AFRICA AND THE ROLE OF MULTILATERAL INSTITUTIONS
by UICIFD STAFF
December 2000
INTRODUCTION:
African countries have received large amounts of aid from multilateral institutions such as the IMF and World Bank in the past. Much of the aid was unsuccessful or failed to achieve its objectives. This issue of the Reading Table examines the role of multilateral institutions and the link between foreign aid and policy reforms in Africa.
ABSTRACTS:
HOW THE MULTILATERAL INSTITUTIONS COMPOUNDED AFRICAN'S ECONOMIC CRISIS
by George B. N. Ayittey, in Economic Crisis, 30 Law & Pol’y Int’l Bus. 585 (1999)
The author takes the position that foreign aid from multilateral institutions, including the IMF and World Bank, have compounded Africa’s economic crisis, but that they are capable of helping Africa reverse its current economic plight. Examples of failed aid efforts by the multilateral institutions are provided, including USAID projects, and IMF and World Bank projects. One reason given for the failure of multilateral institution projects in Africa is the hiring of overly expensive experts and consultants with no ties to Africa, resulting in problem-solvers with little knowledge of Africa and little motivation to help. Another reason given for failure is that multilateral institutions fail to address the fact that the countries receiving help are often governed by corrupt leaders and unconcerned with letting the citizens have a voice in government. The author then suggests that past efforts by the multilateral institutions focusing on economic reform have been unsuccessful. This focus is because political and economic systems in Africa are fused making it impossible to implement economic reform without first implementing political reform. The author suggests that the proper sequence for reform must be intellectual reform, then political reform, followed by economic and institutional reform. In conclusion, the author suggests that the multilateral institutions abandon efforts to reform the current political state, and instead focus on building the informal or indigenous sector. Other suggestions for multilateral institutions include helping to establish independent institutions, such as an independent press, and supporting the initiatives of the African people, not their governments.
THE COST OF DOING BUSINESS:
FIRMS' EXPERIENCE WITH CORRUPTION IN UGANDA
by Jakoc Svensson, at the World Bank Website (2000)
The author has done extensive research in Uganda to determine if corruption can be measured in a systematic manner. After speaking to corporate managers in Uganda, he found that the managers were very willing to talk about the types of bribes they are often required to pay to government officials within the country. He concluded that corruption is measurable, and his research determined that businesses often have to pay bribes to government officials when those officials’ actions have a direct bearing on the businesses’ operations. Such bribes are frequently involved in transactions that involve importing and/or exporting, and as a result, hinder the growth of business within the country. The author then suggests that without institutionalized mechanisms for the accountability of public officials and the public sector, the problem of corruption and its detriments will continue to exist. Such mechanisms include political reform involving greater transparency, and facilitating increased monitoring rights of the citizenry. The article concludes by stating that the political structure present in other sub-Saharan African countries, such as patronage politics and lack of citizen involvement, have also undermined growth in African countries.
UNLOCKING AFRICA'S POTENTIAL:
SOME FACTORS AFFECTING ECONOMIC DEVELOPMENT AND INVESTMENT IN SUB-SAHARAN AFRICA
by Peter K. Nyikuli in 30 Law & Pol’y Int’l Bus., 623 (1999).
This author looks to the past and present to help explain why sub-Saharan Africa has seen such limited success in economic development, despite having what the author considers to be plenty of natural resources and other economically beneficial attributes. With a look to history, the author explains that, although African countries have achieved political freedom, their over-dependence on former colonists hurts development, and subsequent superpower struggles during the Cold War resulted in a failure to address good governance in Africa during the period. A current problem that has plagued Africa is its lack of privatization, which the author feels can drive development. Other factors that contribute to a lack of development include the HIV/AIDS epidemic, political strife, ethnic conflict, heavy indebtedness, and rapid population growth with widespread poverty. The author suggests regional integration to create a more unified African market can help Africa become a larger player in global investment. Other suggestions include focusing on education, especially of women, by improving educational facilities while providing more job opportunities and concentrating on keeping the most talented Africans at home to avoid the "brain drain." Finally, the author suggests that neither recipient governments nor donor communities are to blame for the lack of development in Africa, despite an influx of funds with little to no positive results. He suggests that the burden must fall on African governments to help multilateral institutions design effective policies that lead to self-sustainability, while relying on foreign aid to meet essential needs, such as food and education.
