Rwanda is the country with the highest enrolment in health insurance in Sub-Saharan Africa. Pivotal in setting Rwanda on the path to universal health coverage is the community-based health insurance (CBHI), which covers three-quarters of the population. Despite the importance of the Rwandan case, analyses of the history and politics behind the scheme are largely absent. This article fills this gap by identifying the political drivers behind its development. It engages in process-tracing of the critical policy choices regarding the CBHI: the design of the first pilot, the decision to make enrolment mandatory, the policies to ensure its adequate funding, and the strategy of day-to-day implementation. It argues that the commitment to expanding health coverage is part of the broader efforts of the ruling coalition to foster its legitimacy based on rapid socio-economic development in a context of a dominant political settlement. The paper also argues that CBHI was chosen as a solution to expand access to healthcare over other approaches because it was the policy option that was the most compatible with the ruling coalition core paradigmatic ideas of popular participation, individual and national self-reliance.

Guidelines for public institutions based on the experience of the Government of Catalonia

In most poor countries, basic services in rural areas are less accessible and of lower quality than those in urban settings. In this paper, we investigate the subnational geography of service delivery and its relationship with citizens’ perceptions of their government by analyzing the relationships between service access, satisfaction with services and government, and the distance to urban centers, using data from more than 21,000 survey respondents across 17 African countries. We confirm that access to services and service satisfaction suffer from a spatial gradient. However, distant citizens are less likely than their urban peers to translate service dissatisfaction into discontent with their government; distant citizens have more trust in government and more positive evaluations of both local and national officials. Our findings suggest that increasing responsiveness and accountability to citizens as a means of improving remote rural services may be less effective than promoters of democratic governance and citizen-centered accountability presume.

This paper looks into the role of non-state actors in enhancing participatory governance and local economic development under the African Local Government Action Forum, with a main theme of: Enhancing Participatory Governance in Local Development; and a sub-theme of Linking participatory governance to local economic development and poverty reduction.

This commentary reviews contemporary changes in aid modalities and their impact on processes of decentralization. The main change in aid delivery and disbursement considered is towards a greater emphasis on general budget support (GBS) and sector wide approaches (SWAPs). This includes considering the broad questions of firstly, the impact of emphasising GBS on local government and governance systems, and secondly, the extent to which processes of decentralization can fit in with this new approach.