Why multi-stakeholder groups succeed and fail

Anti-corruption initiatives increasingly use multi-stakeholder groups, comprised of representatives from government, private sector, and civil society organizations, to drive implementation at the local level and serve as a force for transparency. In theory, the multi-stakeholder groups ideal is quite appealing -- each stakeholder has its own interest in the initiative and contributes its unique capacities. In practice, many multi-stakeholder groups have fallen short of expectations. This paper considers two separate but related questions. First, what are the unique barriers to implementation facing multi-stakeholder groups? Second, what policy measures can be taken to improve the likelihood that multi-stakeholder groups will succeed? The authors use existing research in political science and economics to develop a multi-level framework that accounts for the"nested nature"of multi-stakeholder groups. The framework is then applied to experiences of MSGs from the Construction Sector Transparency Initiative, a new pilot program that aims to promote transparency in construction through the release of material project information. The evidence shows that the barriers facing multi-stakeholder groups are substantial, but once the level (individual incentives, organizational dynamics, country context, or international pressures) of the challenge confronting a multi-stakeholder group is identified, the specific barrier, its root causes, and appropriate solutions can be identified. More broadly, the Construction Sector Transparency Initiative experiences suggest that multi-stakeholder groups are best used as a means of promoting dialogue and building consensus, not as the locus of policy implementation and oversight.Public Sector Corruption&Anticorruption Measures,Social Accountability,Emerging Markets,Corporate Law,Corruption&Anticorruption Law

Grand Corruption in Utilities

This paper discusses mechanisms of grand corruption in private sector utility provision in developing countries. By the term "grand corruption," the authors abstract from the petty corruption that consumers experience -- for example, when firms and individuals pay bribes to get water delivery or an electricity connection. The paper focuses on decisions made at the government level involving private sector management, ownership, and provision of utility services. Corruption at that level may influence the pace and nature of private sector involvement and competition in utilities, as well as the level and form of investments, subsidies, and prices. On the basis of a literature review and interviews with firms and regulating authorities in two countries, Tanzania and the Philippines, this paper discusses the levels and determinants of grand corruption in utilities. The paper concludes by discussing a research program to extend this knowledge through a cross-country survey instrument.abuse; access to capital; access to finance; Access to information; accessibility; accountability; anti-corruption; Asian Development Bank; assets; asymmetric information; authority;

Dealing with politics for money and power in infrastructure

Policy recommendations for infrastructure provision usually build on a well-established understanding of best practice for sector governance. Too rarely are they adapted to the country-specific political environment even if this is an area where policy choices are likely to be subject to private agendas in politics. The fact that such private agendas are often ignored goes a long way toward explaining why infrastructure policies fail and why best practice can be counterproductive. While non-benevolence and rent-seeking are well described in the literature and anecdotes abound, there is only limited consideration of how the different incentive problems in politics impede policy improvements in infrastructure. This paper addresses why politics in infrastructure cannot be ignored, drawing on theoretical results and a systematic review of experiences. It reviews how different private agendas in politics will have different impacts for sector-governance decisions -- and hence service delivery. The concept of best practice in policy recommendations should be reconsidered in a wide perspective and allow for tailored solutions based on an understanding of the given incentive problems. Policy recommendations should take into account how coordination trade-offs may complicate efforts to reduce the possible impact of private agendas on infrastructure policy decisions. Although more transparency linked to service delivery indicators is a"safe"recommendation, it is also clear that the demand for good governance will not be sufficient to secure political accountability in a sector with huge vested interests combined with complicated funding schemes and complex contracts.Public Sector Corruption&Anticorruption Measures,National Governance,Governance Indicators,Environmental Economics&Policies,Transport Economics Policy&Planning

Political economy of the petroleum sector in Nigeria

The relatively slow pace of Nigeria's development has often been attributed to the phenomenon of the resource curse whereby the nature of the state as a"rentier"dilutes accountability for development and political actors are able to manipulate institutions to sustain poor governance. The impact of the political elite's resource-control and allocation of revenues on core democratic mechanisms is central to understand the obstacles to development and governance failure. Given that problems of petroleum sector governance are extremely entrenched in Nigeria, the key question is whether and how it is possible to get out of a poor equilibrium after fifty years of oil production. This paper uses a political economy perspective to analyze the governance weaknesses along the petroleum sector value chain and attempts to establish the links between challenges in sector regulation and the following major political and economic attributes: (i) strong executive control on petroleum governance in a political environment of weak checks and balances; (ii) regulatory and operating roles bundled into one institution, thereby creating conflict of interest; and (iii) manipulation of elections and political appointments. The restoration of democratic government has helped improve transparency and management of oil revenue and reforms at the federal level and proposed reforms of the petroleum sector hold much promise. At the same time, the judiciary has started to restore confidence that it will serve as a check and balance on the executive and the electoral process. Yet, these reforms are fragile and need to be deepened and institutionalized. They must be addressed not as purely technocratic matters but as issues of political economy and vested interests that must, through regulation and reform, be aligned with the public interest and a vision of Nigerian development.National Governance,Environmental Economics&Policies,Oil Refining&Gas Industry,Energy Production and Transportation,Public Sector Corruption&Anticorruption Measures

www.ecares.org Dealing with Politics for Money and Power in Infrastructure

Policy recommendations for infrastructure provision usually build on a well-established understanding of best practice for sector governance. Too rarely are they adapted to the country-specific political environment even if this is an area where policy choices are likely to be subject to private agendas in politics. The fact that such private agendas are often ignored goes a long way toward explaining why infrastructure policies fail and why best practice can be counterproductive. While non-benevolence and rent-seeking are well described in the literature and anecdotes abound, there is only limited consideration of how the different incentive problems in politics impede policy improvements in infrastructure. This paper addresses why politics in infrastructure cannot be ignored, drawing on theoretical results and a systematic review of experiences. It reviews how different private agendas in politics will have different impact for sector-governance decisions – and hence service delivery. The concept of best practice in policy recommendations should be reconsidered in a wide perspective and allow for tailored solutions based on an understanding of the given incentive problems. Policy recommendations should take into account how coordination trade-offs may complicate efforts to reduce the possible impact of private agendas on infrastructure policy decisions. While more transparency linked to service delivery indicators is a “safe ” recommendation, it is also clear that the demand for good governanc

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

An Economic Analysis of Debarment

With a view to reducing the consequences of corruption in public procurement, many governments have introduced debarment of suppliers found guilty of corrup- tion and some other forms of crime. This paper explores the market effects of debarment on public procurement. Debarment is found to make little difference in markets with high competition, while in markets with low competition it may deter corruption as long as firms value public procurement contracts in the future and there is a certain risk of being detected in corruption. On the other hand, debarment when it works has an anti-competitive effect, and this effect will contribute to facilitate collusion between suppliers. Debarment may work as a tool against collusion, but only if targeting one firm at the time (such as a ring-leader or the specific beneficiary when the collusion is detected) and not all the members of a cartel. If designed with an understanding of the market mechanisms at play, debarment can deter both collusion and corruption, thus improving the results of public procurement. If so, most current debarment regimes need modification