Public social spending in Africa: do the poor benefit?

This paper, published by the World Bank Research Observer (WBRO), examines the effectiveness of public social spending on education and health care in Côte d’Ivoire, Ghana, Guinea, Kenya, Madagascar, South Africa, and Tanzania. It finds that these programmes tend to favour the better off more than the poor. Although spending on health and education is usually justified on equity and efficiency grounds, most health and education subsidies in the region are not particularly well targeted to the poorest, with the exception of subsidies to primary education.

The paper argues that in the long run, the strategy must be to encourage private providers; it claims this would allow public subsidies to be targeted more effectively at services used mostly by the poor. In the short and medium term, subsidies could be reallocated towards public services used by the poor. Many of the poor, and particularly poor women, do not use health services very much, but this could change if both quality and access were improved. The paper suggests that user fees could improve the effectiveness of health and education spending, but that the decision to impose such fees should be taken with care.