Using data for a sample of developing and transition countries, this paper estimates the relationship between government spending on health care and education, and social indicators. Unlike previous studies, where social indicators are used as proxies for the unobservable health and education status of the population, this paper estimates a latent variable model. The findings suggest that public social spending is an important determinant of social indicators, particularly in the education sector. Overall, the latent variable approach was found to yield more adequate estimates of social production functions, with larger elasticities of social indicators with respect to income and spending on education than the traditional approach, providing stronger evidence that increases in public spending have a positive impact on social indicators. The study also finds that the millennium goal of universal primary education enrollment by 2015 could be achieved through an increase by one-third, on average, in education spending.

More on the Effectiveness of Public Spending on Health Care and Education: A Covariance Structure Model

There are very few documented large-scale successes in nutrition in Africa, and virtually no consideration of contracting for preventive services. This paper describes two successful large-scale community nutrition projects in Africa as examples of what can be done in prevention using the contracting approach in rural as well as urban areas. The two case-studies are the Secaline project in Madagascar, and the Community Nutrition Project in Senegal. The article explains what is meant by 'success' in the context of these two projects, how these results were achieved, and how certain bottlenecks were avoided. Both projects are very similar in the type of service they provide, and in combining private administration with public finance. The article illustrates that contracting out is a feasible option to be seriously considered for organizing certain prevention programmes on a large scale. There are strong indications from these projects of success in terms of reducing malnutrition, replicability and scale, and community involvement. When choosing that option, a government can tap available private local human resources through contracting out, rather than delivering those services by the public sector. However, as was done in both projects studied, consideration needs to be given to using a contract management unit for execution and monitoring, which costs 13-17% of the total project's budget. Rigorous assessments of the cost-effectiveness of contracted services are not available, but improved health outcomes, targeting of the poor, and basic cost data suggest that the programmes may well be relatively cost-effective. Although the contracting approach is not presented as the panacea to solve the malnutrition problem faced by Africa, it can certainly provide an alternative in many countries to increase coverage and quality of services.

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Successful contracting of prevention services: fighting malnutrition in Senegal and Madagascar.

The core determinants of health expenditure in the African context: some econometric evidence for policy.

Using data for a sample of developing countries and transition economies, this paper estimates the relationship between government spending on health care and education and selected social indicators. Unlike previous studies, where social indicators are used as proxies for the unobservable health and education status of the population, this paper estimates a latent variable model. The findings suggest that public spending is an important determinant of social outcomes, particularly in the education sector. Overall, the latent variable approach yields better estimates of a social production function than the traditional approach, with higher elasticities of social indicators with respect to income and spending, therefore providing stronger evidence that increases in public spending do have a positive impact on social outcomes. Copyright # 2003 John Wiley & Sons, Ltd.

/pdf/more-on-the-effectiveness-of-public-spending-on-health-care-4q7q8hs5dh.pdf

More on the effectiveness of public spending on health care and education: a covariance structure model

Excellence in Public Service

This paper presents a broad set of data on health expenditures, services, and outcomes in African countries, as well as examples of how this information can be used. Critical gaps in health information are also discussed with regard to both public and non-governmental provision and financing. This report identifies a growing differentiation in African country health sector expenditures. While the median annual per capita government expenditure on health in Africa was nearly US$6 from 1990 to 1996, it averaged US$3 per capita in the lowest-income countries and US$72 per capita in the middle-income countries. Declines in total fertility rates (TFRs) were much greater in middle-income, lower fertility countries than in the low- and lowest-income countries. The report also flags a reversal in adult mortality trends from 1990 to 1995, with small increases for both males and females. In the course of this study, the relationship between public expenditures on health and key health services was examined, as well as that between health services and health outcomes, measles immunization with childhood malnutrition, contraceptive prevalence with lower infant mortality, and between supervised deliveries with lower infant mortality.

Peters, David H. Kandola, Kami Elmendorf, A. Edw

Papers

Health Expenditures, Services, and Outcomes in Africa: Basic Data and Cross-National Comparisons, 1990-1996