8 C E N T E R F O R WO M E N ' S G LO B A L L E A D E R S H I P perspective of utilization of maximum available resources, it is important to examine the efficiency of expenditure. However, care must be taken when evaluating efficiency. Are all inputs adequately accounted for or are there important resources which are ignored (contributions of unpaid household work or other non-market contributions)? For example, in the health sector, efficiency is typically judged in terms of the financial cost per treatment. This can be reduced by shortening the time that patients spend in hospital. However, patients still need further non-medical care. Therefore, efficiency, narrowly defined, may appear to improve as the cost of providing treatment for each patient drops, but there are huge spill-over costs for unpaid caretakers in households who may be forced to take time off paid work to care for a family member. Therefore, increasing ‘efficiency’ by reducing spending on key inputs may not create true efficiencies, but imposes higher costs on unpaid, family care at home, with disproportionate impacts on women. Similarly, efficiency may appear to improve if governments reduce compensation to public sector workers. States often face pressures to reduce their public sector wage bill. However, in these cases, we must consider whether such actions compromise the social and economic rights of those workers. If so, then such tactics will be less efficient than they appear to be, since the full impact on social and economic rights must take into account the impact on public sector workers. It is also important to examine the effectiveness of spending in achieving positive impact on enjoyment of rights. The quality as well as the quantity of outputs matter. For example, spending on health care may be ineffective if much of it is on administrative costs. Services must be delivered in ways that respect the individual’s dignity, and this may require more time to interact with people and give them personal attention; and more training of public employees on how to treat people with respect, especially poor people, people from minority groups, and women. People must be able to claim their rights in ways that do not stigmatize them. This is especially important in the case of income transfers. Leveraging Private Contributions to Public Services and Infrastructure One form of leveraging private contributions to public services is through coresponsibility, in which communities are asked to provide unpaid services to support the realization of certain rights, e.g., through the construction of schools. This is not necessarily antithetical to human rights, but we must consider who in the community bears the burden of carrying out these new tasks, and whether such services are voluntarily provided. A second form of leveraging is through public-private partnerships (PPPs). With PPPs a government contracts with private companies to carry out infrastructure investment or service provision. In the case of infrastructure investments, the private company raises the money for the investment, not the government, and covers the cost by leasing the assets to the government. This may seem