Nathalie Holvoet

Opening the ‘black box’ of performance-based financing in low- and lower middle-income countries: a review of the literature

Although performance-based financing (PBF) receives increasing attention in the literature, a lot remains unknown about the exact mechanisms triggered by PBF arrangements. This article aims to summarize current knowledge on how PBF works, set out what still needs to be investigated and formulate recommendations for researchers and policymakers from donor and recipient countries alike. Drawing on an extensive systematic literature review of peer-reviewed journals, we analysed 35 relevant articles. To guide us through this variety of studies, point out relevant issues and structure findings, we use a comprehensive analytical framework based on eight dimensions. The review inter alia indicates that PBF is generally welcomed by the main actors (patients, health workers and health managers), yet what PBF actually entails is less straightforward. More research is needed on the exact mechanisms through which not only incentives but also ancillary components operate. This knowledge is essential if we really want to appreciate the effectiveness, desirability and appropriate format of PBF as one of the possible answers to the challenges in the health sector of low-and lower middle-income countries. A clear definition of the research constructs is a primordial starting point for such research.

The challenge of monitoring and evaluation under the new aid modalities: experiences from Rwanda

Monitoring and evaluation (M&E) are sensitive issues in relations between donor agencies and recipient governments, especially in a time when the responsibility for implementing aid activities is shifting towards recipients. This paper deplores that, so far, donors and recipients have adopted an overly technocratic approach to M&E, largely disregarding broader institutional and systemic issues. Using case study material from Rwanda, we illustrate that assessments regarding the quality of a countrys M&E efforts may differ sharply depending upon ones perspective. At the core of the matter is ‘the denial of politics’, one of the most serious flaws in the new aid paradigm promoted in the OECDs 2005 ‘Paris Declaration’. We argue that while a narrowly defined technocratic vision of M&E may seem ‘politically neutral’, in fact it may jeopardise M&Es functions of ‘accountability’ and ‘feedback’. This can eventually undermine the effective implementation of some of the key principles of the ‘new aid approach’.

CREDIT AND WOMEN'S GROUP MEMBERSHIP IN SOUTH INDIA: TESTING MODELS OF INTRAHOUSEHOLD ALLOCATIVE BEHAVIOR

Abstract This article uses empirical data from the authors own South India household survey, which compares the impact of slightly diverging credit schemes upon selected indicators of allocative behavior to test the value added of an economic institutional approach for modeling intrahousehold allocation. It is argued that the income-pooling test and conventional neoclassical household models inadequately picture what happens within households as they start from the premise that behavior is built solely upon free agency. An alternative economic institutional approach is proposed and an expanded test framework is set out. Empirical research findings show that unveiling decision-making processes may indicate why individuals act as if they hold common preferences. The article suggests that changes in selected allocative outcomes occur mainly as a result of changes in underlying allocative processes and further demonstrates that membership in womens groups is one effective way of changing intrahousehold decision-making processes and outcomes.

Gender and network formation in rural Nicaragua : a village case study

Abstract This contribution examines the relation between gender and network formation in rural Nicaragua in 2007 and studies differences in the structure and contents of mens and womens networks. Such differences are relevant, as network theory suggests that structural characteristics – as well as the contents of networks – strongly influence the type and amount of benefits generated. Through the application of dyadic regression techniques, this study examines the determinants of the size and socioeconomic heterogeneity of individual networks. Research findings suggest gender segregation of networks and considerable differences in the structure and content of mens and womens networks. These differences relate to the gendered division of labor and to womens time poverty in particular. Our results are relevant in a context where policy makers increasingly consider social networks an important policy tool. We caution against a gender-blind alignment on existing social networks and argue for detailed mapping and unpacking of social networks through a gender lens.

Multiple Paths to Effective National Evaluation Societies: Evidence from 37 Low- and Middle-Income Countries.

National Evaluation Societies (NES) are situated at the intersection between Monitoring and Evaluation (M&E) supply and demand. To date, little research has explored NES and their potential for strengthening national M&E. This study addresses this gap, examining perceived NES performance relevant to organizational and policy-oriented goals while identifying factors related to that performance. The study draws upon data from a survey of 40 NES in 37 low- and middle-income countries. Qualitative Comparative Analysis identifies multiple pathways to well-performing NES and focuses on the interplay between the context in which evaluation societies operate and their organizational characteristics. The findings underline the importance of political openness while also demonstrating that some NES manage to perform well even in challenging political environments.

