Because of its potential impact, and, in some cases, the harm it has brought, foreign aid is under the microscope. Donor countries, who don't want simply to give money away; recipient nations, who need to make the most of what they have and get; and analysts, policymakers, and writers are all scrutinizing how much is spent and where it goes. Perhaps more important, aid is only a small part of what developing country governments spend. Their own resources finance 80 percent or more of health and education spending except in the most aid-dependent countries. Lives in the Balance investigates a vital aspect of this landscape—how best to ensure that public spending, including aid money, gets to the right destination.The development of democratic institutions and the spread of cheap communications technology in developing countries make it possible for the ""demand-side""—citizens and civil society institutions—to advocate for improved transparency, stronger accountability, better priorities, reduced corruption, and more emphasis on helping the poor. Securing real reform will depend not only on knowledge of how the recipient government operates, but also how to work with partner entities—the media, the private sector, other organizations, and legislators—to raise awareness and compel change.

This book is based on a simple concept: no one is in a better position to hold a government accountable than those it governs.When governments fail to meet the needs of their citizens, the international community often turns to large external organizations such as the International Monetary Fund or the World Bank. These analysts and monitors may have the resources and expertise to analyze and advise on public spending and governance, but where do they go when the time comes to implement new policies? And can they really have a more nuanced understanding of the country's problems than its own citizens? Who is there to watch day and night to hold the government accountable?From the Ground Up proposes that the international community's efforts to improve public expenditure and budget execution decisions would be more effective if done in collaboration with local independent monitoring organizations. Stephen Kosack, Courtney Tolmie, and Charles Griffin track the work of sixteen independent monitoring organizations from across the developing world, demonstrating how these relatively small groups of local researchers produce both thoughtful analysis and workable solutions. They achieve these results because their vantage point allows them to more effectively discern problems with governance and to communicate with their fellow citizens about the ideals and methods of good governance.The authors also outline some disadvantages facing independent monitoring organizations, such as insufficient resources, inadequate access to data, and too little influence with high government officials. Collaboration with larger international organizations could help independent monitoring organizations overcome such obstacles, increasing their chances of improving governance—from the ground up.

This book is based on a simple concept: no one is in a better position to hold a government accountable than those it governs.When governments fail to meet the needs of their citizens, the international community often turns to large external organizations such as the International Monetary Fund or the World Bank. These analysts and monitors may have the resources and expertise to analyze and advise on public spending and governance, but where do they go when the time comes to implement new policies? And can they really have a more nuanced understanding of the country's problems than its own citizens? Who is there to watch day and night to hold the government accountable?From the Ground Up proposes that the international community's efforts to improve public expenditure and budget execution decisions would be more effective if done in collaboration with local independent monitoring organizations. Stephen Kosack, Courtney Tolmie, and Charles Griffin track the work of sixteen independent monitoring organizations from across the developing world, demonstrating how these relatively small groups of local researchers produce both thoughtful analysis and workable solutions. They achieve these results because their vantage point allows them to more effectively discern problems with governance and to communicate with their fellow citizens about the ideals and methods of good governance.The authors also outline some disadvantages facing independent monitoring organizations, such as insufficient resources, inadequate access to data, and too little influence with high government officials. Collaboration with larger international organizations could help independent monitoring organizations overcome such obstacles, increasing their chances of improving governance—from the ground up.

Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets.Colombia embarked in 1993 on a fifteen-year effort to cover its entire population with insurance, in combination with greater freedom to choose among providers. A decade later Mexico followed suit with a program tailored to its federal system. Several African nations have introduced new programs in the past decade, and many are testing options for reform. For the past twenty years, Eastern Europe has been shifting from government-run care to insurance-based competitive systems, and both China and India have experimental programs to expand coverage. These nations are betting that insurance-based health care financing can increase the accessibility of services, increase providers' productivity, and change the population's health care use patterns, mirroring the development of health systems in most OECD countries.Until now, however, we have known little about the actual effects of these dramatic policy changes. Understanding the impact of health insurance–based care is key to the public policy debate of whether to extend insurance to low-income populations—and if so, how to do it—or to serve them through other means.Using recent household data, this book presents evidence of the impact of insurance programs in China, Colombia, Costa Rica, Ghana, Indonesia, Namibia, and Peru. The contributors also discuss potential design improvements that could increase impact. They provide innovative insights on improving the evaluation of health insurance reforms and on building a robust knowledge base to guide policy as other countries tackle the health insurance challenge.

Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets.Colombia embarked in 1993 on a fifteen-year effort to cover its entire population with insurance, in combination with greater freedom to choose among providers. A decade later Mexico followed suit with a program tailored to its federal system. Several African nations have introduced new programs in the past decade, and many are testing options for reform. For the past twenty years, Eastern Europe has been shifting from government-run care to insurance-based competitive systems, and both China and India have experimental programs to expand coverage. These nations are betting that insurance-based health care financing can increase the accessibility of services, increase providers' productivity, and change the population's health care use patterns, mirroring the development of health systems in most OECD countries.Until now, however, we have known little about the actual effects of these dramatic policy changes. Understanding the impact of health insurance–based care is key to the public policy debate of whether to extend insurance to low-income populations—and if so, how to do it—or to serve them through other means.Using recent household data, this book presents evidence of the impact of insurance programs in China, Colombia, Costa Rica, Ghana, Indonesia, Namibia, and Peru. The contributors also discuss potential design improvements that could increase impact. They provide innovative insights on improving the evaluation of health insurance reforms and on building a robust knowledge base to guide policy as other countries tackle the health insurance challenge.