AFRICA-AT-LARGE: AFRICA'S MAJOR OBSTACLES TO DEVELOPMENT
by Daniel Kendie in AFRICA NEWS, Nov.5, 1999.
The article looks at the internal and external causes of Africa’s lagging economic development (marginalization). The possibility of jumpstarting the African economy and closing the gap between the rich and the poor does not look very bright, despite the efforts made by the international community, particularly in the framework of the UN and UNCTAD conference. Against the historical and statistical background of African development during the second half of the 20th century, the author asks why Sub-Saharan African countries’ economies are not able to function even on the very basic level. Mr. Kendie discerns two fundamental problems underlying the regression or stagnation characterizing the African economies: the need for internal changes (stronger cooperation of private sector with the government) and the influence of external factors (World Bank and IMF policies). Lastly, the author raises the issue of repatriation and retention of profits from external investment in Africa.
THE GROWTH AND PROSPECT FOR VENTURE CAPITAL ACTIVITIES IN NIGERIA
by Debbie Ariyo, in Africa Economic Analysis (Apr. 19, 2000)
The author draws attention to the positive economic developments taking place in Nigeria, particularly the government-supported growth of the small business sector. Small businesses are the backbone of technological change, progress and ultimately, economic growth, as it has been proven by the example of India, South Korea, Malaysia and other countries. Ms. Ariyo stresses the importance of attracting venture capital for stimulating entrepreneurial activity in Nigeria and analyses its potential impact on the country. Nigeria is asked to put in place the financial infrastructure, create legal climate favorable for the infusion of venture capital, and encourage institutional investment by providing tax incentives. The article concludes by stressing that only internal efforts to promote venture capital activities, and not clamoring for technology transfer from the West, will give an impetus to Nigeria’s economic growth and prosperity.
NEW PROSPECTS FOR PRIVATE SECTOR LED TRADE INVESTMENT AND ECONOMIC DEVELOPMENT IN SUB-SAHARAN AFRICA
by Irving Williamson in 30 LAW & POL’Y INT’L BUS. 637 (1999)
After two decades of declining economic performance, sub-Saharan Africa is currently staging a promising recovery. A new generation of African leaders and entrepreneurs and current developments in the areas of private sector expansion, debt relief, regional economic integration, and telecommunications have the potential to fuel economic growth in ways not heretofore anticipated. While African countries retain primary ownership and responsibility for the process, the international community can support their efforts by pursuing policies that promote world economic growth and financial stability and expand the region's access to international markets, providing meaningful debt relief, continuing to supply technical and financial assistance to countries committed to reform, and assisting Africa's regional economic groupings. In addition, a growing number of private sector-led trade and business associations in sub-Saharan Africa are working to create increased dialogue between government and the private sector, to improve the business climate, and to promote cross-border trade and investment in the region. Fortunately, current developments in debt relief, regional integration, private sector strengthening, telecommunications, and WTO trade policy capacity building hold the promise of a better future for the developing countries of sub-Saharan Africa.
