Chapter 6 - Service delivery in fragile contexts

Chapter 6 - Service delivery in fragile contexts

 

Service delivery and state-building

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The role of services in state-building

Donors are increasingly concerned with the relationship between service delivery and state-building. This encompasses two related elements: i) how the delivery of basic services can best support state responsiveness, state legitimacy and social cohesion and ii) how donors can support the development of state capacity to deliver or co-ordinate services. Underlying this is a belief that service delivery is ultimately the responsibility of the state, and an intuition that the visible presence of services extends the state’s reach and authority, supports state legitimacy and strengthens the social contract. Related to this, some argue that addressing the equitable delivery of services across disparate groups could help repair societal fractures. Nevertheless, little research has been done in this area to date, and much of it has been cautious about confirming any such causal links.

The state-building imperative encourages donors to consider the impact of their aid delivery mechanisms on the development of state capacity. Many call for donors to better manage the potential trade-offs between delivering services quickly through parallel structures that in some cases may bypass the state, and the long-term development of state capacity and accountability between service providers, government and citizens (rather than to donors).

Practical Action, Save the Children, and CfBT Education Trust, 2011, 'State-Building, Peace-Building and Service Delivery in Fragile and Conflict-Affected States: Literature Review', UK Department for International Development
This review focuses on ways of accessing and delivering services, and service delivery accountability mechanisms. Key findings are that, according to the literature: 1) service delivery can contribute positively and negatively to state-building and peace-building; 2) citizens’ expectations of service delivery vary in different sectors; 3) different types of provision (state versus non-state) may have a different impact on legitimacy through visibility; 4) equitable service delivery is important; and 5) a simultaneous focus on both service delivery and state-building is challenging. The review identifies critical gaps in the literature in preparation for further research.
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Van de Walle, S. and Scott, Z., 2009, 'The Role of Public Services in State- and Nation-building: Exploring Lessons from European History for Fragile States', GSDRC Research Paper, Governance and Social Development Resource Centre, Birmingham
What role can public service delivery play in state-building? This article explores lessons from Western European history to argue that the design of public services is a far more political matter than is often recognised. Rather than being a neutral process, a historical review of service provision shows that it has been used as a political tool for building state legitimacy and concepts of nationhood. The paper concludes that donors need to rethink their approaches to service provision in fragile states in light of these findings.
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Eldon, J., and Gunby, D., 2009, ‘States in Development: State-building and Service Delivery’, HLSP Institute, London
How, when and why do basic services matter for responsive state-building? This paper uses cases studies from Cambodia, Nigeria, South Sudan and Zimbabwe to explore these questions as part of wider research on fragile states. The relationship between state responsiveness and service delivery is not straightforward. Fragility, violence, patronage, ethnicity and economic growth all play a part.
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Eldon J., 2008, 'Health System Reconstruction: Can it Contribute to State-building?', HLSP Institute, London
Can rebuilding health systems in fragile states strengthen the social contract and contribute to wider state-building? This study, which included fieldwork in Nigeria and Sierra Leone, finds that health sector strengthening can contribute to state-building in the health sector, but that its impact on wider state-building remains unclear. There may be more scope for wider state-building and the strengthening of the state-society compact through decentralised and 'bottom up' approaches. Context is the key influencer of potential for state-building, but is often inadequately understood.
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GSDRC, 2009, 'Service Delivery and Stabilisation', Helpdesk Research Report, GSDRC, Birmingham
The most commonly cited potential benefits of service delivery in post-conflict environments are that visible delivery enhances state legitimacy, strengthens the social contract and hence, promotes state-building. Delivery of services can also address underlying causes of conflict, i.e. social exclusion, and services such as health can be used as entry points for wider peace-building processes. In stabilisation contexts, a particular challenge is how, given that the state often lacks the capacity to ensure reliable services, provision by external actors and donors can enhance state legitimacy and not weaken it. In such a case, ensuring that the state’s role in service delivery is clearly communicated is key. The long-term commitment of donors is also important. Furthermore, given that the legitimacy of the state depends on much more than the delivery of services, it is often argued that stabilisation requires a multi-pronged and multi-layered approach.
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Pearson, N., 2010, ‘The Role of the Health Sector in Wider State-Building,’ Health & Fragile States Network Discussion Paper, Save the Children, London
Health sector interventions, whether intended or not, always affect the interaction between citizen, service-provider and policymaker, and therefore international partners should aim to reinforce state resilience through these interventions. Well-designed interventions can build up sub-national capacity and support democratic processes of public reasoning and consent-building.
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Addressing social exclusion through service delivery

There is increasing recognition that service delivery initiatives in fragile states should aim to ameliorate the negative effects of exclusion on certain groups over the long term. But issues of targeting and programming for marginalised and vulnerable groups in service delivery are highly complex and political.

