The challenge of accessible, affordable

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The challenge of accessible, affordable quality
public service delivery Part 1

• Hachemi Bahloul
• Local Development Specialist
• Bratislava Regional Centre
• Development at Local Level in Central Asia
• Workshop
• Ashgabat 8-10 October 2008

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The importance of public service delivery

• Improving public service delivery is one of the
  biggest challenges worldwide
• Public services are a key determinant of the
  quality of life that is not measured in per
  capita income
• Improving public services is a key element of
  poverty reduction strategies and a necessary
  condition for the achievement of the MDGs

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What are public services? (1)

• Public goods the community individuals cannot
  be excluded from accessing the service (markets
  unwilling to provide them)
• Goods which the market fails to provide at the
  required quantity, quality or cost (transport)
• Merit goods of collective utility to society
  equity, human rights, social cohesion (health,
  education)

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What are public services? (2)

• Goods whose efficient provision requires large
  scale production and leads to natural monopolies
  - must be subject to special regulation (water
  supply)
• Services most directly linked to MDGs primary
  education health, clean water, sanitation
  (liquid and solid) energy

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Who is responsible for delivering public
services?

• It is a public responsibility that public
  services are available delivered
• Standards quantity, accessibility, quality,
  cost, timeliness
• Public service delivery is a public sector
  management and a governance matter

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How are public services delivered?

• Central or local government
• Direct provision (central or local)
• Inter-municipal cooperation (local government
  only)
• Through public providers (national or local)
• Jointly with private sector (PPP)
• Contracted to the private sector
• Contracted to NGOs, CBOs and social enterprises

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Basic rules about service delivery modality

• Central or local delivery?
• The greater the heterogeneity of clients the
  greater the benefits of decentralized decisions
  (immigration, girls in Pakistan etc.)
• Publically or privately provided?
• The easier to monitor service outputs (the easier
  to write and enforce contracts) the more services
  should be sub-contracted

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Sectoral specificities

• Health
• Information (nutrition, hand-washing) and
  outreach services (immunization) can be
  contracted out
• Clinical services require public responsibility
  (doctor discretion)
• Education
• Need for central authority oversight (national
  curricula certification) greater local
  influence (teacher discretion)
• Public utilities (water, sanitation, energy)
• Privatization trend but private monopolies
  require strong regulation whether the service is
  public or private

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What are the problems with public service
delivery?

• Availability/accessibility (for the poor)
• Limited transport or number of facilities
  (hospitals)
• Limited coverage (water supply, sanitation)
• Affordability (for the poor)
• Poor often pay more than the better-off (water by
  the bucket, transport) gt associated with less
  use
• Quality (the poor particularly affected)
• Dysfunctional (vacancies, attendance, equipment,
  maintenance, corruption)
• Low technical quality (poor medical advice, poor
  education)
• Unresponsive to diverse clientele (gender,
  religion)

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What is their cause?

• Poor policies and regulations, limited capacity,
  poor human resources management, no incentives,
  corruption, clientelism, limited accountability,
  poor monitoring
• Public spending and outcomes no positive
  correlation gt effectiveness is the missing link
• But these are not causes, these are symptoms of
  SYSTEMIC failures

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The actors and their relationships (1)

• World Bank World Development Report 2004
• Citizens/clients exercise voice over politicians
• Pro-poor policies, hold politicians accountable
• Formal informal politics (NGOs, pressure
  groups)
• Policymakers have compacts with organizational
  providers
• They provide resources to providers, sets and
  enforces the general rules of the games
• Providers set the internal rules (they manage)

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The actors and their relationships (2)

• Organizational providers (ministry, municipality,
  school, NGO, private firm) manage front line
  professionals (doctors, teachers, engineers)
• Providers ensure that front line professionals
  perform
• Select, train and motivate staff
• Clients exercise client power over frontline
  providers
• Citizens hold providers accountable to them
• Interact with front line professionals

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The long and short route of accountability

• World Bank World Development Report 2004

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Accountability failures (1)

