The second ebook in the Rotarian Economist Short Books Series has been published. Partnerships, innovation, and evaluation can increase the quality, scope, and reach of Rotary’s service work in communities. The book suggests with case studies how this can be done. All books in the series are free and available here in multiple formats. Please share this link widely with others for them to be able to benefit from this resource. And if you like the books in the series, please consider writing a quick review at Smashwords!
This post is the last in a series of nine posts on partnerships, innovation, and evaluation in Rotary. The rationale for the series was my conviction that if Rotary is to have a larger impact globally, it must rely more than has been the case so far on partnerships, innovation, and evaluation (and in some areas advocacy, as has been the case with polio). Seven different projects or investments that have relied on partnerships, were innovative, and were evaluated at least in some way, were showcased. A compilation of the case studies together with a brief introduction is available here. Separate briefs are also available for each of the projects here.
As I mentioned it in the introduction to the series, partnerships help to implement larger projects and benefit from the expertise of organizations that are among the best in their field. Rotary’s Foundation was created almost 100 years ago (the Centennial is next year) and it has about $1 billion in assets. This is respectable, but in the world of development projects, which is in practice where Rotary is investing most of its funds, this remains small. Without innovation, the contribution of Rotary is an important drop, but still a drop in the development assistance bucket.
By contrast, if Rotary clubs and district innovate, successful pilots can then be scaled up by other organizations with deeper pockets, thereby potentially achieving much larger impact. However, for innovative projects to be recognized as such, proper evaluations are needed. We must be able to demonstrate the impact of pilot projects. Innovation and evaluation are like twins: they work best in pairs. Together, partnerships, innovation, and evaluation are the key to larger impact.
To encourage clubs and districts to think bigger and more strategically, stories of great projects were shared: an innovative financing mechanism for polio eradication; an award winning project fighting malaria and Ebola in Mali; a teacher training program that is transforming teaching and learning in Nepali classrooms; a project on obstetric fistula saving the lives of mothers and children in Nigeria; a program to invest in the writing skills of disadvantaged youth in the United States; a project to improve access to water and sanitation in Uganda; and a global network of Peace Centers and Peace Fellows to help promote peace.
Some of these programs and projects are large. Others are small. Most were implemented through global grants, but one was implemented through a district grant. All these projects have been in one way or another innovative. They have all leveraged partnerships not only to crowd in financial resources, but also – and even more importantly – to build on great expertise. And they have all relied on monitoring and evaluation mechanisms to assess their impact, at least partially.
Putting together great projects requires work. Fundraising is often time consuming in Rotary given the funding model of the Rotary Foundation that requires raising funds from many clubs and districts first before getting a match from the Foundation. Planning, implementing, and in addition evaluating projects also takes time, especially when one tries to do this in a professional way. Finally, in order to be innovative, Rotarians leading projects need to be aware of where the frontier is in their field, and what could be innovative. This also takes some time.
There is nothing wrong with clubs and districts funding and implementing traditional Rotary projects. Most projects will continue to be fairly simple, with funds provided to worthy charitable causes. These projects, as well as the volunteer time often contributed by Rotarians when implementing them, serve an important purpose. The beneficiaries of these projects are better off thanks to them. These projects help communities, and they also benefit Rotary through the goodwill that the projects create.
But if we want to raise the bar and achieve larger impact, we also need to do more innovative projects. Rotary needs to be bolder, more ambitious. It needs to better learn from its projects, both the great and not so great ones, and make sure that lessons learned are shared broadly, well beyond the Rotary family. The launch of the Future Vision model, despite some challenges, was a step in the right direction. As we celebrate the Centennial of the Rotary Foundation next year, let’s make sure that we have the right vision for what Rotary and its Foundation could accomplish in the next 100 years.
As in other low income African countries, access to water and sanitation remains limited in Uganda, especially for the poor. This third post in a series on partnerships, innovation, and evaluation tells the story of how Rotary is playing an important role in helping to meet some of the water and sanitation needs of Uganda’s population.
A first important initiative is the Uganda Rotary Water Plus (URWP) program. URWP coordinates work on water and sanitation done by 78 Rotary clubs (virtually all the clubs in Uganda). The program was launched by the Ugandan Minister for Water and Environment in October 2011. It promotes effective service delivery to rural and less privileged communities.
