Social Services Viewed Through New Lenses: Agency Problems in Education and Health in Latin America

Latin America spends large amounts of resources on social services, yet its life expectancy and education levels are low compared to other regions with similar levels of income. A key reason is the inherent difficulty of making social services produce efficiently in reponse to demands and needs. This article shows how improving the organization of these service systems can make a significant difference in health conditions and student learning. A general framework applying the lessons of theories of the firm to the particularities of social services is developed, followed by a summary of case studies which assessed the impact of organization on performance in education (in Brazil, Venezuela and Chile), and in health (in Uruguay, Chile and the Dominican Republic). The paper shows that the relationships and rules followed by governments, service providers, and consumers can mean the difference between success and failure. It also describes a wealth of approaches, some of them with long histories, that point toward better ways of organizing social services and ultimately improving health and education in the region. This document is the first chapter of the Research Network book entitled "La organizacion marca la diferencia: Educación y salud en América Latina. "

How Much Do Teachers Earn?

In the continuing debate over how to improve education systems, many people argue that teachers` salaries need to be increased. This paper seeks to establish a reliable method for analyzing the issue using household survey data from Bolivia.

Earnings and the Elusive Dividends of Health

This paper looks at the relationship between health and income. After discussing the general context of health improvements in Latin America during the last few decades, the study elaborates on the interrelationships between the physical and social determinants of health, the complexities that arise in attributing earnings differentials to variations in health status, and the difficulties of accurately measuring health status. The paper presents a methodology for estimating the impact of health on earnings that addresses problems of measurement error and endogeneity, then summarizes the main findings of related studies undertaken as part of a larger project. These studies show that health status does have a significant, although modest, impact on earnings in four Latin American countries. Furthermore, environmental conditions (such as housing and sanitation) appear to have significant impacts on health status, compared to health services and public health facilities, which show little influence. The universally strong relationship between education and earnings is only modestly reduced by the inclusion of health status despite a general expectation that estimated returns to education were, in part, capturing the frequently unmeasured effects of health. By analyzing these relationships together-health determinants and the impact of health on earnings-we can assess the magnitude and importance of the `human capital`component of health status, validate and compare a range of health indicators, and identify promising areas for public policy to invest in health improvements.

A moving target: Universal access to healthcare services in Latin America and the Caribbean

Healthcare services are more widespread in Latin America and the Caribbean today than 50 years ago, yet this availability is not necessarily reflected in popular perceptions. This study documents the expansion of healthcare services in the Region in terms of medically-trained professionals, service utilization, and insurance eligibility. It finds that people in countries with more doctors have a more positive view of access to healthcare and greater confidence in the healthcare system. However, other factors intervene in this relationship between perceptions and objective indicators, such as the strength of local social networks and wealth. As a consequence of rising expectations, differential access and continuing discontent, public policy can be driven by factors that are least likely to improve the population's health

A Moving Target: Universal Access to Healthcare Services in Latin America and the Caribbean

Healthcare services are more widespread in Latin America and the Caribbean today than 50 years ago, yet this availability is not necessarily reflected in popular perceptions. This study documents the expansion of healthcare services in the Region in terms of medically-trained professionals, service utilization, and insurance eligibility. It finds that people in countries with more doctors have a more positive view of access to healthcare and greater confidence in the healthcare system. However, other factors intervene in this relationship between perceptions and objective indicators, such as the strength of local social networks and wealth. As a consequence of rising expectations, differential access and continuing discontent, public policy can be driven by factors that are least likely to improve the population's health.Health Care, Health Financing, Access, Happiness, Health Policy, Latin America, Caribbean

Governance in the health sector: a strategy for measuring determinants and performance

Many different strategies have been proposed to improve the delivery of health care services, from capacity building to establishing new payment mechanisms. Recent attention has also asked whether improvements in the way health care services are governed could make a difference. These approaches ask which factors -- such as rules and institutions -- influence the behavior of the system in ways that are associated with better performance and outcomes. This paper reviews the concept of governance as it is used in the literature on private firms, public administration, international development and health. It distinguishes between indicators that measure governance determinants from those that measure governance performance in order to propose a framework that is analytically coherent and empirically useful. The framework shows how these indicators can be used to test hypotheses about which governance forms are more useful for improving health system performance. The paper concludes by proposing specific measures of governance determinants and performance and describes the instruments available to collect and interpret them.Health Monitoring&Evaluation,Governance Indicators,National Governance,Health Systems Development&Reform,Health Economics&Finance

The disease of corruption: views on how to fight corruption to advance 21st century global health goals

Corruption has been described as a disease. When corruption infiltrates global health, it can be particularly devastating, threatening hard gained improvements in human and economic development, international security, and population health. Yet, the multifaceted and complex nature of global health corruption makes it extremely difficult to tackle, despite its enormous costs, which have been estimated in the billions of dollars. In this forum article, we asked anti-corruption experts to identify key priority areas that urgently need global attention in order to advance the fight against global health corruption. The views shared by this multidisciplinary group of contributors reveal several fundamental challenges and allow us to explore potential solutions to address the unique risks posed by health-related corruption. Collectively, these perspectives also provide a roadmap that can be used in support of global health anti-corruption efforts in the post-2015 development agenda

Cash On Delivery Aid for Health: What Indicators Would Work Best- Working Paper 275

The idea of applying a Cash on Delivery Aid (COD Aid) approach to the health sector has been raised many times, particularly in relation to addressing malaria, HIV/AIDS, maternal health, and water. After assessing the challenges of applying COD Aid in the health sector, this paper considers 10 indicators related to reducing child mortality, maternal mortality, and infections of malaria and HIV/AIDS. It provides guidance to those interested in designing COD Aid approaches to improve health outcomes in developing countries.health, aid effectiveness, accountability, COD aid, mortality, MDG, indicators