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How are services delivered to the people in Malawi - Results of the Service Delivery Satisfaction Survey
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Executive Summary
The Service Delivery Satisfaction Survey (SDSS) deals with issues of outcomes – it relates to individuals’ satisfaction and use of services provided, representing something of a new departure for monitoring in Malawi, which generally looks at inputs or outputs, and impacts. The survey and analysis has been carried out as part of Civil Society’s contribution towards monitoring on the PRS and involved the administration of a closed-ended questionnaire with ordered choices to a randomly selected sample of the population from six districts of the country. The exercise covered service delivery in five specific areas – health, education, agriculture, infrastructure and security. All of these areas are covered by Priority Poverty Expenditures (PPEs) in the budget, and the results of the exercise should be considered alongside the results of other budget monitoring exercises being carried out by civil society networks in the fields of health, education and agriculture.
On average, respondents in the survey have to travel 10.2 kilometres to reach the nearest government health centre, and slightly over three-quarters of all respondents had reason to attend this facility in the past 12 months. In general, the respondents were satisfied with the performance of the staff at the centre - 40 per cent said they were very satisfied and 30 per cent slightly satisfied. Further, the respondents felt those treating them were qualified to do so. However, the positive attitude towards the staff does not extend to the supply of drugs and medications. Almost half of all respondents (43 per cent) reported that they did not receive what they consider the correct drugs for the ailment they were suffering from. When this happens, the most common destination to attain the medication is a private pharmacy.
With regard to the district hospital, respondents have to travel almost 30 kilometres to reach there, taking half the respondents over two hours to get there. Almost 60 per cent of all respondents had attended at this facility in the past 12 months. Similar to the responses for the health centre, respondents feel that the staff are offering a good service and are qualified to do so.
The same problem exists with regard to the availability of drugs at the district hospital, though not to the same extent – in this case almost 22 per cent of respondents said they had not received the correct medication. In these cases, again the most common destination to get the medication is the private pharmacy. Further on the negative side, a number of respondents reported having to wait over four hours to be treated at the district hospital and 40 per cent of all respondents said they were unsatisfied with the amount of time they had to wait.
While only a very small number of respondents said they had been requested to make a payment to receive treatment, almost half said they felt that if they had a relative working at the facility they would have received quicker and better treatment.
The major findings emerging on the subject of education are again that the respondents feel the teachers at the nearest school are qualified to provide the services in question – even though it is apparent that the respondents do not think there are enough teachers.
The respondents were also asked to comment on their satisfaction with the number of classrooms – the most frequent response was that the numbers were “slightly inadequate”. Further to this, respondents did not feel there were adequate numbers of desks to sit at or exercise books or pens and pencils for the children to use
Amongst households that do not send their children to the nearest school, the three most popular stated reasons for this were that they attend a school of better quality (17.1 per cent), the parents cannot afford to send the children to school (14.5 per cent) and that the school is too far away (10.3 per cent).
With regard to agriculture the major finding on the subject of agricultural extension was that 49% of respondents have never been visited by an extension worker, underlining the difficulties connected to improving agricultural production. Further, almost one-third of respondents said they lived in an area that is not even covered by an extension worker. Suggesting a similar situation exists here as in education – there are simply not enough people employed as frontline service providers.
Over 80 per cent of those who received a visit from the extension worker in the past month were satisfied with the frequency of the visit. At the same time over half of the respondents also said they were satisfied with the message that was delivered.
Respondents to the questionnaire were most satisfied in terms of their access to ADMARC. Despite having to travel almost 12 kilometres to the nearest depot, 54.4 per cent of respondents stated that they were very satisfied, with a further 22 per cent saying they were somewhat satisfied. Only 16.1 per cent of respondents stated that they were either slightly or very unsatisfied. This is more than likely a direct result of the fact that 40 per cent of depots were reported as always having inputs, and 71 per cent said that it was a major source of food all year round (half of the remainder said it was an important source of food at certain times of the year).
Despite the fact that 70 per cent of respondents received a TIP package in the previous year, only slightly over half said that it had contributed to improved yields. The most common reasons for this were that bad weather had prevented improvements, followed by the fact that the pack was incomplete and that it had arrived too late to be of any use. Only 62 per cent of respondents felt the TIP was going to the right people.
The survey revealed that for eight months of the year roads are impassable. Attention is rightly drawn to infrastructure’s role in the economy in rural areas and for general market development, however with uncertain financial allocations it is hard to expect that any improvements can be made. When repairs have been carried out, respondents are generally satisfied with the work.
Achievements appear to have been made in terms of the rehabilitation of boreholes – respondents identified that about 17 per cent of boreholes in their communities are not functioning, representing a major improvement in terms of the figures highlighted in the MPRSP.
Issues of security are a concern. It is one of the most inaccessible services to respondents in terms of distance, who have to travel almost 18 kilometres to reach the nearest police post, and even then only 43.7 per cent of respondents said that it made them feel secure. Notwithstanding, amongst those who have had occasion to actually seek assistance from the police, 48 per cent stated they were very satisfied with the services on offer. Advances do appear to have been made in the area of community policing however, while only two thirds of respondents lived in a community with these initiatives, 87 per cent of these said that it did make them feel more secure.
In conclusion, the SDSS reveals that the frontline service delivery workers are trying to do their job, which is acknowledged by the respondents in terms of their satisfaction ratings. Further, anecdotal reports of these people seeking rents for the provision of the service appear to be unjustified. However, there appears to be massive obstacles in terms of staffing levels (simply put there are just not enough people delivering these services), and the distribution and delivery of resources and materials necessary to support their endeavours. The issue and challenge would therefore seem to be how best to support these frontline service providers, rather than looking at means of reducing their numbers or continuously criticising their ability to deliver.
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