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Information and communications technologies (ICTs) are the basis of globalization evolution. In Africa, particularly, the lightning mobile telephony evolution marked by the implementation of wide-band infrastructures has promoted the evolution of ICT in urban areas. It is important, on the other hand, to underline that this evolution in a country is not observed in a proportional way among the various urban and rural areas. In this context, an overall approach of assessment and optimization of the universal access service index in a country, called Universal Access Index, is proposed in this paper. The optimization approach suggested is based on the implementation of corrective actions related to the Universal Service Access Fund and takes into account the intrinsic technical–economic constraints in every area. To assimilate the updated definition of the International Telecommunications Union on the universal access, two significant indicators representing the voice services and data services were integrated in the modelling approach. This approach is applied to a real case study of the state of Ouaddaï in Chad which makes it possible to highlight its relative simplicity of implementation.

Over the past ten years, private-sector-led growth has revolutionized access to telecommunications. Every region of the developing world benefitted in terms of investment and rollout. This revolution would have been impossible without government reform and oversight. Advanced information and communication infrastructure (ICI) are increasingly important to doing business in a globalizing world. Governments, enterprises, civil society, workers, and poor populations in the developing countries need more affordable access. This report proposes strategies that governments can carry out to attract private investment and ensure the continued evolution and spread of information and communication infrastructure. These strategies encompass more than sector policy alone, for investment decisions are based on a wide range of factors including, for example, the roles played by financial sector development and the broader investment environment. The strategies also include potential public sector investments that can catalyze ICI rollout in subsectors where the private sector is not prepared to intervene on its own.

China's recent economic growth has expanded industrialization and urbanization, upgraded consumption, increased social mobility, and initiated a shift from an agricultural-based economy to one based on services and industry. However, more than half of China's population still lives in rural areas, where the average per capital income is less than a third of the urban average. The government of China has increased its commitment to rural development and poverty-reduction programs, with attention to narrowing the rural-urban divide. Informatization—defined as the transformation of an economy and society driven by information and communications technology (ICT)—is increasingly being explored as a way of helping poor people. Rural Informatization in China presents an overview and in-depth analysis of rural ICT initiatives in China. This study reviews the present-day status of China's rural informatization infrastructure, examines and summarizes by organizational model the key initiatives in the past decade, and provides policy recommendations to address current challenges. Case studies of different financing models of rural ICT initiatives from China and other countries are included.

A Development Emergency: the title of this year's Global Monitoring Report, the sixth in an annual series, could not be more apt. The global economic crisis, the most severe since the Great Depression, is rapidly turning into a human and development crisis. No region is immune. The poor countries are especially vulnerable, as they have the least cushion to withstand events. The crisis, coming on the heels of the food and fuel crises, poses serious threats to their hard-won gains in boosting economic growth and reducing poverty. It is pushing millions back into poverty and putting at risk the very survival of many. The prospect of reaching the Millennium Development Goals (MDGs) by 2015, already a cause for serious concern, now looks even more distant. A global crisis must be met with a global response. The crisis began in the financial markets of developed countries, so the first order of business must be to stabilize these markets and counter the recession that the financial turmoil has triggered. At the same time, strong and urgent actions are needed to counter the impact of the crisis on developing countries and help them restore strong growth while protecting the poor. Global Monitoring Report 2009, prepared jointly by the staff of the World Bank and the International Monetary Fund, provides a development perspective on the global economic crisis. It assesses the impact on developing countries, their growth, poverty reduction, and other MDGs. And it sets out priorities for policy response, both by developing countries themselves and by the international community. This report also focuses on the ways in which the private sector can be better mobilized in support of development goals, especially in the aftermath of the crisis.

Universal health coverage (UHC) means that all people can access health services of good quality without experiencing financial hardship. Three health financing functions - revenue raising, pooling of funds and purchasing health services - are vital for UHC. This article focuses on pooling: the accumulation and management of prepaid financial resources. Pooling creates opportunities for redistribution of resources to support equitable access to needed services and greater financial protection even if additional revenues for UHC cannot be raised. However, in many countries pooling arrangements are very fragmented, which create barriers to redistribution. The purpose of this article is to provide an overview of pooling reform options to support countries who are exploring ways to enhance redistribution of funds. We outline four broad types of pooling reforms and discuss their potential and challenges in addressing fragmentation of health financing: (i) shifting to compulsory or automatic coverage for everybody; (ii) merging different pools to increase the number of pool members and the diversity of pool members' health needs and risks; (iii) cross-subsidization of pools that have members with lower revenues and higher health risks; and (iv) harmonization across pools, such as benefits, payment methods and rates. Countries can combine several reform elements. Whether the potential for redistribution is actually realized through a pooling reform also depends on the alignment of the pooling structure with revenue raising and purchasing arrangements. Finally, the scope for reform is constrained by institutional and political feasibility, and the political economy around pooling reforms needs to be anticipated and managed.

