Have pro-poor health policies improved the targeting of spending and the effective delivery of health care in South Africa?

Since 1994 there have been a number of radical changes in the public health care system in South Africa. Budgets have been reallocated, decision making was decentralised, the clinic network was expanded and user fees for primary health care were abolished. The paper examines how these recent changes have affected the incidence of spending and the accessibility and quality of health care. The paper finds that between 1995 and 2003 there have been advances in the pro-poor spending incidence of both clinics and hospitals. The increased share of the health budget allocated to the more pro-poor clinic services has contributed further to the improvement in the targeting of overall health spending. Also, it appears that the elimination of user fees for clinics and the expansion of the clinic network have helped to make health services more affordable and geographically accessible to the poor and were associated with a notable rise in health service utilisation for individuals in the bottom two expenditure quintiles. South Africa’s spending on clinics and hospitals is well targeted and more progressive than other developing country public health systems. Unfortunately, it appears that to a considerable extent this result is driven by perceptions that services offered in public hospitals and clinics are of a low and variable quality. These perceptions seem to be encouraging most of those who can afford to pay more for health services to opt out of the public health system, thereby increasing the pro-poor incidence of public health spending. Complaints by users of public health facilities include long waiting times, staff rudeness and problems with drug availability. Dissatisfaction with health services is significantly higher in the public sector than in the private sector and the gap has expanded slightly over time. It is consequently not surprising that a substantial and increasing share of individuals – also including the very poorest – prefer to consult private providers.fiscal incidence, South Africa, health

Promoting transparency in the NGO sector: Examining the availability and reliability of self-reported data

Amid widespread calls for NGOs to become more accountable and transparent, this work examines the prevalence of discrepancies between what NGOs say and what they do. It does so using a unique dataset of 300 NGOs in Uganda with corresponding beneficiary assessments. Investigating NGO dishonesty with regards to financial transparency and community participation, the study finds a high incidence of misrepresentation among NGOs. Results from a Heckman probit model suggest that the determinants of misrepresentation differ according to the subject matter: the threat of being caught reduces the likelihood of dishonesty about financial transparency, while a desire to ‘save face’ to maintain a good reputation appears to be the main motivator of a misrepresentation of community consultation. The analysis provides tentative indications that NGOs with antagonistic relations with the government may be more likely to hide information and be dishonest. It also lends some support to the view that excessive and unrealistic donor demands may be an obstacle to openness and transparency. The findings of this work caution against an overly naïve and simplistic view of NGOs, and specifically, an overreliance on reported information when regulating, monitoring or surveying NGOs.

Examining the Robustness of Competing Explanations of Slow Growth in African Countries

This research challenges previous findings regarding the robustness of the African growth dummy by expanding the list of variables to include those suggested by Easterly and Levine (1998) and Sachs and Warner (1997b). Using the Bayesian Averaging of Classical Estimates approach, this paper concludes that the African growth dummy does not appear to be robustly related to growth. This supports the interpretation that the presence of the African dummy in other studies results from misspecification. The paper also contributes to the debate on growth strategies for Africa by assessing the robustness of divergent perspectives offered in the recent literature.growth, Africa, model specification, robustness

Examining the Robustness of Competing Explanations of Slow Growth in African Countries

This research challenges previous findings regarding the robustness of the African growth dummy by expanding the list of variables to include those suggested by Easterly and Levine (1998) and Sachs and Warner (1997b). Using the Bayesing Averaging of Classical Estimates Approach, this paper concludes that the African growth dummy does not appear to be robustly related to growth. This supports the interpretation that the presence of the African dummy in other studies results from misspecification. This paper also contributes to the debate on growth strategies for Africa by assessing the robustness of divergent perspectives offered in the recent literature.growth, Africa, model specification, robustness

