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Public Service Provision, User Fees and Political Turmoil


  • Marcel Fafchamps
  • Bart Minten


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:, Oxford University Press.

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  • Marcel Fafchamps & Bart Minten, 2007. "Public Service Provision, User Fees and Political Turmoil," Journal of African Economies, Centre for the Study of African Economies (CSAE), vol. 16(3), pages 485-518, June.
  • Handle: RePEc:oup:jafrec:v:16:y:2007:i:3:p:485-518

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    References listed on IDEAS

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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. 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.
    3. Jann Lay, 2010. "MDG Achievements, Determinants, and Resource Needs: What Has Been Learnt?," GIGA Working Paper Series 137, GIGA German Institute of Global and Area Studies.
    4. 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.
    5. 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.

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    JEL classification:

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


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