Clubs develop projects for the communities they wish to serve. For this purpose, they must first build strong relationships with the community and develop a needs assessment. Having identified needs, clubs then select partners to meet those needs, including other Rotary clubs for fund raising, non-profits and/or business partners for implementations, and local authorities. Co-funding is typically provided by the Rotary Foundation (TRF) and in some cases other funding agencies.
The design of projects must be based on adequate technologies for the community context, with attention paid to gender and environmental issues. Clubs are encouraged to link the projects to other areas of focus of TRF, for example by providing water and sanitation to schools or health clinics.
The idea is that water and sanitation alone can’t transform a community; the “Plus” in URWP refers to other areas of focus of TRF such as supporting education or fighting disease.
The model also encourages local management committees to oversee facilities cost recovery through tariffs so that funds are available for maintenance.
URWP aims to raise $7 million for more than 30 projects. Rotary International is also partnering in Uganda with USAID to invest $4 million over four years through additional projects, following previous successful similar collaborations in the Dominican Republic, Ghana, and the Philippines (this broader partnership is referred to as the International H20 Collaboration).
Beyond the mobilization of funds, the URWP initiative has also succeeded in uniting 4,000 Ugandan Rotarians, more than 3,000 Rotaractors and many members of Rotary Community Corps (RCCs) behind countrywide water and sanitation initiatives. Many have volunteered their time and financial resources to support the projects.
Community Needs Assessments
Another interesting initiative that is part of URWP has been the implementation of a detailed diagnostic of water and sanitation facilities in communities of Apac District located 250 kilometers north of Kampala.
The idea behind the water and sanitation community needs assessment was to prepare an inventory of resources as well as gaps to be used by the Ministry of Water and the Environment as well as Rotary and other funders for the prioritization of investments. Teams visited communities. After an initial meeting in each community, data collection involved implementing a survey, conducting interviews and focus groups, establishing an inventory of all water and sanitation assets in the community, and conducting community mapping exercise.
Data were collected using the FLOW (Field Level Operations Watch) system developed by Water for People. The application relies on Android cell phones together with GPS data and Google Earth software to document water and sanitation infrastructure as well as its functionality.
The community needs assessments was implemented with support from the Apac government and 16 organizations. Rotaractors served as field enumerators. Data were collected for communities as well as public institutions such as schools and health centers, with ratings provided on the quality of facilities and the satisfaction of users. Tests of water quality have also been conducted in some of the areas.
URWP represents a prime example of efforts by Rotary to invest in projects that have a larger impact through partnerships, innovation, and monitoring and evaluation.
The URWP team has established partnerships with multiple NGOs as well as USAID and Ministry of Water and the Environment. It has been innovative in project design to ensure a higher likelihood of sustainability. Evaluations of the projects are not yet available (many projects are still at the design or implementation stage), but monitoring systems are being put in place.
Finally, in the case of Apac district, extensive data collection has been conducted on water and sanitation assets and gaps at the level of communities in order to inform prioritization of future investments. This should also help in achieving higher impact through targeted interventions.
A brief on the URWP initiative as well as the water and sanitation context in Uganda is available here.
by Quentin Wodon
Today is World AIDS Day. Over the last three decades, the pandemic has taken the lives of 36 million people. According to the WHO, 35.3 million people live today with HIV (human immunodeficiency virus), but only about a third (11.7 million) receives antiretroviral therapy in low- and middle-income countries. The theme for the day this year is “Focus, Partner, Achieve: An AIDS-free generation”, calling for governments, NGOs, and individuals to contribute to AIDS prevention and treatment. This post is about the role of civil society and Rotary in fighting the AIDS epidemic.
Role of Civil Society
Governments and donors play a key role in the fight against AIDS, but civil society and individuals also play an important role and that role is being increasingly recognized and supported. Last year I published with World Bank colleagues a book entitled Funding Mechanisms for Civil Society: The Experience of the AIDS Response (the book is available online without charge here). We noted that in the past decade, international funding for the HIV and AIDS response provided by governments rose dramatically.
In addition donors have increasingly shifted their financial support toward funding community responses to the epidemic. Yet little is known about the global magnitude of these resource flows to civil society, especially at the local level, and how funding is allocated among HIV and AIDS activities and services by community organizations.
