Education and Health Expenditure and Poverty Reduction in East Africa : Madagascar and Tanzania This book demonstrates that in the case of very poor countries policies aimed at universal provision of education and health services benefit the poor significantly more than more expensive targeted schemes. The book draws attention to the absolute need for coherence and co ordination so that schools are not built without teachers and dispensaries without drugs. Moreover national macroeconomic policies have to be realistic if the health and education sectors are not to be deprived of resources. Finally the quality of governance is shown to have a direct effect on the efficiency of social spending.