making services work for poor people shanta devarajan world bank
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Making Services Work for Poor People
Shanta Devarajan
World Bank
Services are failing poor people:MDGs—Global Aggregates
Eradicate poverty and hunger
People living on less than $1 a day
23 .4
29
14 .5
0
10
20
30
1990 1998 2015
Eradicate Poverty & Hunger Achieve Universal primary education
Net primary enrollment
84
81
100
80
85
90
95
100
1990 1999 2015
Universal Primary Education
Services are failing poor people:MDGs—Global Aggregates
Promote gender equality and empower women
Ratio of girls to boys in primary and secondary school (%)
8983
100
0
20
40
60
80
100
1990 19992005
Promote Gender Equality Reduce child mortality
Under-5 mortality rate
(per 1,000 live births)
7886
29
0
20
40
60
80
100
1990 19992015
Reduce Child Mortality
Ratio of girls to boys in primary and secondary school (%)
Growth is not enough
Poverty Headcount Primary EducationEnrollment
%
Infant Mortalityper 1000
Target
2015 Growth alone
Target2015
Growth alone
Target2015
Growthalone
EAST ASIA
14 3 100 100 14 33
ECA 1 1 100 100 9 22
LAC 8 7 100 100 14 30
MENA 21 1 100 92 20 46
SA 22 18 100 87 29 70
AFRICA 24 40 100 64 33 87
Source: Global Economic Prospects 2001, p.42 base case; Devarajan (2002)
Why are services failing?
• Governments spend on the wrong goods and people
Benefit Incidence of Public Spending
Health Education
Country/ year Poorest 20% of population
Richest 20% of population
Poorest 20% of population
Richest 20% of population
Cote d’Ivoire (1995) 11 32 13 35 Ghana (1992) 12 33 16 21 Guinea (1994) 4 48 5 44 Kenya (1992) 14 24 17 21 Madagascar (1993) 12 30 8 41 South Africa (1994) 16 17 14 35 Tanzania (1992/93) 17 29 14 37
Why are services failing?
• Governments spend on the wrong goods and people
• Resources fail to reach the service provider (Uganda tracking study)
• Weak incentives for effective service delivery
Examples of ineffective service delivery
• India: Teachers arriving drunk regularly, high levels of absenteeism.
• Zimbabwe: 13% of respondents gave as a reason for not delivering babies in public facilities that “nurses hit mothers during delivery”.
• Guinea: In 1984, 70% of government drugs disappeared.
• Costa Rica: absenteeism rate is 30% in public health facilities.
Why are services failing?
• Governments spend on the wrong goods and people
• Resources fail to reach the service provider (Uganda tracking study)
• Weak incentives for effective service delivery
• Demand-side constraints
Provider
ClientPolicy-maker
Contract relationship Service
relationship
Voice relationship
Donors
Making services work for poor people
Provider
ClientPolicy-maker
Contract relationship Service
relationship
Voice relationship
Relationships
Policymaker-Provider:Contracting NGOs in Cambodia
• Contracting out (CO): NGO can hire and fire, transfer staff, set wages, procure drugs, etc.
• Contracting in (CI): NGO manages district, cannot hire and fire (but can transfer staff), $0.25 per capita budget supplement
• Control/Comparison (CC): Services run by government
12 districts randomly assigned to CC, CI or CO
Utilization of Facilities by Poor People Sick in last month, %
0
5
10
15
20
25
30
35
Control CI CO
BaselineFollow-up
Provider
ClientPolicy-maker
Contract relationship Service
relationship
Voice relationship
Relationships
Client-Provider:EDUCO Program in El Salvador
• Parents’ associations– Hire and fire teachers– Visit schools on regular basis– Contract with Ministry of Education to deliver
primary education
%Effect of 1 more class visit by ACE on math and language score
0
5
10
15
20
25
30
Math Language
EDUCO Effect: School days missed due to teacher absence
-3.01-3.50
-3.00
-2.50
-2.00
-1.50
-1.00
-0.50
0.00All yrs
Avg # of daysmissed: 1.34
Provider
ClientPolicy-maker
Contract relationship Service
relationship
Voice relationship
Relationships
FSSAP Bangladesh
• Criteria:– Attendance in school– Passing grade– Unmarried
• Girls to receive scholarship deposited to account set up in her name
• School to receive support based on # of girls
Provider
ClientPolicy-maker
Contract relationship Service
relationship
Voice relationship
Donors
Relationships