PurposeThe purpose of this paper is to provide evidence-based policy recommendations for improving the implementation of universal service funds (USF) with a view to closing the digital divide in Africa.Design/methodology/approachThe paper adopts a qualitative approach that draws examples from various African countries supported by 25 interviews from key stakeholders with hands-on experience and roles that shape telecommunications policy in Africa and other developing countries.FindingsThe study's findings point out that institutional voids which characterize several African countries inhibit the effectiveness of USF in African countries. The authors identify several institutional and organisational factors and explain how they negatively affect the performance of USF. The authors find that in order to overcome these obstacles, there is a need for a clear redefinition of Universal Access and Service (UAS) policies, restructuring the governance of USF, encouraging cross-sectoral collaborations, and bottom-up initiatives to bridge the digital divide in African countries.Originality/valueThe paper contributes to the underexplored USF literature by shedding light on the role of institutional factors in determining the success of USF. The paper thus complements and provides a different perspective on promoting digital inclusion in Africa from the viewpoint of institutional voids, bringing new insights into the existing literature on how to deal with an intractable area of UAS policy and the wider digital divide debate in developing countries.

Despite overwhelming burdens of disease, health care access in most developing countries is extremely low. As governments work toward achieving universal health coverage, evidence on appropriate interventions to expand access in rural populations is critical for informing policies. Using a combination of population and health system data, we evaluated the impact of two pilot fee exemption interventions in a rural area of Madagascar. We found that fewer than one-third of people in need of health care accessed treatment when point-of-service fees were in place. However, when fee exemptions were introduced for targeted medicines and services, the use of health care increased by 65 percent for all patients, 52 percent for children under age five, and over 25 percent for maternity consultations. These effects were sustained at an average direct cost of US$0.60 per patient. The pilot interventions can become a key element of universal health care in Madagascar with the support of external donors.

Enhancing the role of private sector partners in education can lead to significant improvements in education service delivery. However, the realization of such benefits depends in great part on the design of the partnership between the public and private sectors, on the overall regulatory framework of the country, and on the governmental capacity to oversee and enforce its contracts with the private sector. Under the right terms, private sector participation in education can increase efficiency, choice, and access to education services, particularly for students who tend to fail in traditional education settings. Private-for-profit schools across the world are already serving a vast range of usersâ€\"from elite families to children in poor communities. Through balanced public-private partnerships (PPPs) in education, governments can leverage the specialized skills offered by private organizations as well as overcome operating restrictions such as salary scales and work rules that limit public sector responses. 'The Role and Impact of Public-Private Partnerships in Education' presents a conceptualization of the issues related to PPPs in education, a detailed review of rigorous evaluations, and guidleines on how to create successful PPPs. The book shows how this approach can facilitate service delivery, lead to additional financing, expand equitable access, and improve learning outcomes. The book also discusses the best way to set up these arrangements in practice. This information will be of particular interest to policymakers, teachers, researchers, and development practitioners.

