Direct Provision

Abstract: Many low and middle income countries have inherited publicly funded and provided health services, often operating at relatively low levels of technical efficiency. Changing ideas about the management of the public sector, in particular stemming from new public management theory, are spreading to these countries, whether directly or via the recommendations of multilateral and bilateral aid agencies. Pronouncements of agencies such as the World Bank imply that competitive contracting with the private sector is likely to improve the efficiency of services provision. However, very little evidence is available on whether this is likely to be the case, and in what circumstances delivery of services through contracts with the private sector is likely to be preferable to direct provision by the public sector. This paper draws on evidence from five country case-studies of contractual arrangements, in Bombay, Papua New Guinea, South Africa, Thailand and Zimbabwe, done through collaborative research between the LSHTM Health Economics and Financing Programme and local researchers in each country. A common evaluative framework was applied in each country to selected, existing contractual arrangements. Services provided under contract and evaluated included catering, cleaning, security, diagnostic services and whole hospitals. Information is presented on the design of contracts, the process of agreeing contracts including the extent of competition, and the monitoring of contract performance. A variety of evidence, including information on the relative cost and quality of contracted out versus directly provided services in the case of South Africa, Thailand, and Bombay, is used to explore whether or not contracting out to the private sector represented a preferable means of service provision. This analysis, together with information on the capacity of the agency letting the contract, and on the wider environment including the level of development of the private sector, is used to identify which aspects of the contracting process and the context in which it takes place are important in influencing whether or not contracting with the private sector is a desirable means of service provision.

Abstract: This article examines voluntary provision of a public good that is motivated, in part, to compensate for activities that diminish the public good. Markets for environmental offsets, such as those that promote carbon neutrality, provide an increasingly salient example. An important result is that mean donations do not converge to zero as the economy grows large. The equilibrium is solved to show how direct donations and net contributions depend on wealth and heterogeneous preferences. Comparative static analysis demonstrates how public good provision and social welfare depend on the technology, individual wealth and an initial level of the public good. Why do individuals voluntarily provide public goods? The question has received much attention in the economics literature, and two general answers have emerged. The first is based on a standard model of private provision of a pure public good. Agents are assumed to benefit from the aggregate level of a public good and thus have some incentive for private provision. While the additional incentive to free ride ensures that the equilibrium level of the public good will fall short of the Pareto-efficient level, the theory nevertheless predicts some degree of voluntary provision. 1 The second explanation has grown out of the need to reconcile why observed levels of private provision regularly exceed those that the standard theory predicts. Research in this area can be characterised broadly as refinements or extensions on the impure public good model. The general approach is to assume that agents obtain a private benefit from some aspect of their own provision and this encourages provision beyond that which would occur if benefits came from only the public good itself. Different interpretations of the private benefit range from a feeling of warm-glow satisfaction, social approval, prestige and signalling about income. 2 The present article pursues a further explanation for voluntary provision of a public good. The idea is that provision may occur, in part, to offset other activities that have an adverse effect on a public good. Consider an activity that produces a negative externality through diminishing the level of a public good. Assuming the individual cares enough about the public good, she may seek to minimise her adverse effect on it. One possibility is for the individual to restrain her behaviour voluntarily. 3 Another possibility, which need not be mutually exclusive, is for the individual to offset some (or all) of her detrimental effect through direct provision of the public good.

Abstract: Prepared briefing note: "Unprecedented Nature of Changing Hydrological Conditions in 2012" for Doug Wilson, Head of Research & Monitoring, Environment Agency. Direct provision of data/information to Government Bodies

Abstract: Title Beyond the Pale: asylum-seeking children and social exclusion in Ireland Author(s) Fanning, Bryan; Veale, Angela; O'Connor, Dawn Publication date 2001-07-01 Original citation Fanning, B., Veale, A. and O'Connor, D. (2001) Beyond the Pale: asylum-seeking children and social exclusion in Ireland. Dublin: Irish Refugee Council. Type of publication Report Rights © 2001, the Authors. Item downloaded from http://hdl.handle.net/10468/3714