Part of the study focused on the mechanisms used to fund civil society and community-based organizations (CBOs) by four large AIDS donors: the U.S. President’s Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank’s HIV/AIDS Program, and the UK Department for International Development. On average, these four donors provided at least US$690 million in funding per year for civil society organizations (CSOs) during the 2003–09 period.
Much of this funding went to large national CSOs. While part of the funding also went to smaller NGOs and CBOs, including through partnerships with the larger CSOs, in many cases only a small share of international resources trickles down to local communities. More needs to be done to support local-based organizations that are actively contributing on the ground to the fight against AIDS, often relying on volunteer work.
Role of Rotary
Rotary is active in the fight against AIDS in part through the Rotarians for Family Health & AIDS Prevention (RFHA) Rotarian Action Group. Rotarian Action Groups (RAGs) are groups are led by Rotarians in their field of expertise in order to help clubs implement projects and exchange ideas and experiences. There are close to 20 RAGs operating, and RFHA is one of them.
The signature program of RFHA is Rotary Family Health Days (the information provided here is from the RFHA website). The program promotes healthy living and disease prevention through annual campaigns in four African countries: Ghana, Nigeria, South Africa, and Uganda. Family Health Days provide comprehensive, free health care services to underprivileged communities. The services include lifelong immunizations to children, such as polio and measles vaccines, and comprehensive life-saving annual screens such as HIV, TB, Malaria, Diabetes, Hypertension and more, including information about HIV-AIDS.
The program was initiated in 2011 when Past District Governor (PDG) Stephen Mwanje from Uganda asked Marion Bunch, the founder of RFHA, for partnership support in obtaining funding and other resources for this program. PDG Mwanje’s vision was to have all Rotary clubs in his district work together towards a common cause, focusing on HIV/AIDS but also including other disease prevention measures.
Family Health Days is a Rotary-led program, but it leverages partnerships with others including the Coca-Cola Africa Foundation, the U.S. Mission – including the Centers for Disease Control, USAID and the health service delivery expertise of their Implementing Partners – as well as each of the four countries’ Ministries of Health that provide services and supplies at the sites.
Equally important in each country are the primary media partners that include the SABC and Caxton in South Africa, and other media centers in each of the other countries. The Family Health Days program has grown from serving 38,000 citizens in one day in 2011 to serving 343,622 citizens in 2014 in 402 sites with the help of more than 8,000 Rotary volunteers. RFHA hopes to expand the program in more African countries in 2015 and is planning a pilot in India. Importantly, it is also thinking about the measurement and evaluation of the impact and sustainability of the program.
In the fight against AIDS, community-based organizations play an important role because of their proximity to the population, their knowledge of the issues on the ground, and the trust that the population has in them. Rotary could be considered as a large NGO given the amounts of funding managed by The Rotary Foundation of Rotary International. But it can also be considered as a small local-based quasi-community group given that many Rotary clubs are indeed small and working at the local level collaboratively with other NGOs.
A key question for Rotary is how to leverage effectively the resources provided by its network of clubs and members around the world. The Family Health Days, the signature program of the RFHA Rotarian Action Group, is a very interesting case of a successful mechanism to leverage the energy of many local Rotary clubs into programs that reach at least some level of scale and make a difference in the fight against AIDS and the improvement of broader health indicators.
by Quentin Wodon
International days are often an occasion to provide analysis and commentary about service projects and development issues on this blog. Before the blog was launched on World Polio Day, the annual International Day of Rural Women was celebrated on October 15. The original impetus for this International Day was to recognize rural women’s role in enhancing agricultural and rural development worldwide. Rural women are essential for food security, which is why the day is held one day before World Food Day. Rural women clearly deserve recognition: in many countries, they are the ones who work the most in the household!
Comparative analysis of the work patterns of men and women in urban and rural areas is typically done with time use data (see this book from a few years ago on gender and time poverty in Africa). In virtually all countries, women work longer hours than men, especially in rural areas.
With Clarence Tsimpo I recently conducted a similar analysis with the latest Uganda National Household Survey for 2012/13. The survey is nationally representative and it includes an interesting module on time use. Information is available for all individuals in the sampled households on their time use allocations along five core activities: market activities (for example working for a wage), collecting firewood, fetching water, cooking, and children and elderly care. To the extent that other types of work or domestic chores are not included, the weekly workload of individuals could be underestimated with those data, but on the other hand one could argue that other activities are often performed as secondary activities in combination with primary activities.
