While there has been much discussion about the large infrastructure needs in Asia and the Pacific, less attention has been paid to public expenditure efficiency in infrastructure services delivery. New constructions are not the only solution, especially when governments have limited capital to invest. Globally, new infrastructure projects face delays and cost overruns, leading to an inefficient use of public resources. The root causes include the lack of transparency in project selection, the lack of project preparation, the silo approach by public entities in assessing feasibility studies, and the lack of public sector capacity to fully develop a bankable pipeline of projects. To tackle these issues, governments need a smarter investment approach and to do so, enhancing public service efficiency is very crucial. The paper suggests a “whole life cycle” (WLC) approach as the main strategic solution for the discussed issues and challenges. We expand the definition of WLC to include the entire life cycle of the infrastructure asset from need identification to its disposal. The stages comprise planning, preparation, procurement, design, construction, operation and maintenance, and disposal. This is because we believe any efficient or inefficient decision throughout such a wide life cycle influences the quality of public services. Hence, in this holistic approach, infrastructure life cycle consists of four phases: planning, preparation, procurement, and implementation. Governments could enhance public efficiency and thus improve access to finance throughout the WLC by several solutions. These are (i) preparing infrastructure master plan and pipelines and long-term budgeting during the planning phase; (ii) establishing framework and guidelines and improving governance during preparation phase; (iii) promoting standardization, transparency, open government, and contractual consistency during the procurement phase; and finally (iv) continued role of government and total asset management during the implementation phase. In addition to these phase-specific means, key WLC solutions include proper use of technology, capacity building, and private participation in general and public-private partnership (PPP) in particular.

To analyze the effect of an increase in the quantity or quality of public investment on growth, this paper extends the World Bank’s Long-Term Growth Model (LTGM), by separating the total capital stock into public and private portions, with the former adjusted for its quality. The paper presents the LTGM public capital extension and accompanying freely downloadable Excel-based tool. It also constructs a new infrastructure efficiency index, by combining quality indicators for power, roads, and water as a cardinal measure of the quality of public capital in each country. In the model, public investment generates a larger boost to growth if existing stocks of public capital are low, or if public capital is particularly important in the production function. Through the lens of the model and utilizing newly-collated cross-country data, the paper presents three stylized facts and some related policy implications. First, the measured public capital stock is roughly constant as a share of gross domestic product (GDP) across income groups, which implies that the returns to new public investment, and its effect on growth, are roughly constant across development levels. Second, developing countries are relatively short of private capital, which means that private investment provides the largest boost to growth in low-income countries. Third, low-income countries have the lowest quality of public capital and the lowest efficient public capital stock as a share of GDP. Although this does not affect the returns to public investment, it means that improving the efficiency of public investment has a sizable effect on growth in low-income countries. Quantitatively, a permanent 1 ppt GDP increase in public investment boosts growth by around 0.1–0.2 ppts over the following few years (depending on the parameters), with the effect declining over time.

Financial shocks have an incredible socioeconomic effect on both developed and developing countries. Various recent studies demonstrated that bad public governance impacted public health across all nations. In fact, this study aims to use panel data for 21 countries from the Middle East and North Africa (MENA) region over the period 2000–2020 to scrutinize the effect of both governance and financial crises on public health. We use the generalized method of moments (GMM) approach to carry out the empirical analysis. The objective of using this method is to deal with the issue of endogeneity between exogen variables. Results outline that there is a significant positive association between public governance indicators and public health. Moreover, we found a strong negative association between financial shocks and public health. Thus, the direct negative impact of financial crisis on public health could be mitigated by the indirect positive impacts via institutions and good public governance. This study gives insights to policymakers to take appropriate measures to decrease the severity of the financial shocks and improve healthcare services.

Introduction, purpose of the study: In Central Europe, in Hungary, the state guarantees access to health care and basic health services partly through the Semmelweis Plan adopted in 2011. The Health Plan aims to optimize and transform the health system. The objectives of hospital integration, as set out in the Plan, started with the state ownership of municipal hospitals in 2012, continued with the launch of integration processes in 2012–2013 and culminated today. The transformation of a health system can have an impact on health services and thus on meeting the needs of the population. We aim to study the effectiveness of integration through access to CT diagnostic testing. Our hypothesis is that integration has resulted in increased access to modern diagnostic services. The specialty under study is computed tomography (CT) diagnostic care. Our research shows that the number of people receiving CT diagnostic care has increased significantly because of integration, which has also brought a number of positive benefits, such as reduced health inequalities, reduced travel time, costs and waiting lists. Test material and method: Our quantitative retrospective research was carried out in the hospital of Kalocsa through document analysis. The research material was comparing two time periods in the Kalocsa site of Bács-Kiskun County, Southern Hungary. The number of patients attending CT examinations by area of duty of care according to postal codes was collected: Pre-integration period 2014.01.01–2017.11.30. (Kalocsa did not have CT equipment, so patients who appeared in Kecskemét Hospital but were under the care of Kalocsa), post-integration period 2017.12.01–2019.12.31. (period after the installation of CT in Kalocsa). The target group of the study consisted of women and men together, aged 0–99 years, who appeared for a CT diagnostic examination. The study sample size was 6721 persons. Linear regression statistics were used to evaluate the results. Based on empirical experience, a SWOT analysis was carried out to further investigate the effectiveness of integration. Results: As a result of the integration, the CT scan machine purchased in the Kalocsa District Hospital has enabled an average of 129.7 patients per month to receive CT scans on site without travelling. The model used is significant, explaining 86% of the change in the number of patients served (F = 43.535; p < 0.001, adjusted R² = 0.860). The variable of integration in the model is significant, with an average increase in the number of patients served of 129.7 per month (t = 22.686; p < 0.001) following the introduction of CT due to integration. None of the month variables representing seasonal effects were found to be significant, with no seasonal effect on care. The SWOT analysis has clearly identified the strengths, weaknesses, opportunities and threats related to the integration, the main outcome of which is the acquisition of a CT diagnostic tool. Conclusions: Although we only looked at one segment of the evidence for the effectiveness of hospital integration, integration in the study area has had a positive impact on CT availability, reducing disparities in care.

The study builds on Deborah Stone’s foundational work exploring the mechanics of causal narratives and their implications for framing problems, assigning responsibility, and guiding policy solutions. The purpose of this research is to unravel the complexities of causal narratives in contemporary politics and understand their profound influence on public policy and society at large. In the digital age, where information is abundant and the traditional gatekeeping role of media has diminished, causal narratives have become increasingly multifaceted. The study aims to explore how these narratives, influenced by the intersections of natural phenomena, human actions, politics, risk, and media, shape public understanding and policy directions. The study employs an extensive review of existing literature, covering works from political science, media studies, and public policy. This includes analyzing seminal texts like Deborah Stone’s “Policy Paradox” and recent studies on media’s evolving role in political discourse. Today’s causal narratives are multifaceted, influenced by a myriad of factors including political agendas, scientific findings, and media portrayals. In conclusion, the research highlights the dynamic nature of causal narratives in the digital age and their significant impact on public policy and societal outcomes. It underscores the need for nuanced understanding and strategic approaches in crafting and interpreting these narratives.