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Since the private health sector is an important, and often dominant, provider of health services in Sub-Saharan Africa, it is the job of governments as the stewards of the health system to engage with it. Increasing the contributions that the existing private health sector is making to public health is an important, but often neglected, element of meeting the daunting health-related challenges facing African nations. This Report presents newly collected data on how and how effectively each country in the Africa region is engaging the respective private health sectors; and how the engagement compares across the region. While the approach taken by governments varies greatly between countries, there is much room for improvement in the Africa region overall to engage more effectively and room for exchange of ideas and good practices on how to do so. Improved solutions on the policy/regulatory side should be supported by effective organization of the private sector itself and by adjustments in donor programs that take the dynamics of the private health sector better into account.
This book delves into the critical issue of ensuring the long-term financial viability of local governments in the diverse region of Southern Africa. Across Southern Africa, cities and communities are facing a multitude of challenges, from rapid urbanization and infrastructure challenges to social inequality and environmental degradation. In this thought-provoking book, the authors explore the intricate relationship between financial sustainability and the pursuit of sustainable cities and communities through different lenses. Drawing on extensive research and case studies from various countries in the region, this book provides a comprehensive analysis of the financial realities faced by local governments. It examines the factors influencing revenue generation, expenditure management, and fiscal governance, shedding light on the complexities of financial decision-making in the context of limited resources and pressing development needs. Furthermore, it offers practical insights and actionable recommendations for policymakers, practitioners, and academics. It explores innovative approaches to revenue diversification, efficient expenditure allocation, and effective fiscal management, with the ultimate aim of fostering sustainable development, social services delivery, and environmentally sustainable infrastructure in Southern African cities and communities. This is an essential resource for anyone interested in understanding the challenges and opportunities associated with financial sustainability in the context of urbanisation and sustainable development in greater Africa. It serves as a guide and inspiration for building financially resilient local governments that can support the aspirations and well-being of their citizens while contributing to the broader vision of sustainable cities and communities.
This volume addresses the issues of financing urban growth of the African continent -- which has the highest urban growth rate on the planet -- in the next decades. Considerable investment will be needed to sustain this level of growth and to clear up accumulated backlogs. At the same time, decentralization has resulted in increased responsibilities for local government; but in most cases, institutional reforms were carried out without the transfer of a sufficient level of resources, and local capacities in governance and project management are weak. Which mechanisms will finance these extensive needs, and how will African local governments meet these needs? Specifics on how to finance African cities have not been studied. The actual scale of this market has not been fully grasped. A systemic approach to this market is difficult because of its diversity (country size; institutional context; characteristics of urban network; availability of capital market, currency, etc.) and a lack of data. Donors’ assistance methods in the sector are disparate, marked by disputes between different schools of thought; special-purpose vehicles created by donors operate according to a variety of methods and with wide-ranging and sparsely disseminated results. What is the best way to transform these systems, often antiquated in many respects, into modern financing systems that facilitate access to domestic markets, mobilize local savings and reinforce local government autonomy? There is no single answer to this question in regard to such a variety of institutional and economic contexts. The main objective of the study is to clarify the debates and to enlighten the choices of African decision-makers at local and national level.
This book highlights the need to boost infrastructure investment in cities as also the necessity for fiscal management across all levels of government-within the context of decentralizing service delivery responsibilities. The volume provides case studies reflecting various viewpoints and a range of success and failure stories from five countries. The topics covered include: - Impact of political and fiscal decentralization - Limitations on borrowing - Managing moral hazard - The role of the financial sector in striking a balance between controls and encouraging the local government to maintain fiscal discipline
Abstract: Since South Africa held its first democratic elections in 1994, it has given significant attention to building an effective system of decentralization including provincial and local government. While provincial governments are responsible mainly for the implementation of social services such as health and education, the provision of much of the urban infrastructure is the responsibility of local government. Although many challenges remain, the country has made significant progress over the past decade in addressing urban service backlogs in poor areas. At the same time, it has greatly improved macroeconomic fundamentals. The system of financing local government seeks to place accountability firmly at the local level, with most revenues in the larger urban centers raised locally through a combination of local taxes and fees for services, while poorer regions are predominantly grant funded. The objective has been to encourage the financing of capital infrastructure through local borrowing based on sustainable, transparent local finances rather than national repayment guarantees, which are outlawed. There is some indirect subsidization of loans through the state-owned Development Bank of Southern Africa. But the emphasis is on achieving redistribution through transparent, formula-based grants paid directly from national to local governments. While further bedding down of the system is needed, the approach is proving largely successful. The paper concludes by recommending that the existing division between provinces as providers of social services and local governments as the key locus of responsibility for services related to the built environment should be strengthened, particularly through the devolution of more urban transport related functions. A number of key risks are also highlighted, including issues related to the reform of local business taxes.
First Published in 2009. Routledge is an imprint of Taylor & Francis, an informa company.
Cities in Sub-Saharan Africa are experiencing rapid population growth. Yet their economic growth has not kept pace. Why? One factor might be low capital investment, due in part to Africa's relative poverty: Other regions have reached similar stages of urbanization at higher per capita GDP. This study, however, identifies a deeper reason: African cities are closed to the world. Compared with other developing cities, cities in Africa produce few goods and services for trade on regional and international markets To grow economically as they are growing in size, Africa's cities must open their doors to the world. They need to specialize in manufacturing, along with other regionally and globally tradable goods and services. And to attract global investment in tradables production, cities must develop scale economies, which are associated with successful urban economic development in other regions. Such scale economies can arise in Africa, and they will--if city and country leaders make concerted efforts to bring agglomeration effects to urban areas. Today, potential urban investors and entrepreneurs look at Africa and see crowded, disconnected, and costly cities. Such cities inspire low expectations for the scale of urban production and for returns on invested capital. How can these cities become economically dense--not merely crowded? How can they acquire efficient connections? And how can they draw firms and skilled workers with a more affordable, livable urban environment? From a policy standpoint, the answer must be to address the structural problems affecting African cities. Foremost among these problems are institutional and regulatory constraints that misallocate land and labor, fragment physical development, and limit productivity. As long as African cities lack functioning land markets and regulations and early, coordinated infrastructure investments, they will remain local cities: closed to regional and global markets, trapped into producing only locally traded goods and services, and limited in their economic growth.