Background Kenya aims to achieve universal health coverage (UHC) by 2030 and has selected the National Health Insurance Fund (NHIF) as the ‘vehicle’ to drive the UHC agenda. While there is some progress in moving the country towards UHC, the availability and accessibility to NHIF-contracted facilities may be a barrier to equitable access to care. We estimated the spatial access to NHIF-contracted facilities in Kenya to provide information to advance the UHC agenda in Kenya. Methods We merged NHIF-contracted facility data to the geocoded inventory of health facilities in Kenya to assign facility geospatial locations. We combined this database with covariates data including road network, elevation, land use, and travel barriers. We estimated the proportion of the population living within 60- and 120-minute travel time to an NHIF-contracted facility at a 1-x1-kilometer spatial resolution nationally and at county levels using the WHO AccessMod tool. Results We included a total of 3,858 NHIF-contracted facilities. Nationally, 81.4% and 89.6% of the population lived within 60- and 120-minute travel time to an NHIF-contracted facility respectively. At the county level, the proportion of the population living within 1-hour of travel time to an NHIF-contracted facility ranged from as low as 28.1% in Wajir county to 100% in Nyamira and Kisii counties. Overall, only four counties (Kiambu, Kisii, Nairobi and Nyamira) had met the target of having 100% of their population living within 1-hour (60 min) travel time to an NHIF-contracted facility. On average, it takes 209, 210 and 216 min to travel to an NHIF-contracted facility, outpatient and inpatient facilities respectively. At the county level, travel time to an NHIF-contracted facility ranged from 10 min in Vihiga County to 333 min in Garissa. Conclusion Our study offers evidence of the spatial access estimates to NHIF-contracted facilities in Kenya that can inform contracting decisions by the social health insurer, especially focussing on marginalised counties where more facilities need to be contracted. Besides, this evidence will be crucial as the country gears towards accelerating progress towards achieving UHC using social health insurance as the strategy to drive the UHC agenda in Kenya.

