not irreconcilable, and advocates of the approaches need not regard each other as antagonists.Health Monitoring&Evaluation,Health Systems Development&Reform,Decentralization,Public Health Promotion,Early Child and Children's Health,Health Monitoring&Evaluation,Health Economics&Finance,Poverty Assessment,Agricultural Knowledge&Information Systems,Gender and Education

Location decisions and nongovernmental organization motivation : evidence from rural Bangladesh

Nongovernmental organizations (NGOs) play an increasingly important role in development assistance, but little systematic evidence is available about their objectives and choices in developing countries. The authors develop two stylized accounts of NGO motivation: one in which donor contracts determine location decisions, and another in which altruistic motivations are the principal determinants. The authors then use data from the 1995 and 2000 rounds of the Bangladesh Households and Income and Expenditure Survey to analyze location decisions of NGO programs established between those two sample years. The data show that net change in a community's NGO program was unrelated to the community's need and that NGOs were ready to establish new programs in new areas without being concerned of duplicating the efforts of other NGOs. The findings suggest that contracts with donors, implicit or explicit, probably play a crucial role in determining the incentives that affect NGO program location choices.Poverty Monitoring&Analysis,Insurance&Risk Mitigation,ICT Policy and Strategies,Poverty Impact Evaluation,Agricultural Knowledge&Information Systems,Poverty Monitoring&Analysis,Agricultural Knowledge&Information Systems,ICT Policy and Strategies,Non Governmental Organizations,Community Development and Empowerment

Education, labor rights, and incentives : contract teacher cases in the indian courts

Since the liberalization of India's economy beginning in the early 1990's, the government has increasingly employed contract workers to perform various state functions, including in the education sector. Yet, little research has been done to examine how courts have reacted to this shift in government labor policy. This paper looks at all reported cases involving contract teachers in the Indian Supreme Court and four High Courts over the last thirty years. It finds that although almost never explicitly overturning precedent, the judiciary in India has increasingly become less sympathetic to contract teachers demands, particularly at the Supreme Court level. The paper then argues that the Court could use its power of judicial review to engage the government in a dialogue, not unlike some of its earlier decisions in the 1980s and early 1990s. The Court can help guide the government to create a labor policy that not only achieve better results for students, but better working conditions for teachers. Such a dialogic approach could potentially be adopted to help reframe the government’s contract labor policy more generally.Tertiary Education,Primary Education,Education For All,Teaching and Learning,Access&Equity in Basic Education

Human rights based approaches to developmen t: concepts, evidence, and policy

This paper assesses the benefits, risks, and limitations of human rights based approaches to development, which can be catalogued on the basis of the institutional mechanisms they rely on: global compliance based on international and regional treaties; the policies and programming of donors and executive agencies; rights talk; and legal mobilization. The paper briefly reviews the politics of the first three kinds of human rights based approaches before examining constitutionally based legal mobilization for social and economic rights in greater detail. Litigation for social and economic rights is increasing in frequency and scope in several countries, and exhibits appealing attributes, such as inclusiveness and deliberative quality. Still, there are potential problems with this form of human rights based mobilization, including middle class capture, the potential counter-majoritarianism of courts, and difficulties in compliance. The conclusion summarizes what is known, and what remains to be studied, regarding human rights based approaches to development.Human Rights,Gender and Law,Health Law,Parliamentary Government,Population Policies