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The Political Economy of Improving Health Care for the Poor in Rural Africa: Institutional Solutions to the Principal-Agent Problem

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  • Kenneth Leonard
  • David Leonard

Abstract

Both governments and private for-profit markets have been disappointing in meeting the needs of the African poor for health care. NGO services provide a much more attractive alternative for this clientele, despite the fees they charge. They do so because they represent an institutional solution to the 'imperfect information' problem in health care. Through simulations based on data from Cameroon, we demonstrate that if fee-charging NGOs replace the highly subsidised but poorly managed facilities operated by African governments the poor would be better off. Those NGOs that are decentralised in their financial and personnel management are most effective. The politics of making the recommended changes are assessed.

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  • Kenneth Leonard & David Leonard, 2004. "The Political Economy of Improving Health Care for the Poor in Rural Africa: Institutional Solutions to the Principal-Agent Problem," Journal of Development Studies, Taylor & Francis Journals, vol. 40(4), pages 50-77.
    • Handle: RePEc:taf:jdevst:v:40:y:2004:i:4:p:50-77
    DOI: 10.1080/00220380410001673193
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    Cited by:

    1. Jennings, Michael, 2015. "The precariousness of the franchise state: Voluntary sector health services and international NGOs in Tanzania, 1960s – mid-1980s," Social Science & Medicine, Elsevier, vol. 141(C), pages 1-8.
    2. Sharma, Chanchal Kumar, 2014. "Governance,Governmentality and Governability: Constraints and Possibilities of Decentralization in South Asia," MPRA Paper 61349, University Library of Munich, Germany, revised 15 Jan 2015.
    3. Leonard, Kenneth L., 2009. "The cost of imperfect agency in health care: Evidence from rural Cameroun," Journal of Development Economics, Elsevier, vol. 88(2), pages 282-291, March.
    4. Ahmed Mushfiq Mobarak & Andrew Sunil Rajkumar & Maureen Cropper, 2011. "The Political Economy of Health Services Provision in Brazil," Economic Development and Cultural Change, University of Chicago Press, vol. 59(4), pages 723-751.

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