Skip to main content
    • Aa
    • Aa

Non-state actors and universal services in Tanzania and Lesotho: state-building by Alliance*

  • Michelle D'arcy (a1)

In recent years over half of all African states have re-introduced some form of universal basic service provision, though many more have done so in education when compared with health. Most existing explanations of these developments have emphasised the importance of demand side factors associated with democratisation. This paper argues that while democratisation has been important in generating pressure for reform, alliances with actors outside the state – such as donors and non-state service providers – have been the critical enabling factor allowing weak states to overcome their capacity constraints and respond. Two illustrative case studies are used to show how variation in alliance opportunities has led to differences in outcomes both between social sectors and across countries. An inter-sector comparison of health and education policy in Tanzania shows how a difference in donor policy preferences between sectors – donors having converged behind the principle of universal primary education but not universal healthcare – has led to variation in alliance opportunities and hence policy outcomes. A ‘least likely’ case of healthcare reform in Lesotho shows how an alliance with a non-state provider has made difficult reforms possible.

Corresponding author
Hide All

I would like to thank Niamh Hardiman, Bo Rothstein, Paul Walsh and Vincent Durac, as well as the anonymous reviewers and editors of The Journal of Modern African Studies, for their comments and feedback on earlier drafts of this paper.

Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

P. Amico , C. Aran & C. Avila . 2010. ‘HIV spending as a share of total health expenditure: an analysis of regional variation in a multi-country study’. PLoS One 5, 9 e12997. doi:10.1371/journal.pone.0012997

F. Bourguignon , J. de Melo & A. Suwa . 1991. ‘Distributional effects of adjustment policies: simulations for archetype economies in Africa and Latin America’, World Bank Economic Review 5, 2: 339–66.

J. S. Benson 2001. ‘The impact of privatization on access in Tanzania’, Social Science and Medicine 52, 12: 1903–15.

C. Clapham 1996. Africa and the International System: The politics of state survival. Cambridge: Cambridge University Press.

S. Lall 1995. ‘Structural adjustment and African industry’, World Development 23, 12: 2019–31.

S. I. Lindberg & M. K. C. Morrison . 2008. ‘Are African voters really ethnic or clientelistic? Survey evidence from Ghana’, Political Science Quarterly 123, 1: 95122.

L. MacLean 2002. ‘Constructing a social safety net in Africa: an institutional analysis of colonial rule and state social policies in Ghana and Cote D'Ivoire’, Studies in Comparative International Development 37, 3: 6490.

B. McPake , D. Asiimwe , F. Mwesigye , M. Ofumbi , L. Ortenblad , P. Streefland & A. Turinde (1999). ‘Informal economic activities of public health workers in Uganda: implications for quality and accessibility of care’, Social Science and Medicine 49, 7: 849–65.

C. Mesa-Lago 1997. ‘Social welfare reform in the context of economic-political liberalization in the Latin American cases’, World Development 25, 4: 497517.

P. Mosley and J. Weeks . 1993. ‘Has recovery begun? Africa's adjustment in the 1980s revisited’, World Development 21, 10: 1583–606.

J. Nabyonga , M. Desmet , H. Karamagi , P. Y. Kadama , F. G. Omaswa , & O. Walker . 2005. ‘Abolition of cost sharing is pro-poor: evidence from Uganda’, Health Policy Plan 20: 100–8.

M. Oketch & C. Rolleston . 2007. ‘Policies on free primary and secondary education in East Africa: retrospect and prospect’, Review of Research in Education 31: 131–58.

N. Rudra & S. Haggard . 2005. ‘Globalization, democracy, and effective welfare spending in the developing world’, Comparative Political Studies 38: 1015–49.

J. Shiffman , D. Berlan & T. Hafner . 2009. ‘Has aid for AIDS raised all health funding boats?Journal of Acquired Immune Deficiency Syndromes 52: 45–8.

D. Stasavage 2005a. ‘Democracy and education spending in Africa’, American Journal of Political Science 49, 2: 343–58.

N. Van de Walle 2001. African Economies and the Politics of Permanent Crisis, 1979–1999. Cambridge: Cambridge University Press.

T. Wallace , L. Bornstein & J. Chapman . 2006. The Aid Chain: Coercion and Commitment in Development NGOs. Rugby: Intermediate Technology Publications.

R. Yates 2009. ‘Universal health care and the removal of user fees’, Lancet, 373: 2078–81.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Modern African Studies
  • ISSN: 0022-278X
  • EISSN: 1469-7777
  • URL: /core/journals/journal-of-modern-african-studies
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 5
Total number of PDF views: 59 *
Loading metrics...

Abstract views

Total abstract views: 139 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd August 2017. This data will be updated every 24 hours.