The paper examines the debates regarding place-neutral versus place-based policies for economic development. The analysis is set in the context of how development policy thinking on the part of both scholars and international organizations has evolved over several decades. Many of the previously accepted arguments have been called into question by the impacts of globalization and a new response to these issues has emerged, a response both to these global changes and also to nonspatial development approaches. The debates are highlighted in the context of a series of major reports recently published on the topic. The cases of the developing world and the European Union are used as examples of how in this changing context development intervention should increasingly focus on efficiency and social inclusion at the expense of an emphasis on territorial convergence and how strategies should consider economic, social, political, and institutional diversity in order to maximize both the local and the aggregate potential for economic development.

/pdf/the-case-for-regional-development-intervention-place-based-2f1a1b6mia.pdf

The case for regional development intervention: place-based versus place-neutral approaches*

The 2011 Human Development Report argues that the urgent global challenges of sustainability and equity must be addressed together – and identifies policies on the national and global level that could spur mutually reinforcing progress towards these interlinked goals. Bold action is needed on both fronts, the Report contends, if the recent human development progress for most of the world’s poor majority is to be sustained, for the benefit of future generations as well as for those living today. Past Reports have shown that living standards in most countries have been rising – and converging – for several decades now. Yet the 2011 Report projects a disturbing reversal of those trends if environmental deterioration and social inequalities continue to intensify, with the least developed countries diverging downwards from global patterns of progress by 2050.The Report shows further how the world’s most disadvantaged people suffer the most from environmental degradation, including in their immediate personal environment, and disproportionately lack political power, making it all the harder for the world community to reach agreement on needed global policy changes. The Report also outlines great potential for positive synergies in the quest for greater equality and sustainability, especially at the national level. The Report further emphasizes the human right to a healthy environment, the importance of integrating social equity into environmental policies, and the critical importance of public participation and official accountability. The 2011 Report concludes with a call for bold new approaches to global development financing and environmental controls, arguing that these measures are both essential and feasible.

Human Development Report 2011. Sustainability and Equity: A Better Future for All

https://www.who.int/neglected_diseases/Bottom_billion_ntd_control.pdf

Rescuing the bottom billion through control of neglected tropical diseases

Contemporary research on civil war has largely dismissed the role of political and economic grievances, focusing instead on opportunities for conflict. However, these strong claims rest on questionable theoretical and empirical grounds. Whereas scholars have examined primarily the relationship between individual inequality and conflict, we argue that horizontal inequalities between politically relevant ethnic groups and states at large can promote ethnonationalist conflict. Extending the empirical scope to the entire world, this article introduces a new spatial method that combines our newly geocoded data on ethnic groups’ settlement areas with spatial wealth estimates. Based on these methodological advances, we find that, in highly unequal societies, both rich and poor groups fight more often than those groups whose wealth lies closer to the country average. Our results remain robust to a number of alternative sample definitions and specifications.

/pdf/horizontal-inequalities-and-ethnonationalist-civil-war-a-1eupgm5fiu.pdf

Horizontal Inequalities and Ethnonationalist Civil War: A Global Comparison

In 1975, most civil wars were located in Asia, and all but two were guerrilla wars—contests entailing an asymmetric rebel challenge launched from the country’s rural periphery. In 1993, in contrast, most internal conflicts were located in sub-Saharan Africa, and guerrilla wars comprised less than half of them. Much more common were conventional wars using heavy armor and artillery in a landscape dominated by siege warfare and trenches, or “primitive” wars between poorly armed and trained militias. We argue that this dual geographic and military shift is symptomatic of a broader transformation of internal conflict—the result of a major structural change in the international system: the end of the Cold War. This transformation has been overlooked for three reasons: (1) the literature has stressed the determinants of civil war onset over the way in which civil wars are fought, (2) it has treated civil wars as a homogeneous phenomenon over time and space, and (3) it has emphasized the impact of domestic factors compared to international ones. We show instead that incorporating the international system into the analysis of civil wars

/pdf/international-system-and-technologies-of-rebellion-how-the-lwkkpwke8p.pdf

International System and Technologies of Rebellion: How the End of the Cold War Shaped Internal Conflict