STRENGTHENING THE LEGISLATURE AND JUDICIARY FOR IMPROVING GOVERNANCE IN AFRICA: A CASE FOR THE RULE OF LAW AND ECONOMIC DEVELOPMENT
by David A. Levy in the International Law Institute
While events in Somalia, Liberia, Rwanda, Zaire, and Sierra Leone serve as examples of the failures of the rule of law and the democratic process, there have been a number of notable developments on the continent which demonstrate that political courage and institutional reform can indeed advance the rule of law. The article begins with the thesis that strengthening the democratic institutions of government is essential for the true rule of law. Such institutions are necessary to counter the domination of government by the exercise of excessive executive power, a paradigm which all too frequently has dominated post-colonial governments in sub-Saharan Africa. The rule of law is defined and the roles of the branches of government in advancing the rule of law is examined, from role of the legislature in serving as a democratic check against the abuse of power by the executive to the necessity of a trained, independent judiciary to fulfill the promise of law. The author considers the advancement in legal reform through participation in the international commercial law harmonization process. Actual examples based on recent African experience are drawn upon to illustrate the successes and failures of democratic governance on the continent.
A STUDY IN INTERNATIONAL LABOR STANDARDS AND THEIR EFFECT ON WORKING WOMEN IN DEVELOPING COUNTRUES
Dwasi, Jane. Kenya in 17 WIILJ 347, (Sum. 99).
Dwansi claims that efforts by multilaterals have had limited success and have failed to address the specific problems of working women in developing countries. She states that because the World Bank is an international development agency it has the legal duty to promote and protect worker's rights. She suggests that that the World Bank is in the best position to put pressure on developing countries such as Kenya, where corruption exacerbates the problems of working women's rights. For example, in response to the Kenyan Government underpaying workers, the World Bank can condition loans and development projects on stipulated measures of progress in the area of worker's rights. Dwansi advocates that the World Bank ought to make its credit facilities, development aid, and development contracts available only to governments, organizations, and institutions that recognize and respect worker's rights and protection of worker's rights, as part of its policy.
WHO HAS FAILED AFRICA, IMF MEASURES OR AFRICAN LEADERSHIP?
by Gerald Scott in 8/1/98 JAAS 265.
Scott claims that the balance of payment problems which have plagued the countries of Africa through the 1990's have stemmed from inadequacies in both international and domestic economic development. However, he claims that the biggest setback in developing the economies in Africa is the corruption of leaders, administrators, businesses, and politicians who seek to benefit themselves at the expense of national development. Therefore Scott claims that the current welfare is not an IMF failure. The IMF helps to control corruption the most by removing opportunities for corruption. In fact, the IMF helps with problems of corruption by strengthening institutional capabilities, requiring public accountability and responsibility, emphasizing efficiency, encouraging private sector participation, and by fostering coordination in macro-economic stability. If a particular government has a record of corruption, the IMF may act paternalistic by conditioning lending on government fiscal restraint. For example, the IMF may make a condition limiting governmental production subsidies. Lastly, although IMF measures may harm the urban poor, it would help the rural poor by providing for better private sector enterprises. Thus, the rural poor will benefit because they will be able to buy cheaper domestic products rather than expensive imported products.
DANCING IN KENYA TO THE DONOR'S TUNE: KENYA UNDER IMF TUTELAGE
by F.T. McCarthy in The Economist, 8/5/00.
In 1997 the IMF cut aid to Kenya. The IMF did this because the Kenyan government and its leaders were looting from IMF funds and keeping the funds for themselves. This was after making what were thought to be genuine promises to the IMF that the money would be used accordingly. After years of severe drought, the IMF has agreed to resume lending but only on extraordinarily stringent conditions. The conditions will be the toughest to date on any country. The IMF is insisting that the Kenyan Parliament debate and pass corruption laws that the IMF has already detailed so there will be no real debate. Further, it is insisting that the Parliament pass a code of conduct for all public officials to declare their assets, by providing a daily balance sheet for inspection by the IMF. Lastly, a newly formed Treasury Office will have direct control over other government departments. The IMF is treating Kenya this way because of its bad record, and to show other African countries their ruling policies must be approved by the IMF before they will get lending.
