Making Services Work for Poor People--Three Years Later

By Shantayanan Devarajan

• Corruption
• Decentralization
• Economic theory
• Education
• Gender
• Governance
• Health
• Infrastructure
• Poverty
• Regional
• Water

The 2004 World Development Report showed how basic services are failing poor people because service providers are not accountable to policymakers or to poor clients, and politicians are not accountable to poor citizens. We have since learned that services fail poor people in many more ways. In addition to being absent 40 percent of the time, Indian public sector doctors provide worse service than less-qualified private sector doctors.

Noting that services fail poor people because of accountability failures, the 2004 World Development Report suggested methods for strengthening poor people's ability to hold service providers accountable. For instance, a program in Bangladesh gives scholarships to girls who attend secondary school, and gives a stipend to schools--be they public, private, NGO-run or religious--based on the number of girls they enroll. Secondary school enrolment in Bangladesh is rising twice as fast for girls as for boys. Furthermore, schools now have separate latrines for girls and boys; they are hiring female teachers. Before getting too enthusiastic about this solution, we must remember that it requires parents to know about the schools in their area. A survey in Pakistan showed that parents had heard of only 60 percent of the schools in their village, and had visited less than 20 percent of them. A program in Peru called RECURSO tries to address the problem by specifying a simple reading standard (a second-grader must read 60 words a minute) that schools must meet and parents can easily verify.

Another solution for strengthening "client power" (and hence accountability) in the 2004 World Development Report was increasing participation by clients in service delivery through, for example, parents' associations or school management committees, as in El Salvador or Nepal. Not only were clients (parents) better able to monitor and discipline providers (teachers), but qualitative surveys showed that the teachers felt empowered by the fact that parents were visiting the school on a regular basis. I visited a community-managed school in Nepal where they had recently found a mineral spring. The school management committee was trying to develop the spring into a bottled-water business for one of the poorest families in the community--so they could afford to send their children to school. Lest we become too enthusiastic about client participation, we should keep in mind that this solution, too, demands a fair amount of time and knowledge from the community for it to work. Recent work by Stuti Khemani and colleagues shows that in poor villages in Uttar Pradesh, India, only 7 percent of the villagers had heard of the Village Education Committee. Of these, over half (4 percent of the total) could not name a single member of the VEC--and this included people who were themselves members of the VEC!