A Model of NGO Regulation with an Application to Uganda

We develop a model of regulation of service-delivery NGOs, where future grants are conditional on prior spending of some minimal proportion of current revenue on direct project-related expenses. Such regulation induces some NGOs to increase current project spending, but imposes wasteful costs of compliance verification on all NGOs. Under a large class of parametric configurations, we find that regulation increases total discounted project expenditure over a regime of no regulation, when verification costs constitute no more than 15% of initial revenue. We characterize the optimal regulatory policy under these configurations. We apply our analysis to a large sample of NGOs from Uganda, and find regulation to be beneficial in that context.regulation of non-governmental organizations, developing countries, Uganda

A Model of NGO Regulation with an Application to Uganda

We develop a model of regulation of service-delivery NGOs, where future grants are conditional on prior spending of some minimal proportion of current revenue on direct project-related expenses. Such regulation induces some NGOs to increase current project spending, but imposes wasteful costs of compliance verification on all NGOs. Under a large class of parametric configurations, we find that regulation increases total discounted project expenditure over a regime of no regulation, when verification costs constitute no more than 15% of initial revenue. We characterize the optimal regulatory policy under these configurations. We apply our analysis to a large sample of NGOs from Uganda, and find regulation to be beneficial in that context.Regulation of non-governmental organizations, developing countries, Uganda

Have Pro-Poor Health Policies Improves the Targeting of Spending and the Effective Delivery of Health Care in South Africa?

Since 1994 there have been a number of radical changes in the public health care system in South Africa. Budgets have been reallocated, decision making was decentralised, the clinic network was expanded and user fees for primary health care were abolished

Post-Apartheid South Africa: Poverty and Distribution Trends in an Era of Globalization

South Africa’s transition to democracy in 1994 created new possibilities for economic policy. Economic liberalization brought sustained, if unspectacular, growth that reversed the long decline in per capita incomes, but left its scars in much job shedding associated with business becoming internationally competitive. This accords with international evidence that trade liberalization takes time to realize positive employment effects. Disappointing employment growth in the face of an expanding labourforce fed rising unemployment. However, using poverty estimates from a combination of sources, this study demonstrates that poverty nevertheless declined quite substantially after the turn of the century. Poverty dominance testing shows this conclusion to be insensitive to the selection of poverty line or measure. But empirical analysis does not allow strong conclusions to be drawn on causal relationships between globalization and poverty trends.trade; labour; South Africa; globalization

Post-Apartheid South Africa: Poverty and Distribution Trends in an Era of Globalization

South Africa?s transition to democracy in 1994 created new possibilities for economic policy. Economic liberalization brought sustained, if unspectacular, growth that reversed the long decline in per capita incomes, but left its scars in much job shedding associated with business becoming internationally competitive. This accords with international evidence that trade liberalization takes time to realize positive employment effects. Disappointing employment growth in the face of an expanding labourforce fed rising unemployment. However, using poverty estimates from a combination of sources, this study demonstrates that poverty nevertheless declined quite substantially after the turn of the century. Poverty dominance testing shows this conclusion to be insensitive to the selection of poverty line or measure. But empirical analysis does not allow strong conclusions to be drawn on causal relationships between globalization and poverty trends. ...trade, labour, South Africa, globalization

A series of national accounts-consistent estimates of poverty and inequality in South Africa

This paper makes a unique contribution to the South African literature in combining data from an alternative source of household survey data – the All Media and Product Survey (AMPS) – with national accounts income trends for this country, in the recent tradition of research on the world distribution of income performed by Bhalla (2002), Karshenas (2003), Bourguignon and Morrisson (2002), Sala-i-Martin (2002a; 2002b), and Quah (2002), amongst others. Its usefulness lies in arriving at alternative estimates of post-transition poverty and inequality that are consistent with the story that national accounts and other official data collectively tell us about the path of the South African economy during the post-transition period. While the method of scaling survey distribution data by national accounts means is somewhat controversial, it is not clear that the distributional trends obtained using the post-transition sets of either the IESs or the Population Censuses are more reliable, given serious deficiencies in both sources of data. Adjusted distributions yield lower levels of poverty and a stronger decline in poverty during the second half of the period than the figures obtained from the raw AMPS data. While the levels of poverty obtained using adjusted income distributions are artificially low, the derived downward trend is supported by a number of official data sources.Poverty, Inequality, Income distribution Analysis, South Africa