NEW PROSPECTS FOR SECTOR LED TRADE, INVESTMENT, AND ECONOMIC DEVELOPMENT IN SUB-SARHARAN AFRICA
by Irving Williamson and Stephen D'Alessando in 30 Law & Pol'y Intíl Bus 637 (1999)
Williamson and Alessando give a rather optimistic assessment of Africa's economic future although tempered by the fact that conditions vary widely from country to country. After two decades of declining economic performance, sub-Saharan Africa is currently staging a promising recovery. A new generation of African leaders and entrepreneurs and current developments in private sector expansion, debt relief, regional economic integration, and telecommunications have the potential to fuel economic growth in ways not heretofore anticipated. The authors believe that although African countries retain primary ownership and responsibility for the process, the international community can effectively support their efforts by (1) pursuing policies that promote world economic growth and economic stability and expand Africa's access to international markets, (2) providing meaningful debt relief, (3) continuing to supply technical and financial assistance to countries committed to reform, and (4) assisting Africa's regional economic groupings. In addition, a growing number of private sector-led trade and business associations in sub-Saharan Africa are working to create increased dialogue between the government and the private sector, to improve the business climate, and to promote cross-border trade and investment in the region. Current developments in debt relief, regional integration, private sector strengthening, telecommunications, and WTO trade policy capacity building hold the promise of a better future for the countries of sub-Saharan Africa.
CORRUPTION AND DONOR REFORMS: EXPANDING THE PROMISES AND THE POSSIBILITES OF THE RULE OF LAW AS AN ANTI-CORRUPTION STRATEGY IN KENYA
By James Thuo Gathii in 14 Conn. J. Int'l L. 407 (Fall, 1999)
This article critically examines the post-debt-crisis reform proposals being imposed on sub-Saharan African economies to combat corruption, including the various anti-corruption initiatives that form a part of the rule of law reforms that donors have required because of the many cases of corruption at highest levels of the Kenyan government that have come to light in recent years. These reforms are primarily aimed at instituting fair or impersonal procedures that limit open-ended official discretion. The author argues that although these reforms are significant they do not guarantee or entail fair or substantive outcomes, especially in cases of grand corruption and looting. This is because the nature of corruption in the country is in large measure a reflection of the great degree of inequality of wealth and power. Any approach to dealing with corruption must redress this disproportionate access to power, wealth and influence that makes corruption possible in the first place. What is needed he argues is "substantive justice"-the dismantling of the structures of oppression and exploitation, and the decentralizing of power at all levels: international, national, regional and personal. It requires a framework that does not separate the state and the society from the economy. Procedural fairness focuses too much on the state and the society apart from the economy. The current rule of law efforts to deal with corruption are beset with problems because they are based on the classical liberal assumption that ideally the rule of law should be or needs to be only a procedural and neutral mediation devise. He discusses how this classical definition of the rule of law that individual freedom is sufficient to enable citizens to freely chose and obtain a reasonably good quality of life results in the protection of the status quo which results in particularly bad effects for Kenya and for all of Africa.
THE SEARCH FOR THE KEY: AID, INVESTMENT AND POLICIES IN AFRICA
By David Dollar & William Easterly in World Bank Research Working Paper No. 2070, April 2000
This paper examines the relationship among aid, investment, and policies in Africa and attempts to find the key that unlocks Africa's development potential. The authors believe that multilateral institutions can play a powerful supporting role in African development by providing ideas, technical assistance, and most importantly, foreign aid. Previously, development economists have identified two approaches they believe to be effective in promoting economic growth in Africa. One is called the "aid-financed investment" and the other is "aid-induced policy reform." Investment is considered aid-financed when donors increase aid to boost investment and promote economic growth. However, studies show that a significant and positive relationship between investment and growth is found in only a few African countries. Aid-induced policy reform, on the other hand, takes place when donors disburse aid to induce policy reform in a given country. While foreign aid may be used to cover the initial costs of structural adjustment, aid may also help countries delay reform under poor governance. The improved model of conditioning aid on policy reform will eventually fail due to difficulties in monitoring, the limited life of adjustment programs, and the lack of incentives on the part of donors. The authors conclude that foreign aid is most effective in countries that are committed to structural reform, and that economic growth will follow substantial progress with policy reform.
