Samia Waheed Altaf. So Much Aid, So Little Development. (Shorter Notices-2011-2)

Download the PDF fileSamia Waheed Altaf. So Much Aid, So Little Development. Washington, D.C.: Woodrow Wilson Centre Press. 2011. 204 pages. US$17.99. “So Much Aid, so Little Development” is a novel like volume which discusses the important question of why most international development programmes in the health sector have achieved so little in Pakistan. The author, Saima Waheed Altaf, who is a public health specialist and a former senior advisor to the Office of Health in the USAID Mission in Islamabad, draws on her on ground experiences in order to explain how and why foreign support succeeds or fails in developing countries. She elaborates on the growing dependence of developing countries on international agencies and gives an insider’s look at the bureaucracies of both donors and receivers. This book is a collection of the author’s own experiences with the health programme and eye witness accounts from those that have suffered at the hands of the existing health policies and corruption in provincial health departments. Altaf has pinpointed several health projects that failed because of skewed incentives and misplaced priorities of those who were responsible for making them a success. She has also discussed several reasons behind the failure of the Social Action Programmes (SAP) in context to the health sector. The SAP could not induce any significant budgetary shifts from defense and non-social sector expenditures to the enhancement of social service delivery. Moreover, it faced lack of continuity in governmental policies, and was also affiliated with a climate of intense political instability where in Pakistan saw a change of eight governments over the course of a decade. The fact that the characters, events and the physical locations appearing in the book are all true to life makes this volume a highly informative and an interesting read for anyone who is interested in the political economy of the social sector projects in developing countries. (Hamid Maqsood)

William D. Savedoff and Pablo Gottret (eds.). Governing Mandatory Health Insurance: Learning from Experience. Washington, D.C.: The International Bank for Reconstruction and Development/The World Bank. 2008. 227 pages. US$ 30.00. Little attention has been paid to the governance of the much needed mandatory or expanded health insurance programmes in most developing countries. While most of the existing literature focuses on the operational features of health insurance systems such as eligibility and premiums, it overlooks the institutional and political forces that influence the performance of such programmes. This book highlights the role played by social, historical and political factors in determining the success of health insurance programmes. It is divided into 7 chapters out of which the first 5 chapters discuss five dimensions of governance—coherent decision making structures, stakeholder participation, transparency and information, supervision and regulation, and consistency and stability—all of which affect the coverage, efficiency and sustainability of health insurance programmes in the long run. Each aspect of governance has been illustrated by using experiences of four countries—Chile, Costa Rica, Estonia, and the Netherlands. Governing Mandatory Health Insurance provides guidance and offers various lessons for countries that are interested in reforming or establishing health insurance systems. (Sofia Ahmed)