Title: world development report 2004
1 world development report 2004
Making Services Work for Poor People
Flagship Course on Governance
Anticorruption Washington DC, December 2, 2003
2Messages
- Services are failing poor people.
- But they can work. How?
- By empowering poor people to
- Monitor and discipline service providers
- Raise their voice in policymaking
- By strengthening incentives for service providers
to serve the poor
3Why focus on human development outcomes?
Millennium Development Goals global aggregates
Eradicate poverty and hunger
Universal primary education
Source www.developmentgoals.org
4Millennium Development Goals global aggregates
Promote gender equality
Reduce child mortality
Source www.developmentgoals.org
5Outcomes are worse for poor peopleInfant and
child deaths per 1000 live births
Source Analysis of Demographic and Health Survey
data
6Outcomes are worse for poor peoplePercent aged
15 to 19 completing each grade or higher
Source Analysis of Demographic and Health Survey
data
7Growth is not enough
Percent living on 1/day Percent living on 1/day Primary completion rate (percent) Primary completion rate (percent) Under-5 mortality rate Under-5 mortality rate
Target 2015 growth alone Target 2015 growth alone Target 2015 growth alone
East Asia 14 4 100 100 19 26
Europe and Central Asia 1 1 100 100 15 26
Latin America 8 8 100 95 17 30
Middle East and North Africa 1 1 100 96 25 41
South Asia 22 15 100 99 43 69
Africa 24 35 100 56 59 151
Sources World Bank 2003a, Devarajan 2002.
Notes Average annual growth rates of GDP per
capita assumed are EAP 5.4 ECA 3.6 LAC 1.8
MENA 1.4 SA 3.8 AFR 1.2. Elasticity assumed
between growth and poverty is 1.5 primary
completion is 0.62 under-5 mortality is 0.48.
8Increasing public spending is not enough
Percent deviation from rate predicted by GDP
per capita Source Spending and GDP from World
Development Indicators database. Under-5
mortality from Unicef 2002
9Increasing public spending is not enough
Percent deviation from rate predicted by GDP
per capita Source Spending and GDP from World
Development Indicators database. School
completion from Bruns, Mingat and Rakatomalala
2003
10Similar changes in public spending can be
associated with vastly different changes in
outcomes
Sources Spending data from World Development
Indicators database. School completion from
Bruns, Mingat and Rakatomalala 2003
11and vastly different changes in spending can be
associated with similar changes in outcomes.
Sources Spending data for 1990s from World
Development Indicators database. Child mortality
data from Unicef 2002. Other data from World
Bank staff
12How are services failing poor people?
- Public spending usually benefits the rich, not
the poor
13Expenditure incidence
Health
Education
Source Filmer 2003b
14How are services failing poor people?
- Public spending benefits the rich more than the
poor - Money fails to reach frontline service providers
- In Uganda, only 13 percent of non-wage recurrent
spending on primary education reached primary
schools
15How are services failing poor people?
- Public spending benefits the rich more than the
poor - Money fails to reach frontline service providers
- Service quality is low for poor people
16Examples of low service quality
- India Absenteeism rates for teachers in
government primary schools 50 percent - Bangladesh Absenteeism rates for doctors in
primary health care centers 74 percent - Zimbabwe nurses hit mothers during delivery
- Guinea 70 percent government drugs disappeared
- India Delhi Chennai get 4 to 6 hours of water
per day, Hyderabad gets 1.5 hours every other day
17But services can work
- Infant mortality and malnutrition reduced in
Ceará, Brazil - Citywide services in Johannesburg, South Africa
reformed - Municipal services improved in Bangalore, India
- Rural electricity cooperatives increased access
to power in Bangladesh - More money reached primary schools in Uganda
18What contributes to an effective classroom or
health clinic?
- For a service transaction to be successful, we
need a frontline provider who - is capable
- has access to adequate resources inputs
- is motivated to pursue goals that can be
monitored
19So, spend more money to hire and train more
teachers?
- But governments spend a lot on teachers salaries
- 16 out of 18 sub-Saharan African countries spent
more than the recommended 66 of recurrent
education spending on teacher salaries, some more
than 90 - Its obvious this crowds out other inputs, yet
governments keep spending on salary budgets - So problem is not these proximate determinants,
but with institutional context that generates and
sustains these decisions
20One way of looking at the problem of a motivated
provider
- Reducing teacher absenteeism from, say, 12 to 7
is a matter of money and technical solutions such
as training its a managerial problem - Reducing absenteeism 70 to 7 is not a matter of
money and technical solutions, its an
institutional problem
21What, then, is the right question to ask?