Taking Stock of Monitoring and Evaluation Arrangements in the Context of Poverty Reduction Strategy Papers: Evidence from 20 Aid‐Dependent Countries in Sub‐Saharan Africa

Shifts in thinking and practice concerning aid have posed serious challenges in monitoring and evaluation (ME organisation; capacity‐building; participation of nongovernmental actors; and use. It applies it to a review of the PRSP M&E arrangements of 20 aid‐dependent countries in sub‐Saharan Africa to demonstrate comparative strengths and weaknesses.

Gender sensitivity of Sub-Saharan Africa National Adaptation Programmes of Action: findings from a desk review of 31 countries

There is growing realization that ignoring the mediating influence of gender relations may impact on the effectiveness of adaptation and mitigation policies, which has gradually brought gender issues onto the agenda of national and international fora. Against this background, this article confronts discourse with reality, by investigating to what extent and in what way 31 Sub-Saharan African National Adaptation Programmes of Action (NAPAs) integrate a gender dimension into the different phases of the NAPA cycle, and the different sectors that are especially related to climate change. Additionally, this paper analyses the extent to which women and gender experts participate in diagnosis and decision-making, as well as the gender sensitivity of the format used for participation. The findings of the gender scan demonstrate, among other things, that there is a decline in gender sensitivity throughout the intervention cycle. Furthermore, processes have been more gender-sensitive than the actual content of NAPAs, which suggests that gender actors around the table in NAPA decision-making have not always been able to influence the content of the NAPAs. When it comes to integrating gender issues in climate change budgets, our study suggests that the insights, approaches and tools of gender budgeting could be particularly useful.

Integrating theory-based evaluation and process tracing in the evaluation of civil society gender budget initiatives:

Over the last two decades, gender-responsive budgeting has gained prominence as an effective tool for governments to fulfil gender commitments and the realisation of women’s rights. To date, however, limited empirical evidence exists of the impact and effectiveness of gender budget initiatives. This article proposes and demonstrates the integration of theory-based evaluation and process tracing to examine the effects of local-level civil society-led gender-responsive budgeting on maternal health service delivery in Kabale District, rural Uganda. It involves four steps: explicating the programme theory linking the gender budget initiative to the intended outcome; theorising the underlying causal mechanism; making case-specific predictions of observable manifestations of the mechanism; and testing the empirical evidence using Bayesian logic to make causal inferences about the effects of the civil society gender budget initiative on maternal health service delivery. This approach strengthens our confidence in the inferences made about causality and the effects of gender budget initiatives.

GENDER BUDGETING IN BELGIUM: FINDINGS FROM A PILOT PROJECT

ABSTRACT The article highlights activities and findings of the Belgian initiative regarding gender budgeting, which are put against the background of theory and practice developed so far elsewhere. Attention is drawn upon the opportunities of gender budgeting to push further forward the policy goals of gender equality, thereby overcoming a number of problems commonly associated with the currently widely propagated strategy of gender mainstreaming. The article provides first-hand information on the origin of the Belgian initiative, its political location, the activities performed and the methodology used. Analysis of findings addresses a number of key dimensions in gender budgeting, including (i) the overarching importance of the political location, (ii) the internal management and monitoring function of gender budgeting and the importance of prevailing budgetary systems, and (iii) the external accountability function of gender budgeting and the need to link up with outside-government initiatives.

Look Who's Talking. Explaining Water-Related Information Sharing and Demand for Action Among Ugandan Villagers.

Many national water policies propagate community-based participatory approaches to overcome weaknesses in supply-driven rural water provision, operation, and maintenance. Citizen involvement is thought to stimulate bottom-up accountability and broaden the information base, which may enrich design and implementation processes and foster improved water accessibility and sustainability. Practices on the ground, however, are embedded in socio-political realities which mediate possible beneficial effects of participatory approaches. This paper builds on full social network data collected in a Ugandan village to study the social and political reality of two distinct levels of participation, i.e. local information sharing among citizens and a more active appeal to fellow citizens to improve water services. We use Logistic Regression Quadratic Assignment Procedure to explore what type of actor and network traits influence information sharing and whether the same factors are in play in the demand for action to remedy water-related problems. Whereas social aspects (social support relations) and homophily (using the same water source, the same gender) play an important role in information sharing, it is the educational level, in particular, of the villager who is called upon that is important when villagers demand action. Our findings also demonstrate that those most in need of safe water do not mobilize their information sharing ties to demand for action. This indicates that building local water policies and practice exclusively on locally existing demand for action may fail to capture the needs of the most deprived citizens.