Making services work for poor people: What

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Making services work for poor people Whats
decentralization got to do with it?

• World Development Report 2004
• Shanta Devarajan and Shekhar Shah
• Decentralization Intergovernmental Fiscal
  Reform course
• Washington, DC, March 25, 2003

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WDR 2004 Messages

• 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

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How are services failing poor people?

• Public spending usually benefits the rich, not
  the poor

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Expenditure incidence
Health
Education
Source Compiled from various sources
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Access to primary school and health clinics in
rural areas
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Use of an improved drinkingwater source
Source Analysis of Demographic and Health Survey
data
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How are services failing poor people?

• Public spending usually benefits the rich, not
  the poor
• Money fails to reach frontline service providers
• In Uganda, only 13 of non-wage recurrent
  spending on primary education reached primary
  schools

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How are services failing poor people?

• Public spending usually benefits the rich, not
  the poor
• Money fails to reach frontline service providers
• Service quality is low for poor people

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Examples of low service quality

• Bangladesh Absenteeism rates for doctors in
  primary health care centers 79.
• Zimbabwe 13 of respondents gave as a reason for
  not delivering babies in public facilities that
  nurses hit mothers during delivery.
• Guinea 70 of government drugs disappeared.
• Costa Rica absenteeism rate is 30 in public
  health facilities.

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A framework
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A framework
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A framework
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Citizen-Politician/Policymaker

• Political economy of public services
• Political competition and incentives for service
  delivery
• Informed voting
• Social polarization Curley effect
• Credibility of politicians promises

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What matters more for enrollment? Expenditures
or elections?
point change in gross primary school enrollment
Source Keefer 2003.
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Citizen-Politician/Policymaker

• Political economy of public services
• The nature of political competition and
  incentives for service delivery
• Informed voting
• Social polarization
• Credibility of politicians promises
• Clientelism

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Mexicos PRONASOL, 1989-94

• Large social assistance program (1.2 of GDP)
• Water, sanitation, electricity and education
  construction to poor communities
• Limited poverty impact
• Reduced poverty by 3
• If better targeted, could have reduced it by 64

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(No Transcript)
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A framework
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Policymaker-Provider

• Incentives
• Monitoring

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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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A framework
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Client-Provider

• Reveal demand and strengthen accountability by
• Choice

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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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Client-Provider

• Strengthen accountability by
• Choice
• Participation clients as monitors

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Client-ProviderEDUCO Program in El Salvador

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

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EDUCO promoted parental involvementwhich
boosted student performance
EDUCOs achievements
increase in test scores per visit (in both
types of schools)
Parental visits to traditional and EDUCO schools
in past month
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Deconcentration
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Delegation
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Devolution
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What we can do

• Expand information
• Specific information Uganda PETs, Report Cards
• Strong political interest in fixing the problem
• Issue electorally important
• Role of mass media

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What we can do

• Expand information
• Tailor service delivery arrangements to service
  characteristics and country circumstances

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Eight sizes fit all?
Difficult to monitor Easy to monitor




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Eight sizes fit all?
Difficult to monitor Easy to monitor
Heterogeneous clients
Heterogeneous clients
Homogeneous clients
Homogeneous clients
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Eight sizes fit all?
Difficult to monitor Easy to monitor
Heterogeneous clients Pro-rich politics
Heterogeneous clients Pro-poor politics
Homogeneous clients Pro-rich politics
Homogeneous clients Pro-poor politics
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Eight sizes fit all?
Difficult to monitor Easy to monitor
Heterogeneous clients Pro-rich politics Demand-side subsidies, co-payments by households
Heterogeneous clients Pro-poor politics
Homogeneous clients Pro-rich politics
Homogeneous clients Pro-poor politics Central-government provision Government provision or contracting
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Eight sizes fit all?
Difficult to monitor Easy to monitor
Heterogeneous clients Pro-rich politics Demand-side subsidies, co-payments by households
Heterogeneous clients Pro-poor politics Use local knowledge and monitoring (decentralize) Use local knowledge (deconcentrate)
Homogeneous clients Pro-rich politics
Homogeneous clients Pro-poor politics Central-government provision Government provision or contracting
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Eight sizes fit all?
Difficult to monitor Easy to monitor
Center Pro-rich politics Local Pro-rich politics Demand-side subsidies, co-payments by households
Center Pro-rich politics Local Pro-poor politics Use local knowledge, monitoring and resources (decentralize)
Center Pro-poor politics Pro-rich politics Central funding with contracts, local knowledge (deconcentration)
Center Pro-poor politics Pro-poor politics Central funding, local provision