Economics & Development

The research conducted in Dormaa Central and Hohoe districts in Ghana provided several key findings regarding the Networks of Practice (NoP) program. The study included Patient Pathway Analysis (PPA) and Summative Network Analysis (SNA) to understand and compare patient journeys and network configurations between districts with NoPs and those without. In Dormaa Central, four NoPs were established in November 2020 with USAID/R4D support, while in Hohoe, three NoPs were started in January 2021 with KOFIH support. The research revealed notable positive effects of NoPs in the delivery of health services, including facility-level improvements, service enhancements, and increased collaboration between health facilities. However, some key goals of NoPs, such as strong referral gatekeeping to reduce the patient load at higher-tier facilities, were not fully achieved. Patient preference for higher-tier facilities persisted due to perceived quality and the spectrum of services available at different levels of care. Despite this, districts with NoPs showed a shift towards increased utilization of health centers that were NoP hubs. The study also highlighted improved awareness of the hub and spoke model of care, willingness, and evidence of cross-facility collaboration and sharing of resources.

Impressive economic growth in the United Republic of Tanzania since 2000 propelled it into lower middle-income country (LMIC)1 status in 2020. The country’s gross domestic product (GDP) is composed of near-equal shares of agriculture, industry (including construction), and services. More recently, the services sector remained the main driving force behind Tanzania’s overall economic growth, expanding by 7.3 percent in 2023, supported by growing economic activities in the financial and insurance, tourism, transportation, and accommodation subsectors (World Bank 2024b). Agriculture has been growing at a relatively steady 3 to 4 percent since 2018, while growth in industry has been at a more modest 2.5–4.3 percent between 2020 and 2023, compared to 8.3 percent between 2015 and 2020 (World Bank 2024c). At its current growth rate, Tanzania’s population of 62 million people is expected to double in 23 years (NBS Tanzania 2020b; World Bank 2024b), with the urban population reaching 49 percent by 2040 (UN-DESA 2018). But Tanzania’s economy remains vulnerable to risks, including climate risks. This exposure stems from its reliance on agriculture, which provides nearly 24 percent of its GDP, 20 percent of exports, and 90–95 percent of its food security, and made up 65.5 percent of total employment (Minister of Agriculture 2023, World Bank 202c). Growth over the last decade has been propelled largely by public investment and domestic markets, rather than private investment and export growth. This is unviable in the long term, as evidenced by the drop in foreign direct investment (FDI) from 5.6 to 2.1 percent of GDP between 2010 and 2023. Gains in labor productivity have also been set backs, and exports fell from 20.9 percent of GDP in 2012 to 14.3 percent in 2021. Growth has been driven by sectors that employ relatively few low-income (or poor) workers. Between 2014 and 2021, wage employment as share total jobs remained stagnant, at around 14 percent. The share of people working in agriculture fell from 76 to 67 percent between 2006 and 2014, to 65.5 percent in 2022, while wage employment is at 14.4 percent in 2022 (World Bank 2023d). The largely informal n nature of labor and microenterprises limits their contribution to growth, especially for women-led enterprises

This collection of documents explores the challenges and opportunities facing local governments in the modern era. The focus is improving service delivery through digital platforms, including online appointment scheduling systems. The documents also examine the impact of decentralization on local governance and development and the role of local government in fostering economic growth. The importance of capacity building and meeting regional policy requirements is also highlighted.