So, how hard does Uganda’s population work? Nationally, the mean working time is 47.7 hours for the adult population aged between 15 and 60. This total includes an average of 32.7 hours in market work, 2.1 hours for collecting firewood, 3.4 hours for fetching water, 7.6 hours for cooking, and 6.8 hours for children and elderly care.
However, women work on average 55.2 hours per week, well above the average of 39.3 hours for men. Men do spend more time on market work, but women do most of the domestic chores and this leads them to work longer hours overall. For some women, the workload is much higher than those averages. In rural areas, 19.2 percent of women work more than 69 hours per week, and 8.8 percent work more than 92 hours per week. For men, the proportions are lower at 9.0 percent and 1.8 percent respectively.
Women work on average longer than men because they are involved, as men are, in farm and often other labor market work. But what differentiates women from men in terms of their total working time is the fact that the responsibility to fetch firewood and water as well as to cook and take care of domestic chores typically falls on women and their children, often from a young age.
The time needed for such chores can be consequential in low income countries. In the case of water for example, in Uganda only a very small minority of households (7%) has access to piped water in their house or yard. Under usual definitions from the World Health Organization’s Joint Monitoring Programme three in fourth households in Uganda have in principle access to an improved water source. However these sources are sometimes located far away from household’s dwellings, so that the time needed to fetch water may be substantial.
The fact that for some households, substantial time is needed to fetch water means that time may be lacking to make water safe by boiling it. As a respondent in a focus group explained it: “It’s the woman who suffers with water and that’s why we don’t expect her to travel for a long distance looking for water and boiling it as well since she has other domestic chores awaiting for her.” Not boiling water may have severe health consequences.
In addition to walking time to water sources, waiting time is also common. This is illustrated by the following comments: “They are few public taps available and, there is a lot of congestion, making it hard to access water without waiting for a period of one to two hours”; “At the shallow well, in the dry season the water is very little and after pumping five jerry cans one needs to wait for another 30 minutes”. In areas where water is scarce, congestion may lead to chaos and even fighting at water sources. Instances of abuse of children and wives have been reported, especially when wives take too much time to fetch water according to their husbands.
What can be done to reduce the workload of women and shift some of their time from domestic chores to market work, thereby enabling women to earn additional income and help households emerge from poverty? As I already mentioned it on this blog (see the 3-part series on infrastructure and poverty: Part 1, Part 2, Part 3), better coverage of basic infrastructure services is one of the keys. In Uganda, a connection to the grid or piped water network could enable women to decrease their domestic working time and correspondingly increase their market working time by about two hours per week. The additional earnings that could be generated through this shift could reduce the share of the population in poverty by about one percentage point for each of the two basic infrastructure services.
While this would not by itself eradicate poverty in the country, it would help beneficiary households, and especially rural women, fairly substantially. But whether women work on domestic chores or market work, Uganda’s population can count on them to help carry the day.
by Quentin Wodon
Infrastructure matters for poverty and development (first post in this series), but the needs of the poor are not being met (second post). In this third post, the discussion shifts to what can be done to improve infrastructure services for the poor, considering first reforms and subsidies, and next projects including those by service organizations.
Reforms and Subsidies
PPIs (private participation in infrastructure) and IRAs (independent regulatory agencies) have been among the most important reforms implemented in the past two decades. The empirical evidence reviewed in my book with Antonio Estache suggests that these reforms have improved investment and service quality (as well as reduced corruption in the case of IRAs), but there are differences in these impacts between sectors and the effects have been relatively modest. In addition, while these reforms have helped some households, they probably have helped mostly households among better off groups since the poor simply have no access to basic infrastructure countries in low income countries.
Another area of concern is that of subsidies. Many countries have (often large) consumption subsidies for basic infrastructure services such as electricity and piped water. These subsidies prevent cost recovery by the utilities and this reduces the incentives for them to expand the networks. But in addition, while the subsidies are justified in theory by the aim to make services affordable to the poor, they are in practice very poorly targeted to the poor. In most countries the average subsidy received by a poor person is only a third (or less) of the average subsidy received by a person randomly chosen in the population as a whole.
