Making Services Work for the Poor in Rwanda

WDR04 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

Short and long routes of accountability

A framework of relationships of accountability Poor peopleProviders

In Rwanda Education: demand side transfers for secondary school tuition for poor children, PTAs Health: social marketing, drug revolving fund, subsidies to premiums of micro-insurance (mutuelles), participatory health committees Water: co-payments Energy: tariff structure Agriculture: vouchers for extension services?

Poor people Policymakers A framework of relationships of accountability Providers

In Rwanda Citizen report cards in health, education and administrative services Community Score cards Ombudsman office and local conciliators Civil society review of PRSP monitoring

A framework of relationships of accountability Providers Policymakers Poor people

In Rwanda Education : Capitation grant to schools Health: Community Schemes, Performance Based Contracts for health centers Water: contracts with private operators Energy: management contract for utilities

In Rwanda too, contracting experiences are promising

Rwanda : Evolution of expenditures and number of additional people having access to water p p

Decentralizing Make services closer to clients ? Make government closer to citizens ? Make government closer to services ?

Not One Size Fits All

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… technocratic solutions…

What is to be done? Tailor service delivery arrangements to service characteristics and country circumstances

Eight sizes fit all?

Ah, there he is again! How time flies! It’s time for the general election already! Why don’t services work for poor people? By R. K. Laxman

PRONASOL expenditures according to party in municipal government Source: Estevez, Magaloni and Diaz-Cayeros 2002

Clientelistic politics Can be measured: benefit incidence Dynamic Political process complex: both pro-poor and clientelistic streams Working at the margin: opportunities

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

Eight sizes fit all?

Homogeneous 1. “Externality” Public Good: eg air and water quality, Externalities: e.g communicable diseases, curriculum, roads, water access Network externalities: ef electricity grid

Homogeneous 2. Common needs eg Administrative requirements Antenatal care/ deliveries/ immunization School exams/ requirements

Homogeneous 3. Common destiny eg Policies Legal framework Standards

Decentralization and the service delivery framework Citizens/clients Center Politicians Policymaker Sub-national government Politicians Policymaker Poor Non Poor Providers Organizations Frontline Deconcentration Delegation Devolution Voice Client’s power Compact

Poor peopleProviders National policymakers Decentralization Local policymakers

Eight sizes fit all?

Easy of difficult to monitor Three types of monitors: –clients –Policymakers: –Self Regulation of providers

Making Services Work for Poor People The public private mix varies between countries, interventions and income groups

Who can monitor what Clients can monitor services that are transaction intensive, discretionary and with little asymmetry of information –Eg: use of soap. Handwashing, bed nets, condoms, presence of teachers, presence of nurses, cleanliness of services, quanity and taste of water etc

Who can monitor what Policymakers can monitor services that are standards and non transaction intensive even with high assymetry of information –E.g: water access, learning of kids, diseases surveillance, quanity and quality of standards services (immunization, antenatal care)

Who can monitor what Self regulation need to develop when services are both transaction intensive, discretionnary and with high assymetry of information –-eg clinical care: only doctors can monitor doctors, engineers engineering

Which level of government should monitor what Policymakers can monitor services that are standards and non transaction intensive even with high assymetry of information E.g: water access, learning of kids, diseases surveillance, quantity and quality of standards services (immunization, antenatal care)

Which level of government should monitor what Consequently adequate level of government responsibility would depend on –1. capacity to monitor standard services, with a minimum of assymetry of information –2 capacity to support clients and Citizens in exerting monitoring of discretionary, transaction intensive services –3 capacity to support self regulation

Eight sizes fit all?

Making Services Work for Poor People

Fiscal Decentralization Framework Earmarked (conditional) Transfers Non-earmarked (non conditional) transfers InvestmentSector conditional transfers e.g District Water Contracts (2006) CDF (Development projects based on District Development Plan) RecurrentSector conditional transfers (eg Wages of health and education workers, mutuelles de santé, community health, social assistance) LABSF/Support to local government (wages and operational costs)

Proposed earmarked transfers to manage transition phase (under construction)

Making Services Work for the Poor in Rwanda