Increasing access to rural maternal health services in Zambia through demand-side interventions

This paper examines a demand-side intervention that significantly increased access to maternal health services in rural Zambia in a context where skilled birth attendance rates had been stagnant for over two decades. Aspects of the intervention design that were crucial to the programme's success were the participatory and adult learning-centred approach used to mobilise intervention communities, the use of a community volunteer model, and the design's sensitivity and responsiveness to underlying social factors and problems. The demand-side intervention is already being scaled up in six districts, and is highly suitable for national level scale-up.     

‘New’ approaches confront ‘old’ challenges in African public sector reform

The disappointing performance of conventional public sector reforms in developing countries has led to the rise of ‘new’ approaches seeking to overcome traditional bureaucratic barriers to change: leadership-focused interventions like the Africa Governance Initiative (AGI); accountability-focused initiatives like the Open Government Partnership (OGP); and adaptation-focused models like those of Africa Power and Politics (APP). While these approaches are appealing to aid donors in their promise to move beyond the limitations of purely formal institution building, they fail to provide new answers to the ‘old’ analytical and practical challenges of public sector reform, in particular administrative patrimonialism, public corruption and political capture. The evidence is yet inchoate, but all points to the need for these approaches to work together with conventional ones. Beyond novel implementation tactics, however, there is a need for new strategies of sustained political support for embattled reformers who face powerful incentives against institutional change.