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Three arguments are normally presented as rationale for the privatisation of state owned enterprises. The first relates to the problem of the financing of higher levels of public expenditure / the second is based on the viewpoint that private ownership is more efficient than public ownership / whilst the third claims that the losses of inefficient public enterprise are responsible for excessive budget deficits and other fiscal problems.<br /> <br /> Although empirical evidence proves that privatisation enhances economic efficiency, it negatively affects the affordability of and access to essential services, which may have serous consequences for poorer households. This happens through increased prices of essential services, such as electricity and telecommunication, as well as through loss of employment opportunities during and after privatisation.<br /> <br /> Many countries, also in Africa, implemented various types of privatisation programmes over the past two decades in order to decrease the relative size of governments and to improve efficient delivery of services. Towards the end the 1990&rsquo / s and after the tragic genocide, Rwanda&rsquo / s Government of National Unity also embarked on an ambitious restructuring programme of its state-owned enterprises.<br /> The main purpose of this study was to assess the likely impact of privatisation on poor households in developing countries. The report presents a general overview of the literature, with a specific focus on Brazil, Argentina and South Africa. It investigates the experiences of these countries and derives lessons that can be learnt. Finally it assesses the possible impact of the privatisation of essential service delivery on poor households in Rwanda.<br /> <br /> The main conclusion of the study is that governments should look beyond efficiency benefits of restructuring and focus on the overall opportunity cost of the privatisation of essential service delivery. The specific method of privatisation may determine the final social impact. The case studies also highlight the need for more research into the challenges facing the privatisation of essential service delivery. It is clear that any restructuring should be preceded by a thorough analysis of the likely impact on the poorer sections of the community.

This thesis reports on a multi-disciplinary evaluation of primary level health units, undertaken in Tanzania The research objectives were to evaluate the provision of primary level health care in order to develop recommendations for its improvement and appropriate methods for such assessment at district level. The evaluation used the technique of cost analysis together with specific review of structural and process quality and of the community's satisfaction with the available care, in order to assess production efficiency. An initial group of 58 health units, including both dispensaries and health centres, and government and voluntary agency units, were evaluated in the cost and structural assessments. Process quality was assessed in a sub-sample of twenty units, and community satisfaction in relation to a further subsample of ten units. The range of unit types was maintained at each stage of the study. This study's analysis indicates that these units were inefficient, characterized by poor productivity, limited structural, and weak process, quality. They were also poorly perceived by the community. Health centres were relatively expensive but of poor quality. Voluntary agency units performed no better than government units, and sometimes worse. The study's conclusions point to the need for better management of available resources to bring about more efficient, better quality care. The inadequacy of currently available resources was found to underlie some performance failures but an equally important problem was the weakness of the organizational structure of the health system. The research findings indicate the potential for efficiency savings, as well as considering the additional resources that might be generated through the introduction of user fees at the primary level. However, this potential will only be tapped if structures that encourage flexible and effective management are developed. The methods of this research could be used to strengthen managerial practices, either being adapted for use in other research studies or for monitoring at the district level. Similar research is required to support the development of management structures and systems.

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