Improving Basic Services for the Bottom Forty Percent: Lessons from Ethiopia

Khan, Qaiser M.; Faguet, Jean-Paul; Gaukler, Christopher; Mekasha, Wendmsyamregne

doi:10.1596/978-1-4648-0331-4

Cited by 13 publications

(24 citation statements)

References 12 publications

(15 reference statements)

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“…Both roll-out by the center and take-up by regional and local governments have been impressive. More than 90 percent of woredas and city administrations now post financial information publicly, and further disseminate it via, for example, radio, television, brochures, and printed t-shirts (Khan et al 2014). Social accountability programs are currently being implemented in 25 percent of all woredas nationwide, whereas financial transparency and grievance redress mechanisms have already reached all woredas.…”

Section: Fiscal Contextmentioning

confidence: 99%

“…These actions have expanded local transparency significantly, as financial and operational information on woreda activities was not released to the public before 2006 (Khan et al 2014). Theory predicts that improving such engagement will enhance accountability across different levels of government.…”

Section: Fiscal Contextmentioning

confidence: 99%

“…Our data source for horizontal or geographic equity analysis is the Poverty and Social Impact Assessment (PSIA) database (Khan et al 2014 from woreda-level sectoral administrative data; and information on ethnicity, the frequency of droughts, and other control variables. In addition, regional data on capital expenditures and zonal data on crop yields have been linked to woreda data.…”

Section: Datamentioning

confidence: 99%

“…Following propositions 1 and 2, a block grant system that allocates proportionally more resources to the poorest woredas will also improve spatial equity in service delivery outcomes. We estimate this using the same approach as Khan et al (2014), which showed that per capita block grant allocations were directly linked to service delivery outcomes, using the following equation:…”

Section: Propositionmentioning

confidence: 99%

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Blending Top-Down Federalism with Bottom-Up Engagement to Reduce Inequality in Ethiopia

2017

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Original citation: Khan, Qaiser, Faguet, Jean-Paul and Ambel, Alemayehu (2017) Blending top-down federalism with bottom-up engagement to reduce inequality in Ethiopia. World Development, 96. pp. 326-342. ISSN 0305-750X AbstractDonors increasingly fund interventions to counteract inequality in developing countries, where they fear it can foment instability and undermine nation-building efforts. To succeed, aid relies on the principle of upward accountability to donors. But federalism shifts the accountability of subnational officials downward to regional and local voters. What happens when aid agencies fund anti-inequality programs in federal countries? Does federalism undermine aid? Does aid undermine federalism? Or can the political and fiscal relations that define a federal system resolve the contradiction internally? We explore this paradox via the Promotion of Basic Services program in Ethiopia, the largest donor-financed investment program in the world. Using an original panel database comprising the universe of Ethiopian woredas (districts), the study finds that horizontal (geographic) inequality decreased substantially. Donor-financed block grants to woredas increased the availability of primary education and health care services in the bottom 20 percent of woredas. Weaker evidence from household surveys suggests that vertical inequality across wealth groups (within woredas) also declined, implying that individuals from the poorest households benefit disproportionately from increasing access to, and utilization of, such services. The evidence suggests that by combining strong upward accountability over public investment with enhanced citizen engagement on local issues, Ethiopia's federal system resolves the instrumental dissonance posed by aid-funded programs to combat inequality in a federation. Research Highlights Has the largest donor-financed anti-inequality program in the world lessened horizontal and vertical inequalities in Ethiopia? Horizontal inequality decreased substantially. Donor-financed block grants increased the availability of primary education and health services in the poorest districts. Weaker evidence implies vertical inequality also declined, and poorest households benefit disproportionately from public service investment. Combined strong upward accountability over public investment with developing citizen engagement on local issues seem to drive these results. We estimate for key education and health output indicators. Effects on outcomes are a topic for future research.

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Section: Fiscal Contextmentioning

confidence: 99%

Section: Fiscal Contextmentioning

confidence: 99%

Section: Datamentioning

confidence: 99%

Section: Propositionmentioning

confidence: 99%

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Blending Top-Down Federalism with Bottom-Up Engagement to Reduce Inequality in Ethiopia

2017

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“…2 Analysis of public extension services in Ethiopia has received considerable attention in the literature. Previous work has shown how poorest households are not well covered by the public services for health, education, and agriculture (Khan 2014;Pankhurst and Tiumelissan 2018). While some authors found evidence that there was a gender bias in agricultural service delivery in Ethiopia (Mogues et al 2009;Ragasa et al 2013), others did not (Khan et al 2014;Buehren et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Geography of public service delivery in rural Ethiopia

Abate¹,

Dereje

Hirvonen

et al. 2019

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Health system reforms in five sub-Saharan African countries that experienced major armed conflicts (wars) during 1990–2015: a literature review

Chol

Negin

García‐Basteiro

et al. 2018

Global Health Action

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Background: Sub-Saharan Africa (SSA) has had more major armed conflicts (wars) in the past two decadesincluding 13 wars during 1990-2015than any other part of the world, and this has had an adverse effect on health systems in the region. Objective: To understand the best health system practices in five SSA countries that experienced wars during 1990-2015, and yet managed to achieve a maternal mortality reductionequal to or greater than 50% during the same periodaccording to the Maternal Mortality Estimation Inter-Agency Group (MMEIG). Maternal mortality is a death of a woman during pregnancy, or within 42 days after childbirthmeasured as maternal mortality ratio (MMR) per 100,000 live births. Design: We conducted a selective literature review based on a framework that drew upon the World Health Organisation's (WHO) six health system building blocks. We searched seven databases, Google Scholar as well as conducting a manual search of sources in articles' reference listsrestricting our search to articles published in English. We searched for terms related to maternal healthcare, the WHO six health system building blocks, and names of the five countries. Results: Our study showed three general health system reforms across all five countries that could explain MMR reduction: health systems decentralisation, the innovation related to the WHO workforce health system building block such as training of community healthcare workers, and governments-financing reforms. Conclusion: Restoring health systems after disasters is an urgent concern, especially in countries that have experienced wars. Our findings provide insight from five war-affected SSA countries which could inform policy. However, since few studies have been conducted concerning this topic, our findings require further research to inform policy, and to help countries rebuild and maintain their health systems resilience.

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Improving Basic Services for the Bottom Forty Percent: Lessons from Ethiopia

Cited by 13 publications

References 12 publications

Blending Top-Down Federalism with Bottom-Up Engagement to Reduce Inequality in Ethiopia

Blending Top-Down Federalism with Bottom-Up Engagement to Reduce Inequality in Ethiopia

Geography of public service delivery in rural Ethiopia

Health system reforms in five sub-Saharan African countries that experienced major armed conflicts (wars) during 1990–2015: a literature review

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