Allocating a Sub-district Budget: Water, Clinic, or Road
A sub-district council has 2,000,000 Nakfa to spend this year. It has three proposals.
- Borehole with hand pump, Village A: 1,200,000 Nakfa; serves about 3,000 people who now walk up to 3 hours a day to a river.
- Health post, Village B: 1,300,000 Nakfa; village population about 1,800; nearest clinic 18 km away; last month 14 diarrhoea cases and 3 maternal referrals.
- Feeder road repair: 700,000 Nakfa; links five villages (about 9,000 people) to the market town; the road closes about 40 days a year in the rains, when bus fares double.
The council raises about 300,000 Nakfa a year in local taxes. It may fund at most two proposals this year.
1. Recommend which proposal or proposals to fund, using cost per person reached and any other relevant evidence.
Read the worked answer
Cost per person reached
- Borehole: 1,200,000 ÷ 3,000 = 400 Nakfa per person
- Health post: 1,300,000 ÷ 1,800 ≈ 722 Nakfa per person
- Road: 700,000 ÷ 9,000 ≈ 78 Nakfa per person (but the benefit is indirect - market access, not a direct service)
Affordable pairs
- Borehole + road = 1,900,000 (fits, leaves 100,000)
- Health post + road = 2,000,000 (fits exactly, no reserve)
- Borehole + health post = 2,500,000 (does not fit)
Recommendation: borehole + road repair.
- The borehole reaches 3,000 people at the lowest direct cost per person of the two services and removes a 3-hour daily walk, which mainly falls on women and girls.
- It also attacks the health problem indirectly: the 14 diarrhoea cases in a nearby village are likely linked to unsafe river water, while a health post treats illness rather than preventing it.
- The road serves the largest population and protects market income during 40 days of closure.
- Leaving 100,000 Nakfa as a reserve matters because the health post's running costs (staff, drugs) are not included in its 1,300,000 Nakfa price tag - funding it without a recurrent budget would be a mistake.
2. Explain one trade-off in your recommendation and one piece of evidence that would make you change it.
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Trade-off: Village B goes without a health post for another year. A woman in obstructed labour still travels 18 km, and the three maternal referrals last month show that this risk is real. The council is buying prevention and economic access for many people at the cost of faster emergency care for 1,800.
Evidence that would change the decision
- If clinic records showed a maternal death or a sharp rise in referrals in Village B, the health post becomes urgent, and the combination would switch to health post + road (2,000,000 Nakfa), dropping the borehole.
- If a water test showed the river water is heavily contaminated, or if school attendance by girls rose sharply where boreholes exist, the borehole's case strengthens.
- If the road repair cost rose above 800,000 Nakfa, the borehole + road pair would no longer fit and the choice would have to be reconsidered.
The decision rests on data that can change, not on a fixed rule.
3. Village A's residents ask why their water project was chosen over the clinic in Village B. Explain how the council should justify the choice and what principle is at stake.
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How to justify it
- Publish the cost per person reached (400 vs 722 Nakfa) and the populations served, so the reasoning is visible rather than personal.
- Point out that the borehole also reduces the diarrhoea that the clinic would treat, so health gains are not ignored.
- Show the arithmetic that made the pairing impossible: borehole + health post costs 2,500,000, which is 500,000 beyond the budget.
- Commit to a date and a funding plan for Village B - for example, the 100,000 Nakfa reserve plus next year's 300,000 Nakfa in local taxes plus a request to the regional health office.
Principle at stake: equity versus maximizing benefit. Spending on the projects that reach the most people per Nakfa is defensible, but it can leave a smaller village waiting indefinitely. A fair process requires that the losing village gets a clear reason, a timeline, and a chance to appeal - not just a vote. Transparency is what separates a hard choice from an unfair one.