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1. Why is a delivery of public health care service important?

2. Which factors make the decentralised delivery of public health care service difficult?

3. Which are the consequences of the factors making decentralised public health care service difficult?

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1. How does real competitive elections push the political actors to improve the quality of rural infrastructure?

2. Is voting as the most basic form of participation enough?

3. Which additional forms of participation should also be considered in the improvement of rural infrastructure?

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1. Which approaches do exist to decentralize control over natural resources/local wildlife management? Are they promising?

2. Which stakeholders and interests play a major/minor role in efforts to decentralize control over natural resources/local wildlife management

3. Which factors drive/impede efforts to adopt reforms to decentralize control over natural resources/local wildlife management?

4. Which recommendations can be given to support decentralization in this field?

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-People get sick and need professional support for their recovery.
- Expenditure on health care for citizens is a burden on the state, BUT good acute care and rehabilitation = great economic benefit because people's ability to work and productivity is maintained and they can therefore support themselves
- People no longer have to travel far to receive medical care.

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1. community-based natural resource management(CBNRM)

-shift competences to local/ community level
-CBNRM is likely to be most effective where the value of resources is high and local rights to those resources are secure.
- By contrast, CBNRM is most likely to be politically possible in circumstances where resource values are either low or have a number of other effective claimants in addition to central institutions and authorities

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2.local communities, government, NGO's & Donors

-international donors seeing CBNRM as a technical problem, invest predominatly in central state institutions

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3. -economical value of wild life
-how corrupt/transparent are the state instiutions/ departments beeing involved?
-degree of central control of state institutions

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- however, the transfer of responsibility does not always run smoothly or via corruption and nepotism (however, local officials and their family members are usually treated free of charge and with greater consideration; ordinary citizens, however, are not; officials and health workers are known to each other/related to each other)
- main problem: serious delays in payment of health workers' salaries; caused by e.g.: insufficient revenue due to inefficient tax collection and general poverty of taxpayers
- important factor for service improvement: availability of sufficient funds to pay health workers adequately and on time + a properly functioning supervisory authority;
- infrastructral limitations
- lack of trained personnel

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- Decline in public services leads to people starting to look after themselves
- Most of the health staff have stopped working because they were no longer motivated as they were not paid
- Staff also lack the means to travel from one part of the village to the next
- Lack of medicines: Staff say inadequate supply; however, medicines are taken from public facilities and used in "private practices"
- Citizens react to poor care in three ways:
Switching to private health care
Self-medication
Accepting poor care
- Complaint to councillors:
is seen as a "waste of time" --> corruption and nepotism
could be dangerous (threats could follow) --> people are not able to hold authorities accountable

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Lessons learned:
1. adequate payment of health workers + provision of resources for technical supervision.
2. balance local and extra-local supervision mechanisms.
3. implement and publicise efforts to improve the quality of health services Basis for public interest in having a say in decision-making.

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4.
-improve transparency
-donors shift thier preferences towards local communities
-implement best practice projects