Most existing subsidies are consumption subsidies implemented through the inverted block tariff (IBTs) structures. With IBTs the unit cost per kWh or cubic meter of water is lower for the first few blocks of consumption for all those connected to the network, and often below cost recovery levels. In low income countries, these subsidies are poorly targeted to the poor simply because most of the poor are not connected to the networks.
The targeting performance of those subsidies could be improved by reducing the lower bands of the IBTs so that only those who consume very low amounts of water or electricity benefit from the largest subsidies. Another option is to shift to Volume Differentiated Tariffs, whereby only those consuming in a tariff band receive the subsidy for that bans (under IBTs, all clients receive the subsidies in the lower bands for the part of their consumption in those bands). Both approaches tend to have a limited positive impact on targeting performance, but they help in reducing the cost of the subsidies.
Another alternative is to shift from consumption to connection subsidies. Instead of subsidizing the consumption of those already connected to the water network or the electricity grid, the idea is to subsidize the connection of new and typically poorer households to the network. Still another alternative is to target subsidies to those in need more purposefully (this can be done among others through geographic targeting or proxy means- testing). In those cases, targeting performance to the poor can under some conditions be improved significantly. These are all high priorities that governments and utilities should implement, as argued for example here.
What about the role of the nonprofit community, including NGOs and service clubs? Precisely because so many among the poor do not have access to basic infrastructure services, the role of nonprofit organizations is important to fill part of the gap in coverage of basic infrastructure services. It is important however for nonprofits, including service clubs, to operate in a highly professional and sustainable manner.
Providing access to electricity, water, sanitation, or other basic infrastructure services in poor areas is hard. Many projects are implemented in an unsustainable way, so that they ultimately fail. Research I am doing with Clarence Tsimpo on Uganda suggests that many small water projects fail in large part because of lack of infrastructure functionality (facilities stop to work properly, even shortly after being installed) or lack of local responsibility (poor local leadership or lack of proper community arrangements hinder maintenance, thereby yielding a slower but often irreversible damage in the infrastructure).
Sometimes, expensive technologies are put in place that communities have simply no way to keep up because of the high cost of parts for repairs. Training for proper maintenance may not be provided at all, or provided in a haphazard way, to beneficiary communities. These and other factors lead to the failure of many projects despite the best of intentions. So what are NGOs and especially service clubs to do? They need to get professional advice. In the Rotary family, the good news is that advice may be available from Rotarian Action Groups (RAGs). In the case of water and sanitation WASRAG is ready to help.
My Rotary club was recently considering a promising water harvesting and sanitation project in India. We got detailed specifications ready and they looked good. But we asked for a professional review by a district Rotarian expert in the field. He raised concerns and suggested we contact WASRAG for advice. We did, and in the end we decided to subsume our own small individual project and funds into a much larger project run by WASRAG. This gave us piece of mind that the project would benefit from the professional expertise it needed.
In Rotary, on average (there are of course exceptions), larger projects are likely to be better designed than small ones. They also tend to be better managed because the stakes are higher. This means that they probably have (again on average) more impact, and are more likely to be sustainable. Larger projects also require less administrative work than multiple smaller ones. Not all Rotary service projects need to be large projects where many clubs and districts pool resources together with professional advise from RAGs. But in some cases, when the expertise of RAGs is available, it is a good idea to work with them and pool resources.
by Quentin Wodon
The first post in this series asked whether infrastructure matters for poverty reduction and other development outcomes. It does. This second post asks whether the infrastructure needs of households are being met. They are not. Part of the analysis relies on my new book with Antonio Estache on infrastructure and poverty in Africa.
Challenges in Low Income Countries
Infrastructure does matter for growth and poverty reduction, but there is probably a difference in that relationship between low and middle or high income countries. In low income countries, there is no guarantee that investments in infrastructure will benefit the poor in a straightforward way, unless the investments are designed from the start to do so.
Consider it this way. The priorities of private investors and households in poverty are likely to differ in low income countries. In the African context especially, the number of the poor is rather large, with many living in rural areas and having no access to basic infrastructure services. Only the better off tend to have access to those services, and even at the margin, new investments in infrastructure may not necessarily benefit the poor, simply because they live too far away from the electricity grid or the piped water network. Incentives for private utilities to reach the poor are limited.
