Making Services Work for Poor People world development report 2004 Making Services Work for Poor People Youth Open House, The World Bank New Delhi, March 21, 2005

Making Services Work for Poor People 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

Making Services Work for Poor People 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

Making Services Work for Poor People 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. Why don’t services work? Source: R K Laxman Making Services Work for Poor People

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 Making Services Work for Poor People Why don’t services work?

Making Services Work for Poor People Outcomes are worse for poor people Percent of households who use an improved drinking water source Source: Analysis of Demographic and Health Survey data

Making Services Work for Poor People Outcomes are worse for poor people Infant and child deaths per 1000 live births Source: Analysis of Demographic and Health Survey data

Making Services Work for Poor People Outcomes are worse for poor people Percent aged 15 to 19 completing each grade or higher Source: Analysis of Demographic and Health Survey data

Making Services Work for Poor People How are services failing poor people? Public spending usually benefits the rich, not the poor

Making Services Work for Poor People Expenditure incidence HealthEducation Source: Filmer 2003b

Making Services Work for 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 How are services failing poor people?

Making Services Work for 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 How are services failing poor people?

Making Services Work 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

Making Services Work for Poor People A framework of relationships of accountability Poor peopleProviders

Making Services Work for Poor People Poor peopleProviders Policymakers A framework of relationships of accountability

Making Services Work for Poor People Poor people Policymakers A framework of relationships of accountability Providers Voice

Making Services Work for Poor People Mexico’s PRONASOL, 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

Making Services Work for Poor People PRONASOL expenditures according to party in municipal government Source: Estevez, Magaloni and Diaz-Cayeros 2002

Making Services Work for Poor People 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 Making Services Work for Poor People

A framework of relationships of accountability Providers Policymakers Poor people Compact

Making Services Work for Poor People 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

Making Services Work for Poor People 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 Making Services Work for Poor People

A framework of relationships of accountability Poor peopleProviders Policymakers Client power

Making Services Work for Poor People 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

Making Services Work for Poor People 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 Making Services Work for Poor People

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?

Making Services Work for Poor People 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 Making Services Work for Poor People

Poor peopleProviders Policymakers Services work for poor people when accountability is strong Available at: