The weak link between public spending in health and education, and health and education outcomes can be partially explained by the fact that the delivery of services that are critical to human development -- health, education, water and sanitation -- are widely failing poor people. The money is often spent on private goods or on the non-poor; it often fails to reach the frontline service provider; incentives for service delivery by providers are weak; and poor people sometimes fail to demand these services. This paper examines the experience with alternative mechanisms for service delivery -- contracting out to the private and NGO sectors, community participation, co-financing by service beneficiaries -- and shows that this, as well as the experience of more traditional public sector provision, can be interpreted by looking at three principal-agent relationships in the service-delivery chain: between policymakers and providers; between clients and providers; and between clients (as citizens) and policymakers. Weaknesses in one or more of these relationships can lead to service-delivery failure, while attempts to strengthen one may not always work because of deficiencies in other links in the chain. Copyright 2004, Oxford University Press.

Making Services Work for Poor People

Putting the principles of the Sustainable Livelihoods Approach into fisheries development policy and practice

The notion of food security has an important history as a key concept for 20th-century policymakers. Two overarching perspectives on food security are identified. One centred on raising production as the core answer to under-consumption and hunger. The other is an emerging perspective, more social and ecological, accepting the need to address a complex array of problems, not just production. The first is primarily agricultural-focused; the latter a food systems approach. From its inception in post-World War 2 international reconstruction, the UN and governments have given tackling hunger a high profile, via a changing package of policy measures. Within a few decades, the production-oriented approach or paradigm was being questioned by the emerging paradigm with its more complex, multi-focused notion of the challenges ahead. When oil and agricultural commodity prices spiked in 2007–8, the complex agenda was marginalised by a renewed international focus on primary production and the needs of low-income countries. Against this background, the paper explores the diversity of perspectives on what is meant by food security, concluding that the core 21st-century task is to create a sustainable food system. This requires a more coherent policy framework than currently exists, a goal thwarted by competing solutions vying for policy attention and policy failure thus far to integrate the complex range of evidence from social as well as environmental and economic sources into an integrated policy response.

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Food security and food sustainability: reformulating the debate

This article presents the basic elements for developing a theory of the health transition. Such elements include the definition of concepts the specification of a framework on the determinants of health status the analysis of the mechanisms through which health change occurs in populations the characterization of the attributes that allow us to identify different transition models and the enumeration of the possible consequences of the transition. The propositions are presented with a sufficient level of generality as to make them applicable to different contexts; at the same time an attempt is made to provide them with the necessary specificity to account for different national experiences thus opening a space for future comparative research efforts. The geographic scope is worldwide. (EXCERPT)

Elements for a theory of the health transition

This paper develops a conceptual model to examine the vulnerability of Inuit food systems to food insecurity as a consequence of climate change. The model illustrates that food system vulnerability is determined by the exposure and sensitivity of the food system to climate-related risks and its adaptive capacity to deal with those risks. The model is empirically applied using a case study from Igloolik, Nunavut. Specifically, the paper focuses on how extreme climate-related conditions in 2006 interacted with the food system to affect food security, using 2006 as a lens to identify and characterize some of the processes and conditions shaping vulnerability, and establishing a baseline for identifying and characterizing processes that are likely to shape future vulnerability. There is a high level of adaptive capacity among Igloolik Inuit, with food sharing mechanisms, hunting flexibility, and store-food access moderating the impact of climatic-risks on food security. However, high fuel and commodity prices, the increasing economic burden of adapting to back-to-back years with unfavorable climatic conditions, underlying community vulnerabilities, and the nature to the climate extremes in 2006, overwhelmed the adaptive capacity of many community members. Those dependent on traditional foods and having limited access to financial resources were particularly vulnerable.

A Sen

Papers

Poverty and famines. An essay on entitlement and deprivation [incl. case studies of famines in Bengal, Ethiopia, Sahel, and Bangladesh].