Since the end of its internal conflict in 1998, Cambodia has experienced tremendous developments in the social, economic and health sectors, with the government embarking on substantial reforms in health financing. Health equity funds that have improved access to public health services for poor people have gradually been extended to the entire country. Using the World Health Organization’s methods for the analysis of healthcare expenditure and household survey data from the 2004, 2009 and 2014 Cambodian Socio-Economic Survey, we assessed trends in reported illness, utilization of healthcare services and associated financial burden on households. The impact of out-of-pocket expenditures for health on catastrophic health expenditures, poverty headcount and depth over the same 10-year period are presented, disaggregated by consumption quintile and place of residence (rural, urban and capital). At the aggregated national level, evolution of these indicators was very positive and correlates with a substantial increase in the capacity-to-pay of households, which reduced the average financial burden on households. However, over time inequalities grew between rural and urban areas. By 2014, the national incidence of catastrophic health expenditure was 4.9%, but four times more likely among rural households than their peers in the capital. For rural households with members seeking medical care, catastrophic health expenditure incidence was 12.3%. The impoverishment rate due to health spending among the lowest consumption quintile was 15.3%; the highest rate in this analysis. These findings suggest that economic and health sector developments have indeed benefited many Cambodian people. However, these gains mainly benefited urban residents; especially those in the capital city. We argue that more resources should be allocated to rural health services to address inequalities and healthcare-related financial hardship, which traps vulnerable people into poverty. Depuis la fin de son conflit interne en 1998, le Cambodge a connu d’énormes avancées dans les secteurs social, économique et sanitaire, et le gouvernement a engagé d’importantes réformes portant sur le financement de la santé. Tout en améliorant l’accès des pauvres aux services de santé publique, les fonds d’équité du secteur de la santé se sont progressivement étendus à l’ensemble du pays. Grâce aux méthodes de l’Organisation mondiale de la Santé pour l’analyse des dépenses de santé et aux données des enquêtes auprès des ménages basées sur les résultats des enquêtes socioéconomiques réalisées au Cambodge en 2004, 2009 et 2014, nous avons évalué les tendances en matière de déclaration des maladies, d’utilisation des services de santé et des charges financières connexes pour les ménages. L’impact des dépenses de santé directes sur les dépenses de santé catastrophiques, l’effectif des personnes démunies et la gravité du phénomène au cours de la même période de 10 ans sont présentés, ventilés par quintile de consommation et par lieu de résidence (rural, urbain et cité capitale). En agrégeant les résultats au niveau national, l’évolution de ces indicateurs s’avère très positive et traduit une augmentation substantielle de la capacité de paiement des ménages, avec pour conséquence, une réduction de la charge financière moyenne desdits ménages. Cependant, au fil du temps, le fossé des inégalités entre les zones rurales et les zones urbaines s’est élargi. En 2014, l’incidence nationale des dépenses de santé catastrophiques était de 4,9 %, mais ce taux était quatre fois plus élevé dans les ménages des zones rurales par rapport à ceux de la capitale. Pour les ménages ruraux en quête de soins médicaux, l’incidence des dépenses de santé catastrophiques était de 12,3 %. Le taux d’appauvrissement dû aux dépenses de santé dans le quintile de consommation le plus faible était de 15,3%; soit le taux le plus élevé observé dans le cadre de la présente analyse. Ces résultats donnent à penser que de nombreux Cambodgiens ont effectivement tiré profit de l’évolution des secteurs de l’économie et de la santé. Toutefois, ces gains ont surtout profité aux citadins, en particulier ceux de la capitale. Nous estimons qu’il faudrait allouer davantage de ressources aux services de santé des zones rurales pour remédier aux inégalités et aux difficultés financières liées aux soins de santé, qui enferment les personnes vulnérables dans le piège de la pauvreté. Desde el final del conflicto interno en 1998, Camboya ha tenido un enorme desarrollo en los sectores sociales, económicos y de salud, y el gobierno ha llevado a cabo reformas sustanciales en el financiamiento de la salud. Los fondos de equidad de la salud que han mejorado el acceso a los servicios de salud pública para la gente pobre han sido gradualmente extendidos al resto del país. Utilizamos la Encuesta Socio-Económica de Camboya de 2004, 2009 y 2014 para evaluar las tendencias en enfermedades reportadas, la utilización de servicios de salud y la carga financiara asociada de los hogares, usando los métodos de la Organización Mundial de la Salud para el análisis de los gastos de salud de las encuestas de hogares. El impacto de los gastos de bolsillo de la salud en los gastos catastróficos de salud, el conteo de pobreza y su profundidad durante el mismo periodo de diez años es presentado y desagregado por quintil de consumo y lugar de residencia (rural, urbano y capital). A nivel nacional agregado, la evolución de estos indicadores fue muy positiva y tiene correlación con incrementos sustanciales en la capacidad para pagar de los hogares, lo cual redujo la carga financiera promedio en los hogares. Sin embargo, a medida que pasó el tiempo, las inequidades crecieron entre las zonas rurales y urbanas. En el 2014, la incidencia nacional del gasto de salud catastrófico fue el 4.9%, pero cuatro veces más probable en los hogares rurales que en sus equivalentes en la capital. Para los hogares rurales con miembros que buscan el cuidado de la salud, la incidencia del gasto catastrófico de salud fue el 12.3%. La tasa de empobrecimiento causada por el gasto de salud entre el quintil más bajo de consumo fue del 15.3%; la tasa más alta en el análisis. Estos hallazgos sugieren que los desarrollos en los sectores económicos y de salud han beneficiado a mucha gente en Camboya. Sin embargo, estas mejoras benefician en su mayoría a los residentes urbanos; especialmente a aquellos en la ciudad capital. Argumentamos que más recursos deben ser distribuidos a los centros de salud rurales para abordar las inequidades y adversidades financieras relacionadas con la salud, las cuales atrapan a la gente vulnerable en la pobreza 自1998年结束内战后, 柬埔寨经历了社会、经济和卫生方面的 巨大发展, 政府启动了卫生筹资改革。卫生公平基金改善了贫 困人口的公共卫生服务可及性, 这项措施已逐渐扩展至全国。 我们采用世界卫生组织卫生支出分析方法, 使用2004、2009 和2014年柬埔寨社会经济调查的家庭调查数据, 评估自报疾 病、卫生服务利用和相关经济负担的趋势。本文报告在这10 年期间, 自付卫生费用对不同消费层次、不同居住地（农村、 城市、首都）灾难性卫生支出、贫困人口数和贫困程度的影 响。在全国水平, 上述指标呈现积极变化, 并与家庭支付能力 的显著增加相关, 降低了平均家庭经济负担。但是, 城乡差异 随时间逐渐扩大。至2014年, 全国灾难性支出发生率为4.9%, 但在农村家庭的发生率为首都家庭的4倍。在有成员需要就医 的农村家庭中, 灾难性卫生支出发生率为12.3%。消费水平最 低五分之一家庭的卫生支出制贫率为15.3%, 为本研究最高。 上述发现提示, 经济和卫生发展确实使许多柬埔寨家庭受益。 然而这种受益主要倾向于城市居民；尤其是首都居民。我们 建议将更多资源分配给农村卫生服务, 来解决这种不公平性和 医疗相关的经济困难, 避免弱势人群因此陷入贫困。