Disadvantaged populations, such as the poor, pose a complex set of challenges to the process of economic development. While a girl child born in Japan in 2005 is expected to live for 86 years, deliver her child in a medical institution under skilled supervision and receive appropriate attention during her old age, her contemporary born in Angola, Lesotho, Sierra Leone, Swaziland, Zambia or Zimbabwe is expected to live for about 40 years, deliver her child at home without any skilled supervision and struggle to receive adequate care during old age if she survives that long. The child cannot be faulted for this diverse prospect of length and quality of life: countries that are home to such disadvantaged population groups are in extreme poverty and express their helplessness to rescue such groups. When countries are poor and small, their economies or governments are not in a position to respond effectively to diseases that predominantly affect their poor citizens. This inability to deal adequately with complex situations further impedes such countries’ growth. As a result, many low-income countries, where most of the world’s poor live, are drifting away, in developmental terms, from the rest of the world.

On the other hand, the poor living in countries that are doing well economically face a different set of problems. Such people live alongside the rich and face similar market conditions due to increased globalization and monetization of economies. Possibilities to deal with the problems of poverty exist in better-off countries, but the poor often lack access to them. In such countries, the usefulness of economic growth lies in what it does to enhance people’s health and welfare. “Growth” has no meaning if millions of the poor lack access to basic amenities, such as health care.

Whether developing or not, many low-income countries are caught in several traps which prevent them from prospering. To make things worse, the present global economy is unfavourable to the bottom billion people and the countries in which they live. Hence, it is much harder for disadvantaged countries to break out of the traps in which they find themselves. In this book, Paul Collier discusses four such traps that have previously received little attention. Interestingly, what many people would consider to be a source of prosperity – natural resources – is seen as a trap by the author. The other traps he discusses are conflict, being landlocked and surrounded by bad neighbours, and bad governance.

The author claims that low-income, slow economic growth and high dependence on primary commodity exports are the key determinants of civil war, which is likely to continue longer if a country’s income is low. Civil war also tends to reduce a country’s economic growth by about 2.3% per annum. He notes that 73% of people among the bottom billion have been affected by civil war recently, 29% live in countries where natural wealth dominates the economy, 30% live in countries that are landlocked and resource-scarce and have bad neighbours, and 76% have lived through a prolonged period of bad governance and poor economic policies.

The future progress of the bottom billion people is crucial for health and health system development. These are the people caught in the poverty/ill-health trap. Inequities in access to health care suffered by this group further disadvantage it. Conflicts, bad governance and lack of development clearly have an effect on the national health systems of the worst-affected countries. Breaking out of the traps discussed in the book is important for future health system development, and understanding these and other barriers to development is the essential first step. The book is a welcome contribution to health development literature and makes excellent reading for those who are concerned about poverty and the poor, and for those who tend to think that economic growth is the sum total of human welfare.

The book powerfully describes the increasing income divisions between sections of populations; the difficulties that development agencies face in placing materials and staff in areas with maximum needs; governments’ inabilities and failures to deal with the situation; and investment failures in poor settings. The book also serves as a timely reminder for carrying out suitable policy and development responses. The author’s rich African experience is reflected in the valuable country examples provided, while the narrative style makes the book read well. A deliberately pessimistic view of the future prospects of the bottom billion is presented, but the book does provide some suggestions that the affected countries and the Group of Eight (G8) countries could adopt to improve the status quo. The book would have benefited from use of an analytical framework to better depict the evidence presented. ■

/pdf/the-bottom-billion-why-are-the-poorest-countries-failing-and-17045hnczf.pdf

The bottom billion: why are the poorest countries failing and what can be done about it

Background and Objectives 
This paper focuses on the inadequate attention on women's non-maternal healthcare in low- and middle-income countries. The study assessed the purchase of and financial access to non-maternal healthcare. It also scoped for mainstreaming household financial resources in this regard to suggest for alternatives.
Methods 
A household survey through multi-stage stratified sampling in the state of Orissa interviewed rural women above 15 years who were neither pregnant nor had any pregnancy-related outcome six weeks preceding the survey. The questions explored on the processes, determinants and outcomes of health seeking for non-maternal ailments. The outcome measures were healthcare access, cost of care and financial access. The independent variables for bivariate and multivariate analyses were contextual factors, health seeking and financing pattern.
Results 
The survey obtained a response rate of 98.64% and among 800 women, 43.8% had no schooling and 51% were above 60 years. Each woman reported at least one episode of non-maternal ailment; financial constraints prevented 68% from receiving timely and complete care. Distress coping measures (e.g. borrowings) dominated the financing source (67.9%) followed by community–based measures (32.1%). Only 6% had financial risk-protection; financial risk of not obtaining care doubled for women aged over 60 years (OR 2.00, 95% CI 0.84–4.80), seeking outpatient consultation (OR 2.01, 95% CI 0.89–4.81), facing unfavourable household response (OR 2.04, 95% CI 1.09–3.83), and lacking other financial alternatives (OR 2.13, 95% CI 1.11–4.07). When it comes to timely mobilization of funds and healthcare seeking, 90% (714) of the households preferred maternal care to non-maternal healthcare.
Conclusion 
The existing financing options enable sub-optimal purchase of women's non-maternal healthcare. Though dominant, household economy extends inadequate attention in this regard owing to its unfavourable approach towards non-maternal healthcare and limited financial capacity and support from other financial resources.

