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Public Service Provision, User Fees and Political Turmoil

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  • Marcel Fafchamps
  • Bart Minten

Abstract

This study looks at public service delivery in rural areas of Madagascar. The blockade of the central highlands of Madagascar by a defeated president let us examine the short-term effect of a large unanticipated macro shock and subsequent elimination of user fees on the rural delivery of health and education services. We found enrolment in rural primary schools surprisingly resilient to the crisis, probably because it unfolded in the middle of the school year. In contrast, the blockade led to a large drop in health care services, measured by the number of patient visits to health care centres. Part of this effect can be explained by an increase in monetary poverty. After the blockade, user fees were suspended in schools and health centres but the measure was not applied immediately in all rural communes. Controlling for supply effects, time dummies and school and health centre fixed effects, we find that the suspension of user fees is associated with a significant increase in both school enrolment and visits to health centres. Copyright 2007 The author 2007. Published by Oxford University Press on behalf of the Centre for the Study of African Economies. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org, Oxford University Press.

Suggested Citation

  • Marcel Fafchamps & Bart Minten, 2007. "Public Service Provision, User Fees and Political Turmoil," Journal of African Economies, Centre for the Study of African Economies, vol. 16(3), pages 485-518, June.
    • Handle: RePEc:oup:jafrec:v:16:y:2007:i:3:p:485-518
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    File URL: http://hdl.handle.net/10.1093/jae/ejl040
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    Cited by:

    1. Christophe Nordman & Faly Rakotomanana & Anne-Sophie Robilliard, 2009. "Gender Disparities in the Malagasy Labour Market," Working Papers DT/2009/08, DIAL (Développement, Institutions et Mondialisation).
    2. Giovanni Andrea Cornia & Laura Deotti, 2008. "Millet Prices, Public Policy and Child Malnutrition: The case of Niger in 2005," Papers inwopa08/49, Innocenti Working Papers.
    3. Emanuela di Gropello, 2006. "Meeting the Challenges of Secondary Education in Latin America and East Asia : Improving Efficiency and Resource Mobilization," World Bank Publications - Books, The World Bank Group, number 7173, April.
    4. Anna S. Brink & Steven F. Koch, 2013. "The 1996 User Fee Abolition in South Africa: A Difference-in-Difference Analysis," Working Papers 201332, University of Pretoria, Department of Economics.
    5. Lay, Jann, 2010. "MDG Achievements, Determinants, and Resource Needs: What Has Been Learnt?," GIGA Working Papers 137, GIGA German Institute of Global and Area Studies.
    6. Lépine, A. & Lagarde, M. & Le Nestour, A., 2015. "Free primary care in Zambia: an impact evaluation using a pooled synthetic control method," Health, Econometrics and Data Group (HEDG) Working Papers 15/20, HEDG, c/o Department of Economics, University of York.
    7. World Bank, 2012. "Madagascar - Three Years into the Crisis : An Assessment of Vulnerability and Social Policies and Prospects for the Future, Volume 1. Main Report [Madagascar après trois ans de crise : Evaluation d," World Bank Publications - Reports 12324, The World Bank Group.
    8. Fafchamps, Marcel & Minten, Bart, 2006. "Crime, Transitory Poverty, and Isolation: Evidence from Madagascar," Economic Development and Cultural Change, University of Chicago Press, vol. 54(3), pages 579-603, April.
    9. Maryanne Sharp & Ioana Kruse, 2011. "Health, Nutrition, and Population in Madagascar 2000-09," World Bank Publications - Books, The World Bank Group, number 5957, April.
    10. Valéry Ridde & Seni Kouanda & Aristide Bado & Nicole Bado & Slim Haddad, 2012. "Reducing the Medical Cost of Deliveries in Burkina Faso Is Good for Everyone, Including the Poor," PLOS ONE, Public Library of Science, vol. 7(3), pages 1-8, March.
    11. Ridde, Valéry & Diarra, Aïssa & Moha, Mahaman, 2011. "User fees abolition policy in Niger: Comparing the under five years exemption implementation in two districts," Health Policy, Elsevier, vol. 99(3), pages 219-225, March.
    12. Raphaël Cottin, 2018. "Free health care for the poor: a good way to achieve universal health coverage? Evidence from Morocco," Working Papers DT/2018/16, DIAL (Développement, Institutions et Mondialisation).
    13. Takondwa Mwase, 2021. "Health financing policy reforms for universal health coverage in eastern, central and southern Africa (ECSA)-health community region," Working Papers 179cherp, Centre for Health Economics, University of York.

    More about this item

    JEL classification:

    • O - Economic Development, Innovation, Technological Change, and Growth
    • P - Political Economy and Comparative Economic Systems

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