- What institutional conditions support the
emergence of good frontline providers and
services that work for poor people? - The answer Services work for poor people when
they involve institutional relationships in which
key players in service delivery are accountable
to each other
22Accountability seems key to service delivery
- If accountability is strong or can be
strengthened, services may be improved by
spending more on - building more schools and clinics
- training more teachers and health workers
- designing better curricula drug procurement
schemes - building bigger infrastructure networks
- But if accountability remains weak, addressing
the proximate determinants of success will not
work
23A framework of relationships of accountability
Poor people
Providers
24A framework of relationships of accountability
Policymakers
Poor people
Providers
25The relationship of accountabilityhas five
features
26A framework of relationships of accountability
Policymakers
Voice
Poor people
Providers
27Mexicos PRONASOL, 1989-94
- Large social assistance program (1.2 percent of
GDP) - Water, sanitation, electricity and education
construction to poor communities - Limited poverty impact
- Reduced poverty by 3 percent
- Even an untargeted, uniform per capita transfer
would have reduced poverty by 13 percent
28PRONASOL expenditures according to party in
municipal government
Source Estevez, Magaloni and Diaz-Cayeros 2002
29A framework of relationships of accountability
Policymakers
Compact
Providers
Poor people
30Policymaker-providerContracting NGOs in Cambodia
- Contracted out NGO managed could hire, fire,
transfer staff, set wages, procure drugs - Contracted in NGO managed and could transfer
but not hire and fire staff - Control group Services run by government
- 12 districts randomly assigned to each category
31Contracting for Outcomes health services in
Cambodia
Use of facilities by poor people ill in previous
month
Source Bhushan, Keller and Schwartz 2002
32A framework of relationships of accountability
Policymakers
Poor people
Providers
Client power
33Keeping girls in secondary school in Bangladesh
choice
- Girls to receive scholarship deposited to bank
account set up in their name if - Attend school regularly
- Maintain passing grade
- Stay unmarried
- Schools receive grants based on number of girls
enrolled
34EDUCO program in El Salvador participation
- Parents associations contract with Education
Ministry to deliver primary education - Associations have authority to
- visit schools on regular basis
- hire and fire teachers
35EDUCO promoted parental involvement
which boosts student performance
Source Adapted from Jimenez and Sawada 1999
36Accountability and decentralized service delivery
37Degrees of decentralization
38What not to do
- Leave it to the private sector
- Simply increase public spending
- Apply technocratic solutions
39What is to be done?
- Expand information
- Tailor service delivery arrangements to service
characteristics and country circumstances
40Eight sizes fit all?
41Eight sizes fit all?
42Eight sizes fit all?
43Eight sizes fit all?
44Eight sizes fit all?
45Eight sizes fit all?
46Eight sizes fit all?
47Politics matters for service delivery
- Lack of information among voters about politician
performance - Social, cultural, ideological polarization that
leads to identity-based voting - Lack of credibility of political promises
- Politics dominated by clientelism, political
patrons providing private goods to clients
48Some puzzles on politics
- Why do politicians who depend on political
support of poor people not deliver basic services
to them? - Why are voters not able to provide stronger
incentives for politicians service providers to
deliver better service outcomes? - What is the impact of political market failures
on basic service outcomes for poor people?
49Some how-to research questions on voice politics
- How can information mechanisms be
institutionalized that allow voters to provide
stronger incentives for better performance? - How to design high-impact sectoral interventions
that politicians might find easier to commit to
and take credit for? - How to unpack notions of political credibility to
understand its process of change?
50How donors provide aid matters
51Donors and service delivery
Policymakers
Project implementation units
Global funds
Poor people
Providers
Community driven development
52What donors can do to scale up
- Harmonize procedures
- Integrate aid in recipients budget system so
that accountability is not undercut - Finance impact evaluations of service innovations
(300 million/year -World Bank) - Create conditions for knowledge-driven
development, particularly in clientelist settings
53Implications for World Bank adjustment lending
- PRSCs in Benin, Ethiopia, Rwanda, Madagascar
focusing on service delivery - India Andhra Pradesh, Karnataka, Orissa rising
social sector expenditures but impact? - PRSCs supporting service delivery experiments
with evaluation Ethiopia, Nepal - Readiness for reform 8 sizes fit all?
- Staffing implications who leads PRSCs?
54Implications for policy dialogue
- Service delivery as entry point in difficult
political settings - Middle East and North Africa Governance Report
- Symptoms v. causes of corruption
- Ghost doctors in Bangladesh
55Latin America
- Use WDR framework to understand success and
failures - Cochabamba v. Cartagena
- Mainstream impact evaluation
- Cross-fertilizing experiences of evaluation and
scaling up - Evaluation now a major emphasis in country
strategies
56Plans in South Asia
- Background rapid growth in India Pakistan but
poor service delivery MDG implications - Fixing service delivery institutions learning
from success failure - Power sector tariffs
- Contracting out education in Madhya Pradesh
- Providing knowledge services in high-capacity
settings - WDR director will be new Chief Economist for the
South Asia region
57Services work for poor people when accountability
is strong
http//econ.worldbank.org/wdr/wdr2004