Global Health Watch 1 in one file
Global Health Watch 1 in one file Global Health Watch 1 in one file
The wider health context | D2 Box D2.2 The public sector can do it just as well Porto Alegre City in Brazil has developed one of the best water utilities in Latin America. Porto Alegre’s civil servants campaigned to bring the leftist Worker’s Party to power in the city in 1989 and set up what is now cited by the UN as a model for local governance – participatory budgeting processes that allowed the new administration to raise taxes and invest them wisely and rationally for the city’s overall prosperity. In ten years Porto Alegre improved water coverage to 99.5% of residents, and reduced infant mortality to 13.8 deaths per 1000 births compared to a national average of 65. households. This is highlighted by the growing use of self-disconnecting prepaid water meters in countries such as Brazil, the US, the Philippines, Namibia, Swaziland, Tanzania, Brazil, Nigeria and Curacao. Banned in the UK in 1999 because they were considered a health threat and an affront to the notion of citizenship, an international civil society campaign is under way against them (see Resources). The transition from old to new roles and from old to new rules in this rearrangement of relationships has not been altogether successful (Gutierrez et al. 2003). Granted, the private sector can fill the gap and provide a better service when governments are corrupt and inefficient. The non-profit independent sector has demonstrated its ability to improve access to water, particularly to the poor. But even well-intentioned private efforts cannot be sustained without a democratic, accountable state. There is no evidence of the intrinsic superiority of the private sector over the public (1997), and many examples of public sector effectiveness and efficiency (Box D2.2) and private sector collapses. Furthermore, profit-maximizing companies tend to abuse their natural monopolies, underinvest, overcharge consumers, cut off supplies to those who cannot pay, neglect the environment, and shift pollution costs to the public. ‘The rising level of private investment in water services has been accompanied by an alarming number of incidents involving corporate malfeasance and irresponsibility and rising charges that effectively exclude the poor’ (Friends of the Earth 2003). The capacity for effective regulation is often weak, in low and middle-income countries owing to an absolute lack of human and financial resources, while even strong regulation, as in the UK, can be costly and sometimes ineffective (Box D2.3). Countries that have seen privatization accompanied by cuts in public sector budgets are particularly susceptible to regulatory capture or failure. 214
Box D2.3 Regulating private water companies in the UK Water privatization in England and Wales is sometimes cited as a positive model that dramatically reduced financial burdens on taxpayers, mobilized billions in private capital, improved water quality standards, and increased efficiency in water and sanitation services. The supposed success is partly ascribed to an effective regulatory framework with three sets of regulators – economic, environmental and quality. Various rules and rights have emerged, including price-setting by the economic regulator and a system of penalties and fines for contractual breaches and environmental offences. Private companies cannot disconnect any user and prepaid meters are outlawed. Nevertheless there is evidence of regulatory and market failure despite this robust regulatory framework, active consumer groups and an open media. Water companies continue to breach environmental standards and underinvest in infrastructure. The system tolerates high levels of leakage because it is considered more cost-effective to increase desalination capacity than to conserve water. Although profit margins and profits have recently decreased, it remains questionable whether the public and the environment are better served by privatization (Lobina and Hall 2001, Hall 2004). Indeed, a major indictment of the thrust to privatize the water sector, especially in developing countries, has been the simultaneous insistence on downsizing governments and failing to invest in empowering civil society to hold government and the private sector accountable to social and environmental standards. In some countries, deregulation and privatization are actively supported by government officials and local elites who may benefit personally (Box D2.4). Many governments are also being coaxed to ‘decentralize’ – dismantle central government water services and create smaller local structures – while changing their role from direct provider to stakeholder, facilitator or enabler of services. With no accompanying capacity development of the decentralized structures, this weakens regulatory capacity. Case studies from Accra, Dar es Salaam and Kathmandu reveal the power imbalance between poorly paid local civil servants, with insufficient information and staff support, having to oversee and negotiate with highly paid, well-connected and well-informed lawyers from multinational companies (Gutierrez et al. 2003). Public sector failure is rarely improved by the introduction of for-profit companies. Communities can find their interests and views further marginal- Water 215
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Box D2.3 Regulat<strong>in</strong>g private water companies <strong>in</strong> the UK<br />
Water privatization <strong>in</strong> England and Wales is sometimes cited as a positive<br />
model that dramatically reduced f<strong>in</strong>ancial burdens on taxpayers, mobilized<br />
billions <strong>in</strong> private capital, improved water quality standards, and <strong>in</strong>creased<br />
efficiency <strong>in</strong> water and sanitation services.<br />
The supposed success is partly ascribed to an effective regulatory framework<br />
with three sets of regulators – economic, environmental and quality.<br />
Various rules and rights have emerged, <strong>in</strong>clud<strong>in</strong>g price-sett<strong>in</strong>g by the<br />
economic regulator and a system of penalties and f<strong>in</strong>es for contractual<br />
breaches and environmental offences. Private companies cannot disconnect<br />
any user and prepaid meters are outlawed.<br />
Nevertheless there is evidence of regulatory and market failure despite<br />
this robust regulatory framework, active consumer groups and an open<br />
media. Water companies cont<strong>in</strong>ue to breach environmental standards and<br />
under<strong>in</strong>vest <strong>in</strong> <strong>in</strong>frastructure. The system tolerates high levels of leakage because<br />
it is considered more cost-effective to <strong>in</strong>crease desal<strong>in</strong>ation capacity<br />
than to conserve water. Although profit marg<strong>in</strong>s and profits have recently<br />
decreased, it rema<strong>in</strong>s questionable whether the public and the environment<br />
are better served by privatization (Lob<strong>in</strong>a and Hall 2001, Hall 2004).<br />
Indeed, a major <strong>in</strong>dictment of the thrust to privatize the water sector, especially<br />
<strong>in</strong> develop<strong>in</strong>g countries, has been the simultaneous <strong>in</strong>sistence on downsiz<strong>in</strong>g<br />
governments and fail<strong>in</strong>g to <strong>in</strong>vest <strong>in</strong> empower<strong>in</strong>g civil society to hold government<br />
and the private sector accountable to social and environmental standards.<br />
In some countries, deregulation and privatization are actively supported by<br />
government officials and local elites who may benefit personally (Box D2.4).<br />
Many governments are also be<strong>in</strong>g coaxed to ‘decentralize’ – dismantle central<br />
government water services and create smaller local structures – while<br />
chang<strong>in</strong>g their role from direct provider to stakeholder, facilitator or enabler<br />
of services. With no accompany<strong>in</strong>g capacity development of the decentralized<br />
structures, this weakens regulatory capacity. Case studies from Accra, Dar es<br />
Salaam and Kathmandu reveal the power imbalance between poorly paid local<br />
civil servants, with <strong>in</strong>sufficient <strong>in</strong>formation and staff support, hav<strong>in</strong>g to oversee<br />
and negotiate with highly paid, well-connected and well-<strong>in</strong>formed lawyers from<br />
mult<strong>in</strong>ational companies (Gutierrez et al. 2003).<br />
Public sector failure is rarely improved by the <strong>in</strong>troduction of for-profit<br />
companies. Communities can f<strong>in</strong>d their <strong>in</strong>terests and views further marg<strong>in</strong>al-<br />
Water<br />
215