Discusses both normative accounts for regulation (Why should we regulate?) and alternative accounts that attempt to explain the existence of regulation (Why do we regulate?)

This chapter goes over the decision to purchase health insurance (or not). The way information is presented to individuals has a significant impact on their decision to purchase insurance to protect themselves from the financial consequences of health risks. Eliminating minor inconvenience costs or simplifying the insurance selection process can influence whether or not people purchase insurance. This chapter examines the roles of adverse selection and moral hazard in insurance-related behaviour, as well as the barriers to insurance uptake for individuals ranging from affordability to unobservable quality and information/choice overload. The chapter investigates the role of various nudges in increasing health insurance uptake.

Policies are the instrument that governments mobilize for carrying out their intentions to interfere in reality, transforming their vision for the development of the territories they encompass into reality, whether on a national, local or supralocal scale. Several definitions have been proposed for the concept, with the following being suitable for the purposes of this publication: “a process, which involves decisions on the part of governmental bodies and authorities, and actions, carried out by an actor or a group of actors, which consists of goals and the means to achieve them” (Heller & Castro, 2007).

A question frequently arises in the field of human rights as to why the rights do not become real, even when they are recognized in legal frameworks. More specifically, how to convert economic, social and cultural rights into concrete reality? Why do not the legal frameworks translate into equality, changing the circumstances of those living in vulnerable conditions? Or, more specifically, what are the conditions that favour or hinder the implementation of ESCR?

In most societies, many groups and individuals rely on places beyond the scope of the household to live and enjoy their rights, including their rights to water and sanitation. These groups include persons in penal institutions and detention centres, health care professionals and patients who spend long periods in hospitals and health centres, students in boarding schools and workers who are required to spend considerable lengths of time in open workplaces. They also include people who reside in those spheres because of homelessness, people living in poverty who may lack access to water and sanitation in or near their homes and people who work formally or informally in the public spaces of urban areas. More broadly, they include the general public who commute daily.

The debate around the international framework for HRtWS is permeated by challenges and endorsements from United Nations member states and civil society. Such a debate has implications both as to what precisely the content of the rights are and what the nature of countries’ obligations related to such rights is, as well as how these should be concretely realized in practical terms.

Inequalities based on gender exist basically in every country and in all aspects of social life, and are echoed in the vast divides between men and women in their ability to access, manage and benefit from water, sanitation and hygiene. A large and growing body of studies suggests that women and men often have differentiated access, use, experiences and knowledge of water, sanitation and hygiene. Cultural, social, economic and biological differences between women and men consistently lead to unequal opportunities for women in the enjoyment of the HRtWS, with devastating consequences for the enjoyment of other human rights and gender equality more generally.

The ability to appreciate and account for the magnitude and complexity of the interactions of efficiency and viability, on the one hand, and social concerns (including equity), on the other, continues to be a major regulatory challenges. One of the keys to effective targeting is to distinguish between lack of access and lack of affordability. For both challenges, regulators can rely on large menu of pricing, direct and cross-subsidies, technological or quality options or service obligations to reduce or eliminate the undesirable social biases. The optimal choice depends on the local preference, on the local fiscal capacity and on the implementation capacity of the regulators. And this requires a specific institutional diagnostic. Regulators should pay more attention to the costly default options often found in menus of service levels, and push for these to be reset so as to maximize the odds of helping those who need it most. To ensure that regulation delivers on the social goals to be addressed, regulators must make the most of the growing volume of data available and use it with more rigour to refine the social targeting efforts.

The environmental concern and its social side effects will be at the core of regulatory authorities’ agenda on top of short-term efficiency objectives in the foreseeable future. The steady growth of ‘big data’, of digitalization and of the new data-processing technologies will change the way firms and governments use and share information in the design, compliance and enforcement of regulation. The institutional environment of regulation will need to evolve to correct institutional mistakes of the past and to internalize the impact of the data revolution on the distribution of regulatory mandates across agencies and across sectors within countries and across countries. Non-traditional financial actors will press regulators to internalize more systematically financial markets’ concerns in the design of regulation in exchange for their willingness to help close the financing gap of many regulated industries. Keeping the right balance between the return-on-investment objectives of non-traditional financial actors, investment targets, users’ needs and taxpayers’ benefit is a challenge for the regulators of the future. Tools emerging from applied research in behavioural economics will offer new alternative regulatory tools to improve the effectiveness and targeting of regulation.

In this chapter we set out to consider what is needed to ensure that Africa’s infrastructure remains financially sustainable throughout its life cycle. Managing the operational phase is at least, if not more, crucial than ensuring a project is constructed in the first place, but evaluation, particularly in relation to affordability, is weak even at the global level. We identify that in Africa there are frequently weak systems of governance, fragile and risky political institutions and lack of financial management capacity. We empirically examine five Ghanaian projects in electricity generation, water desalination, and the use of private finance to deliver and operate university buildings, to demonstrate financial and accountability shortcomings. We identify four methods that could improve financial sustainability for African infrastructure projects: namely, the establishment of independent infrastructure agencies; training and salary support of competent government technical staff; a move to more transparent decision-making; and the introduction of project monitoring and contingency planning.