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Governance in the Health Sector : A Strategy for Measuring Determinants and PerformanceMany different strategies have been proposed to improve the delivery of health care services, from capacity building to establishing new payment mechanisms. Recent attention has also asked whether improvements in the way health care services are governed could make a difference. These approaches ask which factors -- such as rules and institutions -- influence the behavior of the system in ways that are associated with better performance and outcomes. This paper reviews the concept of governance as it is used in the literature on private firms, public administration, international development and health. It distinguishes between indicators that measure governance determinants from those that measure governance performance in order to propose a framework that is analytically coherent and empirically useful. The framework shows how these indicators can be used to test hypotheses about which governance forms are more useful for improving health system performance. The paper concludes by proposing specific measures of governance determinants and performance and describes the instruments available to collect and interpret them.
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Centralization, Decentralization, and Conflict in the Middle East and North AfricaThis paper examines broadly the intergovernmental structure in the Middle East and North Africa region, which has one of the most centralized government structures in the world. The authors address the reasons behind this centralized structure by looking first at the history behind the tax systems of the region. They review the Ottoman taxation system, which has been predominantly influential as a model, and discuss its impact on current government structure. They also discuss the current intergovernmental structure by examining the type and degree of decentralization in five countries representative of the region: Egypt, Iran, West Bank/Gaza, Tunisia, and Yemen. Cross-country regression analysis using panel data for a broader set of countries leads to better understanding of the factors behind heavy centralization in the region. The findings show that external conflicts constitute a major roadblock to decentralization in the region.
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Ethiopia : Decentralization, Delivery and AccountabilityOne of the fruits of this partnership was the preparation of an unusually rich set of background papers, under the umbrella of a process-driven Institutional and Governance Review (IGR); this Analytical and Advisory work was skillfully designed to support the design and implementation of PSCAP. Some of the papers focused on policy; others provided qualitative assessments of the realities on the ground; yet others benchmarked different facets of the governance environment, as a basis for monitoring going forward. A comprehensive synthesis of these IGR papers (referenced in Part A of the bibliography) is neither necessary not desirable; they stand on their own terms. (Also: see the powerpoint overview in Appendix 1 of Ethiopia's decentralization experience prepared by the World Bank team which led the process.). The objectives of this IGR summary are more modest, namely to; Provide (following staff turnover in the World Bank team) an entry point of access to some of the rich materials which have been prepared under the IGR umbrella; draw on the materials (plus other background material on Ethiopia) to provide a qualitative, on-the-ground sense of the extent to which the 2002 reforms have transformed the local governance realities; highlight some of the important base-line benchmarking exercises which were completed under the IGR umbrella, and which provide a key basis for monitoring progress going forward ; and point to some ways in which benchmarking can support the broader objective of strengthening the accountability for performance of Ethiopia's government, in the context of the political realities prevailing in 2006.