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.

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.

One powerful political idea is the following: if you give people a voice then they will be able to hold leaders to account and put pressure on them to take decisions that will improve public services and reduce poverty. This research starts with this idea. We want to know how (and whether) an index based on local research data and shared amongst citizens could put pressure on local politicians and civil servants to perform better in Tanzania.

This volume presents important original research on ICT and local goverance in Africa that must not be ignored by public policymakers – at municipal, regional, national and continental levels – in the respective countries in Africa. It is strongly recommended that this work be used and debated.

Decentralization - an essential pillar of institutional reform - is of critical importance in developing countries, particularly in regard to democratization, effective development, and good governance. Uganda, since 1986 and the start of decentralization measures under Yoweri Museveni and the National Resistance Movement, has represented one of the most serious commitments in Sub-Saharan Africa. With the benefit of extensive fieldwork, Fumihiko Saito demonstrates how conflict resolution, information dissemination, and encouragement of the many and varied stakeholders to form partnerships are critical to successfully bringing services "closer to the people. Decentralization and Development Partnerships: Lessons from Uganda goes beyond theory to compare academic assumptions to the reality of decentralization implementation in modern Uganda. Although the process is by no means free of difficulties, Saito concludes that a "win-win" outcome is a real possibility.