What have we learned on getting public services to poor people? What’s next?

March 24, 2014

     By Duncan Green     

Ten years after the World Development Report 2004, the ODI’s Marta Foresti reflects on the past decade and implications for the Marta Forestifuture

Why do so many countries still fail to deliver adequate services to their citizens? And why does this problem persist even in countries with rapid economic growth and relatively robust institutions or policies?

This was the problem addressed by the World Bank’s ground-breaking 2004 World Development Report (WDR) Making Services Work for Poor People. At its core was the recognition that politics and accountability are vital to improve services, and that aid donors ignore this at their peril. Ten years on, these issues are still at the heart of the development agenda, as discussed at the anniversary conference organised jointly by ODI and the World Bank in late February.

As much as this was a moment to celebrate the influence of the WDR 2004 on a decade of development thinking and practice, it also highlighted just how far we have to go before every citizen around the world has access to good quality basic services such as education, health, water and electricity.

health careLet’s begin with what we learned from WDR 2004 and what we know better today as a result of the work of the last ten years. First off is the role of information in improving accountability for service delivery. As Leni Wild suggests in her reflections on the conference, there has been real progress in understanding not only what types of information can be used and by whom, but also in how information can foster accountability. Ten years on, there is widespread agreement that while important, information alone rarely leads to improved services, and a growing awareness that it is incentives that matter if politicians and service providers are to act on information and data. In other words, information is a necessary but not sufficient condition for change.

Related to this, Ruth Levine of the Hewlett Foundation was among those who noted the progress made in the past decade in the research and quality of evidence on service delivery. This is the result, in part, of greater interest and investment in impact evaluation and randomised control trials (RCTs) that provide vital insights on what works to improve services in different contexts and – to a lesser extent – on why. However the mood at the conference was not one of hype around RCTs and other experimental approaches: much as they provide relevant evidence, they fail to explain the complex relationship between contextual factors, institutional arrangements, programmes and their outcomes. Lant Pritchett from CGD summed this up neatly in his blog last November: ‘RCTs are one hammer in the development toolkit and previously protruding nails were ignored for lack of a hammer, but not every development problem is a nail.’

Shanta Devarajan, Director of the WDR 2004, reminded us of one of its key lessons: that money alone is not enough to fix public service delivery problems and that, by extension, aid plays only a minor role. Countries undergoing fast economic growth, such as Nigeria, still fail to provide access to education to many poor girls and even Brazil – seen as a world leader on improving services to the poor – faces trade-offs between a pro-poor tax system and improved education and health.

Despite the influence of WDR 2004 on development thinking and practice over the past ten years, thorny issues remain that still need attention and, most importantly, far more debate. This will demand open minds and a real desire to break down disciplinary barriers, a step-by-step approach, experimentation with new ideas, and a willingness to acknowledge and learn from failure.

The first thorny issue is the role of the private sector in delivering services, which was a much debated theme: the evidence may showFree-healthcare-007 promising results and outcomes, but can we really expect the private sector to substitute for improved public institutions? And what are the implications for the long-term sustainability of services for the poor? Most importantly, where states are weak, their markets are also often weak, casting doubt on the notion of markets as a short cut to accountability. Public and private provision is not a matter of ‘either/or’: they are inter-related and this close relationship requires more analysis.

Lant Pritchett put forward the second challenge for the next ten years: public services should be for all, the poor, of course, but also the middle classes. When service delivery is abysmal right across the social spectrum, the focus on the poor might miss important opportunities to identify a significant and powerful constituency for change amongst the ‘elites’.

The third thorny issue is human behaviour and all the assumptions that surround it. The forthcoming WDR 2015, Mind and Culture, focuses on social norms and behaviour and there is much expectation that behavioural economics (which, as Ruth Levine reminded us, used to be called psychology) will shed some light on our preconceptions about how we attempt to induce better behaviour among politicians, as well as service providers and ourselves.

But I am not convinced that this alone will get us to the root of how political incentives work, let alone broader questions about risk-taking individuals and their chances of thriving in fundamentally risk-averse bureaucracies. We need to look at the role of social and political organisation, and in particular the kind of organisation that permits collective action to unblock processes of reform and change.

One of Oxenbury’s illustrations for We’re Going on a Bear HuntWhich leads me to my final – and most important – point:  the politics of it all. The conference ended with a clear indication of what the future holds: politics is not only part of the problem, but also of the solution. Working around politics rather than with it does not work: meaningful education reform cannot happen despite teachers’ unions, but in negotiation with them. Equally, efforts to stimulate the voice of citizens and their demand for services only work when they are met with equal efforts to better understand the incentives and decision-making logic of the politicians and civil servants responsible for the delivery of those services. As Alison Evans put it, via Michael Rosen’s iconic bear hunt: ‘We can’t go over it, We can’t go under it; Oh no, we have to go through it’

Above all, there is a need for a healthy dose of humility about the role of external actors in what are, fundamentally, domestically driven political processes.