RAISING GROWTH AND INVESTMENT IN SUB-SAHARAN AFRICA: WHAT CAN BE DONE?
By Ernesto Hernandez-Cata, IMF Policy Discussion Paper, May 2000
This paper examines the sub-Saharan Africa's (SSA) economic performance and outlook, focusing on what multilateral institutions can do to promote development and growth in the region. While SSA's growth performance was unsatisfactory during the1980s and early 1990s, there is some encouraging growth performance between 1995 and 1997. Though some believe that SSA's development is severely obstructed by its poor soil quality and the tropical climate, the author believes the low level of private investment and low productivity play significant roles in SSA's development. Five risks have been identified to deter private investment, including macroeconomic instability, inadequate legal systems, frequent armed-conflicts, high marginal tax rates, and overhanging external debts. Some of these risks can be eliminated through the assistance of multilateral institutions. For example, the IMF can help SSA countries develop an efficient legal system, increase assistance to countries engaged in peacekeeping operations, rebuild infrastructure through post-conflict programs, and provide faster, deeper and broader debt relief. Additionally, six economic distortions and institutional deficiencies have been identified as the cause of low productivity and growth, including restrictions on international trade, overhauled exchange rates, inadequate infrastructure, low labor force productivity, corruption, and exploitation of agriculture. The multilateral institutions should actively assist SSA countries in liberalizing trade, reducing and simplifying external tariff structure, increasing investment in human capital, removing import, export quotas, and discontinuing granting privileges to interested groups. To cooperate with multilateral institutions' efforts in revitalizing African development, developed countries should open their markets to the exports from sub-Saharan Africa.
REFORMING FOREIGN AID TO AFRICAN DEVELOPMENT: THE POLITICALLY AUTONOMOUS DEVELOPMENT FUND
By Goran Hyden in Development Dialogue, April 1995
Recognizing that slow economic growth, deteriorating terms of trade, the burden of debt servicing, and stagnating flows of external financing have significantly hindered social and economic development in SSA, the author believes that foreign aid plays a major role. He also questions how foreign aid can be converted into more lasting development activities. The author introduces a new model of how foreign aid can be made more productive in sub-Saharan Africa (SSA). The "politically autonomous development fund" is designed to serve as an intermediary between the donor countries and the recipients, by channeling aid into sectoral funding mechanisms and reducing the administrative burdens on both the donor and the recipient. The proposed model is a public but politically independent institution that caters to both government and civil society and aggregates finances from many sources. The new model will accelerate social and economic development by converting physical capital into social capital, enable donors to withdraw from direct operational or administrative involvement in externally funded project activities, and help African countries generate more support for their development efforts. The author believes that the new model will operate more effectively than the rural development funds, private/charitable foundations, UNDP and UNICEF, and multilateral development funds.
DEVELOPMENT IN SOUTH AFRICA AND VENTURE CAPITAL: THE CHALLENGES AND OPPORTUNITIES FOR THE ENTERPRISE FUND FOR SOUTHERN AFRICA
by Rafael X. Zahralddin-Aravena in 15 BERK. J. INT'L L. 62, 81 (1997).
The article illuminates the specific challenges to private investment and development that the legacy of post-Apartheid South Africa presents: high population growth, racial disparity, unemployment, and the "wide gulf in development between black and white communities." These challenges are not insurmountable. The use of enterprise funds is essential for encouraging development in South Africa. Historically, these kinds of funds, which have their origins in the U.S. Small Business Investment Company Act (SBIC), have had considerable effects elsewhere, influencing the Enterprise Funds in Eastern Europe, Russia, and the Newly Independent States. The South African Enterprise Development Fund (SAEDF) should rely on the SBIC as a model as well in order to promote a strong venture capital industry. By analyzing the successes and failures of similar development funds the SAEDF should focus initially on providing education, information dissemination, and counseling to bodies which provide government funds and foreign aid. The SAEDF should further promote transparency between government and commercial relations, eliminating the "gravy train" mentality, entitlement, and cronyism that thrived under apartheid. Only when these goals are well in hand should there be a shift in emphasis to promote small business, entrepreneurs without political entanglements, and other private investing ventures. Ultimately the author argues that the goal should be the creation and promotion of growth companies.