/pdf/addressing-women-s-non-maternal-healthcare-financing-in-28gmf15v50.pdf

Addressing women's non-maternal healthcare financing in developing countries: what can we learn from the experiences of rural Indian women?

Decentralization involves the dispersion of power, functions and finances from a central authority to regional and local authorities. Decentralization reforms have become widespread in low- and middle-income countries, mainly due to movements towards democratiza-tion, the spread of multi-party electoral systems and transitions towards market economies. In particular, decentraliza-tion of financing systems, particularly for health, is now a common aspect of reform in these countries. The main advantage is the dynamism it can bring into the resource allocation mechanism; it also can facilitate re-allocation of funds through a visible, vibrant and bottom-up approach.

/pdf/emerging-opportunities-for-recruiting-and-retaining-a-rural-10fm3aj2pd.pdf

Emerging opportunities for recruiting and retaining a rural health workforce through decentralized health financing systems.

Purpose – Modern lifestyle changes led to increased dental care needs in India. Consequently, there has been a sharp rise in dentist numbers. Karnataka state alone produces 2,500 dentists annually, who are engaged in the non-government sector owing to inadequate public sector opportunities. This article aims to assess Karnataka private dental clinic quality and efficiency. Design/methodology/approach – Dentists were interviewed using a close-ended, structured interview schedule and their clinics were assessed using a checklist adopted from guidelines for providing machinery and equipment under the National Oral Health Care Programme (NOHCP). Dental “hotel” and clinical quality were scored based on this checklist. Findings – Clinical quality was “excellent” in 12 per cent of clinics and poor in 49 per cent. Clinics with better infrastructure charged higher price (pPractical implications – The multi chair clinics offered better quality at higher prices and single chair clinics provided poorer quality at lower prices. In other words, they had a sub-optimal price-quality mix. Therefore, there is a need to regulate price and quality in all clinics to arrive at an optimal price-quality mix so that clients are not overburdened financially even while receiving good quality dental care. Originality/value – The article advocates that resources are used optimally as a way to achieve value for money and to achieve break-even points thereby providing quality care in a competitive market. Factors that influence dental practitioner behaviour are evaluated.

Using Dental Care Resources Optimally: Quality-Efficiency Trade-Offs in a Competitive Private Market

Given the increasing need for mainstreaming household financing for women's nonmaternal health care and evidences on community-based financing's contribution to women's health care in general, this study explored their scope for nonmaternal health care in Orissa. A qualitative assessment conducted focus group discussions with rural women who met the eligibility criteria. Community-based financing provided financial access and risk protection for women's nonmaternal health care during the previous 1 year, though not adequately. Schemes covering outpatient care (or mild illnesses) provided relatively more financial access. The major determinants of their restricted financial access were limited sum assured, noncomprehensive coverage of services, exclusion of elderly women, and the lower priority households gave to nonmaternal health care. Community-based financing requires relevant structural changes along with demand-side behavioral modifications to ensure optimal attention to women's nonmaternal health care. Language: en

Varatharajan Durairaj

Papers

The bottom billion: why are the poorest countries failing and what can be done about it

Addressing women's non-maternal healthcare financing in developing countries: what can we learn from the experiences of rural Indian women?

Emerging opportunities for recruiting and retaining a rural health workforce through decentralized health financing systems.

Using Dental Care Resources Optimally: Quality-Efficiency Trade-Offs in a Competitive Private Market

Leveraging community-based financing for women's nonmaternal health care: experiences of rural Indian women.