Because of its potential impact, and, in some cases, the harm it has brought, foreign aid is under the microscope. Donor countries, who don't want simply to give money away; recipient nations, who need to make the most of what they have and get; and analysts, policymakers, and writers are all scrutinizing how much is spent and where it goes. Perhaps more important, aid is only a small part of what developing country governments spend. Their own resources finance 80 percent or more of health and education spending except in the most aid-dependent countries. Lives in the Balance investigates a vital aspect of this landscape—how best to ensure that public spending, including aid money, gets to the right destination.The development of democratic institutions and the spread of cheap communications technology in developing countries make it possible for the ""demand-side""—citizens and civil society institutions—to advocate for improved transparency, stronger accountability, better priorities, reduced corruption, and more emphasis on helping the poor. Securing real reform will depend not only on knowledge of how the recipient government operates, but also how to work with partner entities—the media, the private sector, other organizations, and legislators—to raise awareness and compel change.

This book is based on a simple concept: no one is in a better position to hold a government accountable than those it governs.When governments fail to meet the needs of their citizens, the international community often turns to large external organizations such as the International Monetary Fund or the World Bank. These analysts and monitors may have the resources and expertise to analyze and advise on public spending and governance, but where do they go when the time comes to implement new policies? And can they really have a more nuanced understanding of the country's problems than its own citizens? Who is there to watch day and night to hold the government accountable?From the Ground Up proposes that the international community's efforts to improve public expenditure and budget execution decisions would be more effective if done in collaboration with local independent monitoring organizations. Stephen Kosack, Courtney Tolmie, and Charles Griffin track the work of sixteen independent monitoring organizations from across the developing world, demonstrating how these relatively small groups of local researchers produce both thoughtful analysis and workable solutions. They achieve these results because their vantage point allows them to more effectively discern problems with governance and to communicate with their fellow citizens about the ideals and methods of good governance.The authors also outline some disadvantages facing independent monitoring organizations, such as insufficient resources, inadequate access to data, and too little influence with high government officials. Collaboration with larger international organizations could help independent monitoring organizations overcome such obstacles, increasing their chances of improving governance—from the ground up.

This book is based on a simple concept: no one is in a better position to hold a government accountable than those it governs.When governments fail to meet the needs of their citizens, the international community often turns to large external organizations such as the International Monetary Fund or the World Bank. These analysts and monitors may have the resources and expertise to analyze and advise on public spending and governance, but where do they go when the time comes to implement new policies? And can they really have a more nuanced understanding of the country's problems than its own citizens? Who is there to watch day and night to hold the government accountable?From the Ground Up proposes that the international community's efforts to improve public expenditure and budget execution decisions would be more effective if done in collaboration with local independent monitoring organizations. Stephen Kosack, Courtney Tolmie, and Charles Griffin track the work of sixteen independent monitoring organizations from across the developing world, demonstrating how these relatively small groups of local researchers produce both thoughtful analysis and workable solutions. They achieve these results because their vantage point allows them to more effectively discern problems with governance and to communicate with their fellow citizens about the ideals and methods of good governance.The authors also outline some disadvantages facing independent monitoring organizations, such as insufficient resources, inadequate access to data, and too little influence with high government officials. Collaboration with larger international organizations could help independent monitoring organizations overcome such obstacles, increasing their chances of improving governance—from the ground up.

Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets.Colombia embarked in 1993 on a fifteen-year effort to cover its entire population with insurance, in combination with greater freedom to choose among providers. A decade later Mexico followed suit with a program tailored to its federal system. Several African nations have introduced new programs in the past decade, and many are testing options for reform. For the past twenty years, Eastern Europe has been shifting from government-run care to insurance-based competitive systems, and both China and India have experimental programs to expand coverage. These nations are betting that insurance-based health care financing can increase the accessibility of services, increase providers' productivity, and change the population's health care use patterns, mirroring the development of health systems in most OECD countries.Until now, however, we have known little about the actual effects of these dramatic policy changes. Understanding the impact of health insurance–based care is key to the public policy debate of whether to extend insurance to low-income populations—and if so, how to do it—or to serve them through other means.Using recent household data, this book presents evidence of the impact of insurance programs in China, Colombia, Costa Rica, Ghana, Indonesia, Namibia, and Peru. The contributors also discuss potential design improvements that could increase impact. They provide innovative insights on improving the evaluation of health insurance reforms and on building a robust knowledge base to guide policy as other countries tackle the health insurance challenge.

Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets.Colombia embarked in 1993 on a fifteen-year effort to cover its entire population with insurance, in combination with greater freedom to choose among providers. A decade later Mexico followed suit with a program tailored to its federal system. Several African nations have introduced new programs in the past decade, and many are testing options for reform. For the past twenty years, Eastern Europe has been shifting from government-run care to insurance-based competitive systems, and both China and India have experimental programs to expand coverage. These nations are betting that insurance-based health care financing can increase the accessibility of services, increase providers' productivity, and change the population's health care use patterns, mirroring the development of health systems in most OECD countries.Until now, however, we have known little about the actual effects of these dramatic policy changes. Understanding the impact of health insurance–based care is key to the public policy debate of whether to extend insurance to low-income populations—and if so, how to do it—or to serve them through other means.Using recent household data, this book presents evidence of the impact of insurance programs in China, Colombia, Costa Rica, Ghana, Indonesia, Namibia, and Peru. The contributors also discuss potential design improvements that could increase impact. They provide innovative insights on improving the evaluation of health insurance reforms and on building a robust knowledge base to guide policy as other countries tackle the health insurance challenge.