1. Improving Service Delivery for Children

2. Key areas identified for improving availability and quality of Services:
Pre-natal Care
Immunization
Responsive feeding and caring
Pre-school education
Primary education
Despite improvements during past few decades, many of these services fail to reach the Poorest

3. Why are services failing to reach the poor ?
Demand
Knowledge
Empowerment
Affordability
Social Barriers
Physical access
Human Resources
Supply
Availability of
Consumables
Resource
Allocation
Governance

4. The Challenges Inadequate program monitoring
Weak implementation capacity
Inadequate program monitoring
Over centralization and lack of flexibility in design
Lack of accountability

5. Services can improve by strengthening accountability mechanisms.
Policy
Maker
Indirect
Voice
Indirect
Compact
Client
Provider
Direct
Client Power

6. But, services can still work by Strengthening Client Power.
Empowering the poor to monitor and discipline
Citizen’s Report Cards in Bangalore
Co-producing health and nutrition services
Mid Day Meal Program in Tamil Nadu
User associations hire and pay health staff in Mali
Co-operative Pharmacies in Haiti, Singapore.

7. Services can improve by Strengthening incentives to providers to serve the poor
Buying Results. The Government as active purchaser of health services thru performance based contracts directly with health providers or with intermediaries
Urban Slums Project in 74 municipalites in AP
Contracting our nutrition Services in Senegal & Madagascar
Incentives for working in underserved areas.
Hardship allowances
Quota for higher education

8. Services can improve by sharing information and giving voice to the poor
Display of funds devolved to schools in DPEP
Publishing education grants to schools in Uganda
Sharing information relevant for local context
Ma-beti melas in DPEP/Mahila Samakhya
Meena by UNICEF
Polio Campaign
Informing facts and figures to generate informed debate
Child labor and Schooling

9. Services can improve by strengthening accountability mechanisms.
Immunization Services in Tamil Nadu
Enhancing collective accountability – Madhya Pradesh in
education

10. Services can improve by offering demand side financing
Educational scholarships for Girls in Bangladesh
Conditional Cash Transfers in PROGRESSA, Mexico

11. None of these solutions are fast are easy
None of these solutions are fast are easy. But, success is clearly possible.
“It does not matter how slowly you go so long as you do not stop”
Confucius
WDR 2004