What about the links between infrastructure and employment? There is no doubt that lack of infrastructure is an obstacle for firms to operate. In enterprise surveys, close to half of firms declare that lack of electricity is a constraint for them, and one fourth cites lack of telecom and transportation services. This compares to 40 percent of firms citing corruption as a major obstacle to doing business. These rates are high, suggesting that lack of infrastructure is indeed a major constraint to investments and growth. But at the same time, in low income countries only a small minority of workers is engaged in the formal sector where these firms operate. Even if the firms would do better, this still may not have a direct immediate impact on the poor, apart from trickle down effects.
Another challenge relates to the cost and quality of service provision – such as the generation, transmission, and distribution of electricity. In part because the networks are small in many countries, operating costs tend to be higher in Africa than in other regions of the world. In some cases high costs result from over-engineering of projects. As for quality, in part due to capacity constraints, service is often provided only intermittently. These and other challenges make it difficult to serve the poor, especially in Africa.
Gains in Coverage?
Organizations such as NGOs and service clubs are not engaged in large infrastructure projects. But they can play an important role in meeting household demand for basic infrastructure – including for off-grid electricity, water, and sanitation. In the case of Rotary for example, the Water and Sanitation Rotarian Action Group (WASRAG) is actively involved in providing access to water and sanitation in local communities. The question of whether household demand for basic services is being met is thus important not only for governments and utilities, but also for nonprofit organizations.
Progress in meeting household demand has unfortunately been very slow, especially in Africa. In telecoms there has been dramatic progress thanks to the mobile cell phone revolution. But in other sectors, with the exception of gains in rural electrification in some countries, coverage rates have not improved much (see this paper). For piped water, coverage rates have remained below 20 percent on average across countries with no clear gain over time. For electricity, there has been an increase in coverage rates from a fourth of households to about a third thanks as just mentioned to gains in rural areas. For flush toilets as for piped water, access has also remained flat with only about one in ten household being served. Even when gains in coverage are being achieved, these tend to benefit mostly better off households.
Cost, Affordability, and Supply
In urban and peri-urban areas small-scale providers are filling some of the gaps left by national or regional utilities, but they often have high costs and substantial margins, and are thus expensive for households. In Niger, a study suggests that the cost of water per liter from street vendors could be up to five times higher than the cost from the piped network.
Is the lack of coverage of infrastructure in the population a demand or supply issue? Lack of affordability of modern infrastructure services is an issue for the poor, and it may reduce the demand for those services. Yet the main constraint is lack of supply, not lack of demand (see this paper). The fact is that it is often more expensive for households to meet infrastructure needs through small scale providers or alternative sources than through the networks. For electricity and lighting, the cost of batteries, candles, or kerosene lamps is often higher, at least per unit of efficient energy, than the cost of an electricity bill.
The problem is not that households do not want to connect to networks. It is that even though households would benefit from a connection to existing networks, the opportunity to do so is often not available. This may be because households live too far from the networks. But it may also be because connection costs requested by utilities are often high, especially for the poor and when the costs have to be paid in a single installment.
This quick diagnostic suggests that a lot of work remains to be done to provide basic infrastructure services to the poor in Africa and many other developing countries. In the third post of this series, the record of the reforms and policies of the past two decades will be discussed, together with their implications for projects by organizations such as Rotary.
by Quentin Wodon
World Toilet Day will be celebrated in a few days on November 19. Some 2.5 billion people do not have access to proper sanitation, including toilets and latrines. Lack of sanitation has dramatic consequences for health. Several million people, many of them children, die from diarrheal diseases every year. Many of these deaths are attributed to unsafe water, poor sanitation including lack of toilets, and poor hygiene. Access to basic infrastructure services – not only for sanitation, but also electricity, piped water, and transport – remains low in many countries.
This 3-part post series discusses the relationship between infrastructure and poverty. The focus is on Africa (the region discussed in my book with Antonio Estache published this week), but the lessons apply more broadly. I will ask three questions: (1) Does infrastructure matter and is funding sufficient? (2) Are household infrastructure needs being met?; and (3) Have reforms succeeded, and what does it mean for us?
Infrastructure has long been recognized as essential for growth, and growth in turn is empirically proven to be the best way to reduce poverty in the long run (reducing inequality also helps, but has a much lower impact, especially in very poor countries where there is not much to redistribute). Estimates suggest that the elasticity of GDP to infrastructure is in the 0.4 to 1.5 range. This is large – better infrastructure has a major impact on growth.