• Voice failures (citizens politicians)
• Apathy of the state due to weak/divided voice of
  citizens (limited resources, ineffectively
  applied, focused on elites, no information)
• gtAlternative strategies of public sector
  management will fail to lead to better services

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Accountability failures (2)

• Compact failures (policy makers - providers)
• Vague or non-existent specification of goals
• No clear responsibilities for outputs/outcomes
• Budgets allocation/staffing not directly linked
  to performance
• Impossible to create enforceability
• Discourages innovation and responsiveness

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Accountability failures (3)

• Management failures (providers front line
  professionals)
• Provider monitors only inputs and compliance with
  processes and procedures
• No stipulations for service quantity and quality
  (no result orientation)
• No staff incentives
• Symptoms of weak institutional arrangements
• Internal organizational reforms focusing on the
  management of front line workers will fail (more
  money, better training, computers etc.)

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Accountability failures (4)

• Client power failures (clients providers)
• Poor clients have no choice (subsidized public
  service delivery)
• Clients have no information on performance (was
  the medical treatment appropriate?)
• Clients have no means to influence performance
  (subsidized service delivery arrangements often
  neglect the role of clients, nobody cares)

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The need for systemic solutions

• The problems are obviously systemic
• Policies should go beyond simply strengthening
  the management capacity of providers (training of
  the providers, optimizing management structures
  etc.)
• What is need is institutional reform

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Trends in public sector management (1)

• Standards modalities of public service delivery
  shaped by New Public Management
• Steering not rowing government (Osborn 1992)
• Competition rather than monopolies
• Missions rather than rules
• Outcomes rather than inputs and outputs
• Focus on customers not on bureaucrats
• Earn money rather than just spend

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Trends in public sector management (2)

• Traditional top-down approach emphasises control
  and uniformity
• Horizontal governance gt governments alone may
  not have the capacity, knowledge or legitimacy to
  solve complex public policy problems in a diverse
  society
• The governments role to define strategic
  priorities, policies and regulate gt no
  obligation to provide services but to see that
  they are provided

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Trends in public sector management (3)

• Characterized Element Traditional (Old)
  PSM New PSM
• Organizational Structure Centralized
  Decentralized, autonomous
  specialized units
• Relations between units Undefined
  Separation of roles
• (policy, production, regulation)
• Mode of operation No organizational changes
  Evolving (like private sector)
• Mode of financing Steady or growing budget
  Reduction in resource use
• Management Style Based on political skills
  Strategic, participatory
• legal justification
  results based , accountable
• Outcome orientation No clear goals/standards
  Transparent goals/standards
• Control Only
  procedures and finances Also monitoring of
  outcomes

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New PSM public service delivery

• Move from central command and control which
  focuses on managing inputs and activities
• TO
• Decentralization and outsourcing of public
  services which is focused on managing outputs and
  outcomes

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Overview of public service delivery in Central
Asia (1)

• Central level policy, standards and allocation
  of resources
• Delegation of responsibilities to Kenesh/Jaomat,
  rayon and oblast levels
• Combination of direct provision and through local
  companies (depending on service)
• Generally limited involvement of private sector
• Double subordination to central and regional
  level
• Limited local level decision making power (key
  decisions and resources come from the centre)

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Overview of public service delivery in Central
Asia (2)

• General deterioration of quality of services
• Poor state of infrastructure
• Lack of resources (investment, maintenance)
• Limited capacity for policy formulation and
  regulation Non compliance with (Soviet) norms or
  standards
• Subsidized service delivery
• No information on service delivery performance

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Reform initiatives in Central Asia

• Kazakhstan
• Educational services are offered by private
  sector as well as central and local government
• Kyrgyzstan
• Ongoing efforts to establish private
  participation in electricity distribution through
  concession
• World Bank recommends the establishment of a PPP
  unit to define guidelines for the use of
  concessions
• Tajikistan
• Many public utility institutions have been
  privatized and some private institutions provide
  medical and health services
• Uzbekistan
• Efforts to commercialize utilities through full
  cost recovery but in reality recovery of
  operating costs

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• THANK YOU!

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• Question for discussion
• What are the causes of PSD issues in Central
  Asia? (40 minutes)