THE ROLE OF MULTILATERAL INSTITUTIONS IN AFRICAN DEVELOPMENT
by: W. Paatii Ofosu-Amaah, Ian Vasquez, and Ernesto Hernandez-Cata in 30 Law & Pol'y Int'l Bus. 697 (1999).
W. Paatii Ofosu-Amaah discusses the various bodies which fall under the definition of "multi-lateral institutions," including the International Bank for Reconstruction and Development, the IMF, and the International Development Association. There is a particular emphasis on the history of the actions of these institutions beginning with their initial activities that had as their primary goal the building of infrastructure (Boke Mining project in Guinea, Kariba dam in Rhodesia) to the switch in emphasis in the 70's and 80's to the alleviation of poverty. The World Bank has been changing in recent years with the arrival of its latest president, Mr. Wolfensohn. W. Paatii Ofosu-Amaah stresses that now, for the first time, the Bank in engaged in close dialogue with the leaders of Africa in order to learn from the inside what their priorities are, and how the bank can mobilize to support these priorities by working in civil service, legal and judicial reform, as well as supporting anti-corruption initiatives.
Ian Vasquez addresses the problem as he sees it with a fundamental policy that the IMF and World Bank share: lending only to governments or lending on the basis of government guarantees which expands the state sector at the expense of the private sector. Ian Vasquez also makes another point, well taken, by explaining a paradox in much of IMF and World Bank activity. In Africa, these organization's activities have too often had the opposite effectóimpeding growth and change where it seeks to promote it by ìrewardingî a reduction in economic freedom with greater flows of aid. Mr. Vasquez advocates the forgiveness of debt incurred by poor African nations and a termination in lending there.
The mid 1990's saw relatively good economic growth in Africa; it appeared the trend could continue if it could meet the challenges of globalization and declining official development assistance. Two other problems subsequently developed: The East Asia financial crisis caused a subsequent drop in world commodity prices, and the armed conflicts spread in the region. Ernesto Hernandez-Cata argues that in order for Africa to get back on track, the IMF should aid in the promotion of good governance by 1) eliminating distortions that hinder the operation of markets (import quotas, cutting Government power to confer privileges on the few, etc) 2) ensuring that public resources are not misappropriated 3) promotion of regional integration 4) assisting countries in the aftermath of armed conflicts (reestablishing the countries ability to generate budgetary revenue) and 5) doing more to assist debt reduction.
COPING STRATEGIES OF HEALTH PERSONNEL DURING ECONOMIC CRISIS: A CASE STUDY OF CAMEROON
by Syed Muhammad Israr, Oliver Razum, Victor Ndiforchu and Patrick Martiny in Tropical Medicine and Environmental Health, April, 2000.
The article reviews a study conducted by the authors regarding recent and current practices of Cameroon government health care professionals in response to Structural Adjustment Programs (SAPs). Similar to the experiences of other African nations, the implementation of an SAP in Cameroon caused substantial wage decreases among public sector employees and an increase in consumer prices. After initiating its SAP in 1994, government salaries fell by 70% and food prices increased by 50% in recent times. The authors identified coping measures used by government-employed physicians, nurses, pharmacists, and laboratory technicians in response to the economic changes. Many of the professionals reported that they would often sell drugs and medical equipment directly to patients in order to generate money. Many also ran private clinics or services, resulting in high degrees of absenteeism at their government jobs. In order to save money, health professionals often skipped meals or ate low quality food, used second-hand clothes, and resorted to non-health related jobs to generate income. The overall effect of these professional and life-style changes was a reduction in on-the-job morale. Survey participants reported a general feeling of frustration, resulting in less attentiveness to patients and other negative work practices. To make matters worse, the implementation of SAPs often require the introduction of fees for government health services. Patients expecting a higher quality of health care instead experience lower quality care due to the coping strategies of government health service workers. The authors suggest that strategies be implemented at the time SAPs are introduced in order to preempt the negative effects of individual coping measures used by government health professionals.