Infrastructure also matters for other development outcomes at the individual and household level. As mentioned above, many child deaths could be adverted with access to improved water sources and better sanitation. Infrastructure also helps households shift time from domestic chores to productive work.
This has gender implications. In the developing world women work on average longer hours than men. They are involved, as men are, in farm and labor market work, but in addition they have the responsibility to fetch firewood and water. This responsibility can be time consuming. As a villager from Uganda explains: “They are few public taps available here and there is a lot of congestion, making it hard to access water without waiting for a period of one to two hours”.
In work I am doing with Clarence Tsimpo on Uganda, regression analysis with the latest household survey suggests that in areas where the electricity grid or the piped water network is available, a connection to the grid or piped water network for those households not yet connected could enable women to decrease their domestic working time, and correspondingly increase their market working time by about two hours per week.
The additional earnings that could be generated through this shift could reduce the share of the population in poverty by about one percentage point for each of the two basic infrastructure services. While this would not by itself eradicate poverty in the country, it would help beneficiary households, and especially rural women, fairly substantially.
Infrastructure as a New Priority
Throughout much of the last two decades, funding allocated to infrastructure by governments fell in proportion of available budgets. It has also been said that transport was one of the forgotten MDGs (Millennium Development Goals). Today, the situation has changed and the crucial role of infrastructure is widely recognized. Yet funding remains a challenge.
According to the World Bank, private infrastructure investment in emerging markets and developing economies dropped from US$186 billion in 2012 to $150 billion last year. At its annual meetings last month, the World Bank announced the launch of a new global infrastructure facility. While developing countries invest US$1 trillion per year on infrastructure, this would need to be doubled to maintain current growth rates and meet future demand for infrastructure from firms, households, and regions.
The private sector will play a key role in future infrastructure investments, but governments will need to invest more as well. For this, they will need to rely on both their own tax revenues and the availability of foreign aid. For low income countries, concessional financing (grants or very low interest loans) will remain crucial.
When increasing funding for infrastructure, governments and donors will need to be careful to assess fiscal and institutional capacity – not all countries have the same absorptive and implementation capacity. The worst that could happen would be to have large investments in sub-optimal infrastructure projects. The risk of an increase in debt to unsustainable levels must also be managed. But many countries do have the capacity to absorb more funding for infrastructure.
This is the big picture about the relationship between infrastructure and poverty in Africa and many other parts of the world. The next post in this series will discuss whether household needs are being met, and if not, why not.
by Divya Wodon, Naina Wodon, and Quentin Wodon
“I have been a mediator for the past 15 years so the concept of reducing conflict through mediation appealed to me.” Phil Reynolds from the Annapolis Rotary Club took over from a fellow Rotarian as lead international club contact for the Uganda peace project about six months before it started. When he heard about the project and that someone new was needed, he volunteered right away: “The project was natural for me (…) I helped the United Nations Development Program set up an electoral assistance program, so the Uganda project, which focused on electoral hot spots, drew my attention”. With his years of experience in UN projects, Phil was able to refine the grant application and the activity plan.
The goals of the project are to create an early conflict warning system and mediation tools that can be used by local communities to facilitate conversations within youth groups and bring children from different tribal backgrounds together. The project will also help create a truth and reconciliation program initially in four of districts, with the possibility of an expansion later.
The project has had many successes thanks in part to the efforts of the Uganda Joint Christian Council (UJCC) in executing it. Phil was inspired by “the courageous and effective evaluation carried out by the UJCC on its own nine months into the project”. He was excited when results of the projects came back and there were encouraging examples of conflicts in the four pilot districts that had been resolved by the local project personnel. Phil hopes that in the future the peace project will be able to expand to other districts in Uganda.
There were of course challenges. For example the communication was not always as reliable as it should have been between the US and Uganda teams. Phil is convinced that “project plans must be specific and time-bound,” but he quickly adds “with a human face)”. And “as a French colleague once said, you must leave room for some unanticipated successes”.
