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Contents
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Introduction: The Politics of Service Delivery in Democracies – Better Access for the Poor
Ingrid Widlund
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The Conundrum of Services: Why Services are Crucial for Making Service Provision Better
Anirudh Krishna
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Democratic Politics and Pro-Poor Social Services: Unpacking the Concept of “Reform”
Joan M. Nelson
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Seeing and Believing: Political Obstacles to Better Service Delivery
Philip Keefer
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Can Information Campaigns Overcome Political Obstacles to Serving the Poor?
Stuti Khemani
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When do the Poor Demand Better Services? Accountability, Responsiveness and Collective Action in Service Delivery
Anuradha Joshi
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Extending Services over the Last Mile: Bridging the Gap between Intermediate and Local Levels
James Manor
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Giving Citizens What They Want: Preference Matching and the Devolution of Public Service Delivery
Omar Azfar
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The Politics of Service Delivery Reform: Improving Basic Education in Brazil
Marcus Andrй Melo
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The Provision of Health Services in Brazil: Decentralization and Participation
Clбudio Duarte
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Has the Distribution of Public Health Services Become More Equitable? Refl ecting on the case of Sгo Paolo
Vera Schattan P. Coelho and Nнlian Silva
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Helping Developing Democracies to Get Better at Delivering Services to the Poor. Some Early Lessons from the Public Management and Citizenship Program, Brazil
Peter Spink
About the Contributors
Appendix: Write-up from Workshop in Stockholm, 27-28 April 2006
Introduction
Clean drinking water, primary education, preventive and curative health facilities are all fundamental for human development and well-being. Yet, as the World Development Report 2004 demonstrated, the provision of such vital services in developing countries is typically skewed in favour of the non-poor. The better-off have not only the means to rely on private alternatives, but a higher percentage of public spending accrues to the richer sections. Furthermore, public services intended to benefi t the broader citizenry tend to be fraught with problems of corruption, absenteeism and low quality. Funding is misappropriated, service providers do not report to work, buildings are in need of repair, basic materials (like medicines and teaching devices) are missing, and so forth (World Bank, 2003).
This is not an acceptable situation in any context, but the dismal performance of democratic regimes is particularly problematic and noteworthy. Democracies
have the institutional mechanisms for toppling leaders who govern badly. Rulers can formally be held accountable for their performance, and citizens have a decisive infl uence on who is to govern on what grounds. As we all know, this is in many contexts not enough to ensure an equitable distribution of public services, or making improved educational and health outcomes a political priority. Why not? And what can be done about it?
These are questions for governments and citizens in the countries concerned, but they are also questions for donors of official development assistance. How to best strengthen democratic procedures and institutions so that public decision-making also benefits people in poverty underpins the very rationale for democracy promotion in development cooperation – to ensure influence for each and every (adult) citizen over his or her life situation. There is furthermore an increasing move from supporting single projects to untied general budget support and sector-wide approaches. The core commitments of the Paris Declaration – harmonization, alignment and ownership – follow from the analysis of the WDR 2004 to strengthen domestic systems and processes. These commitments have also resulted in an increased focus on Public Finance Management, i.e. methods and routines for the efficient use of public resources in policy planning and implementation.1 New forms and priorities for official development assistance raise new challenges. Will for example direct budget support to central governments risk undermining the authority and room for manoeuvre of local governments? And what are the appropriate instruments for democracy promotion when moving away from project support?
The main insight of Making Services Work for Poor People, is that the pro-vision of service delivery is a deeply political matter, much beyond resources
and institutional engineering. From that starting point, the Expert Group on Development Issues, EGDI, at the Swedish Ministry for Foreign Affairs, invited researchers and practitioners to a workshop in Stockholm in April 2006. Its aim was to encourage an informative debate on how to ensure better service delivery to the poor, and how democratic processes can contribute to that end. The theme and content was deliberately formulated in broad terms. Rather than focusing on a particular aspect of improving services (like strengthening ‘voice’), or a particular service (like health), the organisers wanted the discussions to cover a range of issues and provide several perspectives on those issues. Participants represented different disciplines, approaches and opinions.2 The common understanding was that a strategy for improving basic services to the poor requires more than a technical management approach. The political conditions and dynamics must be considered for understanding current problems, and identifying remedies to them.
This volume brings together eleven of the papers prepared for the workshop, reflecting an array of understandings and approaches – thereby also reflecting the great complexity of the problem at hand. While the contributions are diverse in many respects, most of them analyse or recommend either governance reforms, or measures to affect the broader political arena. The first type refers here to changes in the administrative apparatus, that is, following Nelson (chapter 3, this volume), to ‘shift the allocation of authority and responsibility for social service delivery’. Different forms of decentralisation are cases in point. The second type concerns the relationship between various societal actors in relation to elected politicians and the state.3 Another distinction that appears between some of the contributions is whether mechanisms for responsiveness or accountability are emphasised. Responsiveness refers to the actions and attitudes of bureaucrats and politicians vis-а-vis the citizens: to acknowledge and respond to demands. Accountability refers to the obligation of bureaucrats and politicians to justify and explain their actions, and to the possibility of citizens to sanction poor performance. In the analysis of the WDR 2004, it is precisely the strength of accountability relations between citizens, providers, and politicians that explain why services fail, or do not fail, the poor.
When entering a discussion on democracy and service delivery, one should keep in mind that authoritarian regimes can be very successful in providing basic services to its citizens, whether poor or non-poor. Democratic governance is in other words not a necessary condition for ‘access for the poor’. However, could the equitable provision of social services be a necessary, if clearly not sufficient, condition for democratic governance? In the strict sense, the answer is
of course in the negative, but in this publication we meet the argument that the provision of social services do matter for the quality of democracy: in empowering
citizens to make demands, claim their rights and be fully included in society.
Anirudh Krishna’s contribution (chapter 2), highlights the democratic and economic importance of services in education and health. Education promotes political participation, and more accessible health services would, apart from the obvious benefits, also prevent many people from falling into poverty. In addition, accessible information about democratic rights, remedies and responsibilities has a separate and crucial effect on political awareness, efficacy and faith in the democratic system. Being poor often means being poorly informed, not only about one’s rights and the means to exercise them, but also about economic opportunities and career paths. The ‘conundrum’, according to Krishna, is that people need services in education, information and health in order to be empowered to efficiently demand those services. From a similar vantage point, Peter Spink advocates in the final chapter (12) for a perspective on service delivery, in which the consequences for the quality of citizenship are at centrestage. Efficiency and effectiveness in the provision of health, education and the like, should above all be judged against its implications for ‘the conditions and practice of citizenship’. In addition, Spink argues that absent or skewed services are generating poverty, not just leaving poor people where they are.
This introduction is structured around three themes that come to the fore in and between the papers, and also correspond with important concerns and policies of international donors. The two distinctions that were outlined above will be visible in the account, but more directly addressed in the final section.
Footnotes:
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See for example Sida’s manual (Sida, 2007).
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See Appendix for a summary of the workshop discussions.
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This is not a water-proof distinction as governance reforms obviously alter the relationships between actors on the political arena, but it nevertheless serves to identify a relevant difference in emphases between the contributing authors.
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