NEOLIBERALISM REVISED? A CRITICAL ACCOUNT OF WORLD BANK CONCEPTIONS OF GOOD GOVERNANCE AND MARKET FRIENDLY INTERVENTION
by Ray Kiely in International Journal of Health Services, v.28, no. 4, 1998.
The article criticizes current World Bank paradigms regarding government involvement in economic growth, with particular emphasis on the East Asian economic experience in reference to sub-Saharan Africa. The author argues that the World Bank has not only incorrectly identified the causes of the East Asian "economic miracle," but currently misapplies its conclusions to Structural Adjustment Programs (SAPs) in Africa. The Bank asserts that limited government intervention results in low-price distortion, a corollary of unhindered free market operation. For the Bank, "good governance" equates to state policies which foster private sector activity free of market-distorting intervention. However, the author makes use of several examples showing that East Asian governments implemented numerous interventionist strategies that accounted for rapid industrial growth. Therefore, the Bank's economic growth model is inherently flawed, and applying this model to African development is subsequently incorrect. For example, a review of 37 adjusting African nations shows that although 24% of those economies had better growth rates than previously, 52% had worse rates. Even Ghana, a nation often touted by the Bank as being a showcase for the success of SAPs, experienced a decline in manufacturing employment and industrial growth in recent years. The author concludes that World Bank conceptions of government roles in economic growth be over-hauled in exchange for strategies involving state intervention and protection of domestic economies.
PUBLIC SOCIAL SPENDING IN AFRICA: DO THE POOR BENEFIT?
by Florencia Castro-Leal, Julia Dayton, Lionel Demery, Kaplana Mehra, in The World Bank Research Observer, February 1999
The authors conducted a study on the distribution and usage of government subsidized health and education benefits to citizens of Cote d'Ivoire, Ghana, Guinea, Kenya, Madagascar, South Africa, Tanzania, and others. Employing a "benefit incidence" approach, the authors estimated the unit costs per person of health and educational benefits, and then measured their distribution and usage rates across categories of people grouped by income. In terms of health spending, the study concludes that although these governments attempt to distribute health benefits to all of its citizenry, the poorest one-fifth of the population do not use health services nearly as much as the richest one-fifth. In other words, the poorest quintiles utilize far less than 20% of government subsidies distributed to them, and the richest quintile consume far more than their 20% allocation of health expenditures. This may be due to a number of reasons. Health care is readily available in richer urban areas, but poorer rural folk must travel long distances to seek care. Also, more expensive specialized care and pharmaceuticals are readily available for richer classes, but often unavailable for the poor. The authors also found that poorer classes tend to self-treat illnesses rather than obtain professional services. Similar results were found in distribution and use of education subsidies. Although governments attempt to evenly distribute subsidies to all social sectors, actual usage of educational benefits in relation to their intended distribution is not equitable. This may be due to the fact that although public-supported primary education is utilized fairly evenly across social classes, secondary and tertiary education is utilized almost exclusively by the middle and upper classes. Thus, richer segments of the population are not only consuming much more government funding for education, but also obtaining a much higher degree of education at the same time. The authors conclude that more equitable public spending results could be achieved through re-orientation of subsidy programs specifically addressing structural problems facing the poor. Also, changes in household behavior are key, particularly in regards to gender biases in favor of males.