Note: This story is reproduced with minor changes from a book published by the authors entitled Membership in Service Clubs: Rotary’s Experience (Palgrave Macmillan, 2014).
by Quentin Wodon and Clarence Tsimpo
Today is World Habitat Day. Created almost 30 years ago, the day promotes adequate shelter for all. Why should this be mentioned in a blog on investing in health? Because adequate shelter, including access to safe water and sanitation, is essential for health. Several million people, many of them chidren, die from diarrheal diseases every year. Many of these deaths can be attributed to unsafe water, poor sanitation and poor hygiene.
Given the importance of water and sanitation for well-being and health, one would hope to see rapid progress in access, but this is not the case. Trends in coverage of piped water and sanitation prepared for a World Bank study on Africa’s infrastructure a few years ago suggest stagnant rates (more progress is being achieved for electricity, and course, cell phones). Water networks are expanding, and latrines are being built, but too often this only enables countries to keep up with pressure of population growth and the reduction in household size (the smaller the average household is, the more households need to be served for any given population).
Uganda is a good example. Despite rapid growth in the water network in recent years, on a small minority (7%) of households had access to piped water in the latest survey for 2012/13. Under usual definitions from the Joint Monitoring Program of the World Health Organization (WHO), three in four households have access to an improved water source, but some of the sources imply out-of-pocket costs or opportunity costs for the time needed to reach the source. The situation is similar in many other low-income countries.
Why is progress slow? Apart from increasing demand, findings from qualitative fieldwork suggest that supply factors are also at play. In the case of water, these include lack of infrastructure functionality(facilities may notbe working properly, even shortly after being installed), lack of local responsibility (poor leadership may hinder investments in water supply or leadto lack of maintenance) and scarcity (in some communities, water is simply not easily available).These factors tend to be organizational in nature, or physical in the case of water scarcity. But in addition, one should not underestimate the role of culture, tradition, and behaviors.
For example, households know that boiling water is one of the best ways to make it safe. But a minority (less than 40%, according to the latest survey) do it. A few quotes from qualitative fieldwork illustrate why: “We do not have time to boil this water because of the demanding household chores. We feel it is a waste of time since this water looks clean.”“We are aware this water is bad, but it takes a long time to bring the water to boil and firewood has become scarce.”“I am about 57 years old and I have been living on un-boiled water without falling sick. What matters to us is for the government to expandthe availability of water points, not to tell us to boil the water.”
Adequate sanitation is also essential for health. Yet again, in many low-income countries, only a small minority of households has access to improved sanitation. Part of this may be due to a low priority assigned to sanitation in terms of public funding. But part of it is also due to cultural and traditional norms, as well as lack of income or time. Poor terrain or soil type and a lack of land to build latrines also play a role in some areas.
When public latrines are available, there is often a consensus on charginguser fees to ensure maintenance, but enforcement is weak. The same is true for by-laws in areasrequiring households to build their own latrines, which are often expensive to build, at least for the poor.
Focus group participants were asked why they pay for cell phones but not for latrines. They responded that latrines have a much larger one-time cost, but also that having a cell phone is a sign of modernity and important for one’s status in communities. Clearly, more needs to be done to convince households of the importance of latrines, for example through sanitation marketing campaigns.
Finally, in terms of health benefits, there is perhaps no more cost-effective intervention that the promotion of hand washing, but only a small minority of Uganda’s households (less than one in ten) has a facility to wash hands with both soap and water. Information campaigns are held, but, as aparticipant in focus groups noted, “many of the community members do not attend them, saying that these trainings are a waste of time.”
Sometimes even children contribute to low uptake of the practice: “We used to have hand washing utensils, but the children would play with them and waste the water, so we gave up”. More fundamentally, local leadershipappears to be one of the keys: “Local leaders have campaigned, but there is poor adoption, because hand washing is viewed as a very strange practice to the local culture. Local leaders themselves are not visibly seen practicing hand washing… You cannot simply continue telling people about what they should do, but do not see you doing!”
Studies from the Bank’s Water and Sanitation Program suggest that the cost of lack of sanitation is high. As in other low-income countries, Uganda has invested over the years in safe water and sanitation. But the constraints faced by households and communities are complex. The qualitative work implemented in 14 districts suggests that solutions often must be context- and community-specific. This may not lead to cookie-cutter solutions, but it is important to document precisely because of the variety of local circumstances.
Note: This post is reproduced with minor modifications from a post in October 2014 on the Investing in Health blog at the World Bank, available at http://blogs.worldbank.org/health/