Gardener, J. and Subrahmanian, R., 2006, 'Tackling Social Exclusion in Health and Education: Case Studies from South Asia', Report prepared for the Department for International Development, GHK International
In many Asian countries, poverty reduction is undermined by inequality and insecurity. Achieving the Millennium Development Goals in these countries requires effort from governments and development agencies to help excluded groups access health and education services. This paper from GHK International and the Institute of Development Studies uses examples from across Asia to identify ways of tackling social exclusion.
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Non-state service providers in fragile states

The absence or weakness of state services in fragile situations usually means the majority of services are delivered by non-state actors (including donors, international and local NGOs, traditional and commercial (small and large) service providers), particularly in the early recovery phase. Many recent studies have argued this results in the fragmented and uneven provision of services. In addition, many donors are concerned that the delivery of services through non-state providers negatively impacts on the development of state legitimacy and capacity. Recently, donors have become concerned with how states with weak capacity can effectively perform the indirect ‘stewardship’ roles  of managing, co-ordinating and financing non-state providers of basic services. Related to this is the issue of transition from non-state to state provision, specifically, how non-state providers can support the development of state capacity for direct provision in the long-term.

GSDRC, 2009, 'Non-State Providers of Health Services in Fragile and Conflict-Affected States', Helpdesk Research Report, GSDRC, Birmingham
Most mechanisms that use NSPs to deliver services are only being applied at a very small scale in fragile states. There is some evidence that the most widely used mechanism - contracting - can increase service utilisation, increase service quality, improve efficiency, reduce service fragmentation, and support strengthening of national capacity. The basic package of health services (BPHS) contracting approach, in particular, is often cited as an effective mechanism for health service delivery in fragile states. However, some observers have voiced concern that contracting can promote precipitous decentralisation, erode NSP independence, and actually fragment the health system given that NSPs are seldom able to provide an overall framework in which to operate.
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GSDRC, 2009, 'Non-State Providers of Education Services in Fragile and Conflict-Affected States', Helpdesk Research Report, GSDRC, Birmingham
NSPs are generally viewed as key service providers and as more pragmatic, flexible and adaptable than state structures in fragile states. By allowing communities to identify their own priorities they are often seen as having the potential to empower communities, set up local governance structures and strengthen social accountability mechanisms. There are also drawbacks however. As NSPs often operate outside government regulation, there is a danger that some may be providing low-quality education. In addition, they can also be disconnected from policy development in the wider sphere. Gender issues – in terms of awareness of oppressive attitudes and exploitative employment practices – are also a concern.
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Batley, R., and Mcloughlin, C., 2010, ‘Engagement with Non-State Service Providers in Fragile States: Reconciling State-Building and Service Delivery’, Development Policy Review, Volume 28 Issue 2, Pages 131 - 154
The OECD questions whether non-state services in fragile states may delegitimise the state in the eyes of citizens, arguing that 'state-building' depends on governments' engagement in service management. This article reviews the available evidence to identify what types of engagement are feasible and most likely to contribute to service delivery, or not to damage it. It considers the capacity requirements and the risks associated with state intervention through policy formulation, regulation, contracting and mutual agreements, and concludes by identifying ways of incrementally involving the state, beginning with activities that are least likely to do harm to non-state provision.
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The previous article is based on a study commissioned by the UK Department for International Development through the GSDRC.

GSDRC, 2009, 'Donor Support to Non-state Providers of Security and Justice in Fragile States', Helpdesk Research report, GSDRC, Birmingham
Supporting non-state justice and security is widely acknowledged to be a highly complex and controversial area which donors have historically tended to avoid. There is, consequently, very little in the way of systematic lessons-learned‘ in this area. However, much of the available literature recommends that donors take a pragmatic approach to working with both state and non-state providers, and to increasing communication and transparency between these different sources of authority.
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DFID commissioned a cross-country study of non-state provision of basic (primary) education, primary and community health-care, and water and sanitation in 2005. Findings, including lessons learned for donors for supporting non-state providers, are available on the website of the International Development Department at the University of Birmingham.

Further resources

Further resources on non-state providers can be found in the service delivery topic guide.