world development report 2004

Making Services Work for Poor People

world development report 2004


Youth Open House, The World BankNew Delhi, March 21, 2005


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


The reality of South Asia

• No city in South Asia has 24 x 7 water supply– Delhi & Dhaka: 6-8 hours a day; Hyderabad & Karachi: 3

hours every second day

– intermittent supply and attendant health problems

• Over 50 percent of water not accounted for: South Asian cities are leaking buckets

• Cost recovery only 20 percent of O&M: decaying infrastructure


Why are you clearing it… any VIP visiting the city?

Why don’t services work?

Source: R K Laxman

I can’t understand these people. Not a soul here knows how to read or write and yet they want a school.


Source: R K Laxman


We will shift the garbage temporarily to the other pavement and bring it back later. They are going to dig up this pavement!

By R. K. Laxman




Outcomes are worse for poor peoplePercent of households who use an improved drinking water source

Source: Analysis of Demographic and Health Survey data


Outcomes are worse for poor peopleInfant and child deaths per 1000 live births



Outcomes are worse for poor peoplePercent aged 15 to 19 completing each grade or higher



How are services failing poor people?

• Public spending usually benefits the rich, not the poor


Expenditure incidence

Health Education

Source: Filmer 2003b


• 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



• Public spending benefits the rich more than the poor

• Money fails to reach frontline service providers

• Service quality is low for poor people



Examples 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

• Bangladesh: Arsenic has reduced rural drinking water access from 97 to 75 percent

• India: Delhi & Chennai get 4 to 6 hours of water per day, Hyderabad gets 1.5 hours every other day


A framework of relationships of accountability

Poor people Providers



Policymakers



Poor people

Policymakers


Providers

Voice


Mexico’s 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


PRONASOL expenditures according to party in municipal government

Source: Estevez, Magaloni and Diaz-Cayeros 2002


Ah, there he is again! How time flies! It’s time for the general elections already!

Why don’t services work for poor people?

Source: R K Laxman




Providers

Policymakers

Poor people

Compact


Policymaker-provider:Contracting 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


Contracting for Outcomes: health services in Cambodia

Source: Bhushan, Keller and Schwartz 2002

Use of facilities by poor people ill in previous month

Politics, patronage, and poor network services

POLITICIANS

EMPLOYEESUTILITY

COMPANY

CONNECTEDPOPULATION

Operational subsidiesAppointment of directors

Political favours

Artificiallydepressed

tariffs

Poorquality of

service

Over-staffing

UNCONNECTEDPOPULATION

High prices

CONTRACTORS

Untendered contracts





Policymakers

Client power


Keeping girls in secondary school in Bangladesh

• 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


What not to do

• Leave it to the private sector

• Simply increase public spending

• Apply technocratic solutions

Of course we have progressed a great deal, first they were coming by bullock-cart, then by jeep and now this!

What not to do…

By R. K. Laxman



What is to be done?

• Expand information

• Tailor service delivery arrangements. One size does not fit all

• Why do democracies fail to deliver services? Think about the politics of service delivery

• Services just for poor people or for all?


One size does not fit all

• Different sectors & countries need different accountability relationships to be strengthened

• Making just one link more effective may not be enough, & may cause problems: over-supervising curative care, promoting user groups to detriment of local government

• So, a constellation of solutions needed to enhance accountability, each matching a particular set of conditions

• Impact evaluation helps us learn what works, where, and why

Oh yes, this village has improved a lot, sir – it’s almost like a big city now – no water, no electricity here either!

By R. K. Laxman




Policymakers

Services work for poor people when accountability is strong

Available at: http://econ.worldbank.org/wdr/wdr2004

world development report 2004

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