Health care professionals in Egypt conduct a stakeholder analysis to help spell out governance principles for Egyptian hospitals.
A hip replacement in the United States, paid for out-of-pocket (i.e., without health insurance), would cost anywhere from $11,000 to $125,000, depending on what hospital you go to, according to a 2013 survey of 100 hospitals featured on National Public Radio. And that was among the hospitals that, when asked, could actually produce a quote – 40 of the 100 hospitals surveyed couldn’t quote a price at all.
Those fortunate enough to have insurance don’t need to worry about price-shopping. When I go to my primary care physician, I pay a $20 co-pay. (Under our previous insurance, provided by my wife’s former employer, it was $10. Why the difference? Who knows?) I have no idea how much my insurance company pays the doctor. I suppose I could find out, but… honestly? There’s really no compelling reason for me to do so. It’s $20 no matter who I see.
And it turns out that, even if there were more incentive for me to price-shop, more expensive hospitals aren’t necessarily better hospitals, according to a 2014 study.
A member of one of Kenya’s new county assemblies sets up an office in an open-air market outside of Nairobi. (Photo: VOA News)
One way to improve democratic governance is to devolve more responsibilities to local and regional governments — but only if those governments have the capacity take on such responsibilities and a willingness to listen to input from their constituents. This is the challenge Kenya faces as it implements the devolution outlined in its new constitution.
On April 9th, Chief Executive Officer of CIPE partner in Kenya Institute of Economic Affairs (IEA) Kwame Owino gave a presentation at the National Endowment for Democracy on the status of the country’s constitutional reforms. Owino explained the contentious transition that has been occurring in Kenya since the March 2013 elections, which transferred some key powers from the central government to 47 newly-created counties.
Owino cited many roadblocks in the way of quick, successful decentralization, including power struggles between newly-established governors and county senators, a highly centralized government bureaucracy reluctant in some cases to relinquish power after an institutional life of 50 years, and an economy weakened by poor policies and widespread corruption.
To address the uncertainty regarding the strength of the devolution movement, Owino stated that accountability was the answer, arguing that Kenyan civil society organizations had a place as “protectors of devolution,” and that they must put pressure on the government to stay the course of decentralization. For devolution to succeed, the constitution needs to be followed exactly, and not be avoided or ignored as it is in many instances to maintain some of the employment and power institutionalized in the old bureaucracy.
Academics and development practitioners have long sought out commonalities of sustainable economic growth in different economies around the world. While there is no one formula for achieving economic growth and stability, inclusive growth and accountable governance have been central components of progress. Effective governance, while not traditionally thought of as part of an international development agenda, has come to be seen as an essential component of international economic development.
In the latest Economic Reform Feature Service article, consultant James Michel explores the complex relationship between good governance and economic development around the world. He looks at the ways in which academics and practical experience shape these two intertwined factors of development.
The private sector is a key actor in efforts to promote economic growth, reform the business climate and strengthen democratic policymaking worldwide. Dialogue is a key part of the Busan process, which recognizes that the for-profit private sector is a central driver of development and emphasizes the importance of inclusive dialogue for building a policy environment conducive to sustainable development.” Businesses possess the know-how of economic conditions, obstacles and opportunities for growth, while governments have the means to pass business-friendly legislation.
From a democratic point of view, a vibrant private contribution to dialogue expands participation in policymaking by creating space for civic engagement in governance, improves the quality of business representation and supplements the performance of democratic institutions.
Building upon its longstanding experience in the field, CIPE has been invited to participate in the 7th Annual Public Private Dialogue Global Workshop organized by the World Bank, BMZ-The German Federal Ministry for Economic Cooperation and Development, and GIZ in Frankfurt, Germany.
Senior Knowledge Manager Kim Bettcher will moderate a session on long term public private dialogue sustainability and the role of chambers of commerce and business associations. Director of Multiregional Programs Anna Nadgrodkiewicz will make a presentation on a new initiative between the CIPE, the World Bank Institute, and development partners on building an open and collaborative platform for public private dialogue resources.
CIPE has extensive experience in advancing policy dialogue around the world and supports market-oriented reform and private sector development by mobilizing representative business associations and strengthening their capacity to advocate for policy solutions. CIPE also invests in business association development that enables effective dialogue. Some regional success stories in public private dialogue are outlined in more detail below.
UN peacekeepers patrol the North Kivu region, where democratic failures, lack of economic development, and a dangerous neighborhood have led to years of violence. (Photo: UN)
Recently I heard Jakkie Cilliers present his paper “The future of intrastate conflict in Africa: More violence or greater peace?” at The Center for Strategic and International Studies (co-authored by Julia Schunemann for the Institute for Security Studies in South Africa). I went to the event thinking the discussion was going to focus on current conflicts and tensions in Africa, and I was going to leave debating whether or not intrastate conflict will ruin the progress African countries have achieved. I was surprised to find that instead the discussion focused on drivers of intrastate conflict in Africa and even more surprised to find that a majority of the drivers are related to democratic and economic factors.
The authors have identified seven correlations associated with internal conflict:
- Poverty and Instability
- Transitions from Autocracy to Democracy
- A Democratic Deficit
- Unemployed or Underemployed Youthful Populations
- A Tendency toward Repeat Violence
- The “Bad Neighborhood” Effect
- Poor Governance
Excluding a tendency toward repeat violence, the other six correlations can be grouped into two larger categories, democracy and economy. In terms of democratic factors, the authors purport that it’s a lack of democracy and democratic governance that correlates with violence in Africa. Research shows that “[s]tates that experience stalled transitions from autocracy to democracy or adverse regime changes” are more likely to experience intrastate conflict.
On June 11 the World Bankreleased a report titled, “Moldova: Policy Priorities for Private Sector Development.” The report highlights business constraints and proposals for reform in five key areas: customs administration, tax administration, business regulation (licenses, authorizations, permits, and inspections), competition framework, and access to finance. These priorities are in line with the National Business Agenda (NBA) prepared by CIPE partners in Moldova. In fact, the World Bank report makes multiple references to the 2012-2013 NBA document, citing it as “reflecting the views of a broad range of private sector stakeholders.”
The NBA is not only a document. To prepare it, a network of over 30 business associations and chambers of commerce from across Moldova go through a well-structured process that includes building broad consensus on priorities, analyzing the legal framework for each issue, and developing joint proposals for reform. Using this methodology, the chambers and associations utilize the NBA framework to prepare for a constructive dialogue with government. CIPE has partnered with leading Moldovan think tank Institute for Development and Social Initiative (IDSI) to build the capacity of NBA members to jointly articulate not only the key barriers businesses face, but also concrete proposals to overcome them.
In addition, CIPE and IDSI have been providing assistance to the NBA member organizations to create a private sector platform. Today this platform is well-known among policymakers, the broader business community, and civil society as the NBA network. The member organizations are committed to developing a partnership with government through public-private dialogue. The goal is to work together on improving the economy, creating more jobs, and improving the climate for doing business. The voice of the NBA network is especially important in the reform process as it represents the views of the small and medium-sized domestic enterprises that comprise a majority of the Moldovan private companies.