Making Services Work for Poor People

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Making Services Work for Poor People

• Shanta Devarajan
• World Bank

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Services are failing poor peopleMDGsGlobal
Aggregates
Eradicate Poverty Hunger
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Services are failing poor peopleMDGsGlobal
Aggregates
Promote Gender Equality
Reduce Child Mortality
Ratio of girls to boys in primary and secondary
school ()
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Growth is not enough
 
 Source Global Economic Prospects 2001, p.42
base case Devarajan (2002)
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Why are services failing?

• Governments spend on the wrong goods and people

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Benefit Incidence of Public Spending
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Why are services failing?

• Governments spend on the wrong goods and people
• Resources fail to reach the service provider
  (Uganda tracking study)
• Weak incentives for effective service delivery

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Examples of ineffective service delivery

• India Teachers arriving drunk regularly, high
  levels of absenteeism.
• Zimbabwe 13 of respondents gave as a reason for
  not delivering babies in public facilities that
  nurses hit mothers during delivery.
• Guinea In 1984, 70 of government drugs
  disappeared.
• Costa Rica absenteeism rate is 30 in public
  health facilities.

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Why are services failing?

• Governments spend on the wrong goods and people
• Resources fail to reach the service provider
  (Uganda tracking study)
• Weak incentives for effective service delivery
• Demand-side constraints

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Making services work for poor people
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Relationships
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Policymaker-ProviderContracting NGOs in Cambodia

• Contracting out (CO) NGO can hire and fire,
  transfer staff, set wages, procure drugs, etc.
• Contracting in (CI) NGO manages district,
  cannot hire and fire (but can transfer staff),
  0.25 per capita budget supplement
• Control/Comparison (CC) Services run by
  government
• 12 districts randomly assigned to CC, CI or CO

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Utilization of Facilities by Poor People Sick in
last month,
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Relationships
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Client-ProviderEDUCO Program in El Salvador

• Parents associations
• Hire and fire teachers
• Visit schools on regular basis
• Contract with Ministry of Education to deliver
  primary education

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Effect of 1 more class visit by ACE on math and
language score
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EDUCO Effect School days missed due to teacher
absence
Avg of days missed 1.34
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Relationships
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FSSAP Bangladesh

• Criteria
• Attendance in school
• Passing grade
• Unmarried
• Girls to receive scholarship deposited to account
  set up in her name
• School to receive support based on of girls

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Relationships