From Poverty to Power Green, Oxfam 2008 - weman

FROM POVERTY TO POWERof sub-Saharan Africa. Faced with the inefficiencies, costs, and corruptionof private sector water provision, the British state stepped into create public water and sanitation systems. 46 In the nineteenthcentury in Germany the national health system unified multipleinsurance schemes under one equitable system. Compulsory publiceducation was extended across Europe, North America, and Japan inthe early part of the twentieth century, and these welfare states expandedfurther after the Second World War.The state does not have to be the end provider of every school,clinic, or water pipe. In practice, these are often delivered by NGOs,religious groups, and private companies. Community-based workers,both paid and voluntary, in areas such as health and veterinary serviceshave proved an effective way to rapidly improve coverage in Lesothoand South Africa. 47 But the state must ensure that civil societyproviders are part of a single coherent system. Governments sometimesachieve this by funding the running costs and regularly monitoringthem to maintain standards. Successful examples havecombined regulation and incorporation of other providers with a significantscaling up of state provision. 48In Armenia, NGOs stepped into the breach when the state healthsystem effectively collapsed after the fall of the communist governmentin 1991. Support to Communities (STC), a local NGO, set up asimple health financing scheme, asking people to contribute smallamounts to fund local clinics, a nurse, and a functioning water system.The intention was to create a model that the state could eventuallytake up and replicate. STC rapidly won the trust of communities andspread the scheme across dozens of villages in remote areas beforemoving on to lobby the Armenian government to expand it across thecountry.In contrast, when China phased out free public health care infavour of profit-making hospitals and health insurance schemes,household health costs rose forty-fold, and progress on tackling infantmortality slowed. Services that were once free are now paid forthrough health insurance, which covers only one in five people inrural China. 49The good news is that advances both in technology and in ourunderstanding of how to provide services mean that success is now48