Service delivery

Non-state providers

The state is no longer seen as the sole provider of basic services such as water, sanitation, education and health. There has been a proliferation of non-state providers (NSPs) in developing countries in recent years.  This is primarily due to the rise of small, often informal, providers who are increasing in numbers, scope, scale and impact to fill the gap left by weak state capacity. The privatisation of some public services, for example in the water sector, or the private management of public services on behalf of government have also contributed. 

There are various types of NSP:

1. market-based, for profit providers, ranging from large private firms to individual practitioners and informal local entrepreneurs
2. non-profit providers, for example NGOs, including faith-based organisations and volunteer groups
3. Groups rooted in alternative political authority, for example revolutionary movements.

Page contents:

• Pro-poor provision
• Quality and regulation
• NSP relations with the state
• Privatisation
• PPPs and contracting

Pro-poor provision

Some experts argue that NSPs can be pro-poor, for example because they often provide access to services in areas that are not covered by state provision. Others argue that they are not pro-poor because they are often expensive, are under no obligation to consider equitable access and sometimes require poor people to make contributions that are not expected of non-poor communities. Research shows that poor people use private providers to a surprising extent, given the associated costs, sometimes choosing them over free state provision. 

Grindle, M., 2002, 'First in the Queue? Mainstreaming the Poor in Service Delivery’, Kennedy School of Government, Harvard University, paper prepared for World Bank/DFID seminar in support of the World Development Report 2004, Nov, 2002
Is the poor reputation of the public sector in service delivery justified? Is non-government provision in fact the only way to effectively deliver services to the poor? This paper for the World Development Report 2003/04 workshop by the Kennedy School of Government, USA, re-evaluates public and non-government service provision. It suggests that while state service delivery generally fails to reach the poorest, it is better at getting to less-poor and middle classes. Assessing and understanding the reasons for this will allow governments to design better strategies for mainstreaming the poor in service delivery.
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Tooley, J., 2005, 'Is Private Education Good for the Poor?', Working paper, University of Newcastle Upon Tyne, UK
Many believe that the private sector has little to offer in terms of reaching the Millennium Development Goal of 'education for all' by 2015. Private education is often assumed to be concerned only with serving the elite or middle classes, not the poor. What is the nature and extent of private education for the poor? This working paper outlines how private schools can play an important role in reaching the poor and satisfying their educational needs.
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Quality and regulation

Some researchers argue that NSPs are more responsive than state providers and are more able to be innovative and inclusive. Often, small scale providers are able to reach underserved areas and give poor people access to vital services that they would otherwise be denied. Other researchers argue that despite these positive aspects, NSPs are under-regulated and often provide poor quality services. Weak state capacity, lack of information and a poor dialogue between the state and NSPs makes regulation difficult.  Whilst users are reliant on NSPs to fill the gaps left by public provision, governments are often wary of endorsing them due to concerns over quality and accessibility. 

Moran, D., 2006, ‘Comparing Services: A Survey of Leading Issues in the Sectoral Literatures’, Public Administration and Development, vol. 26, issue 3, p 197-206 
What does the literature say about the interaction between state and non-state provision of basic services? What does it tell us about government capacity to regulate, facilitate and contract non-state providers (NSPs)? This article from the journal Public Administration and Development reviews recent research into government interventions in non-state provision of education, health, water and sanitation, and identifies gaps in the literature.
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NSP relations with the state

Until recently, little research has explored the relationship between the state and NSPs. Relations are generally marked with deep scepticism and a weak policy dialogue. Several authors suggest that the government must move from reluctance to engage with NSPs and repressive forms of regulation, to creating an enabling environment for NSPs. This includes promoting creative, alternative forms of regulation, improving dialogue and providing practical support.

Batley, R., 2006, ‘Engaged or Divorced? Cross-service Findings on Government Relations with Non-state Service Providers’, Public Administration and Development, vol. 26, issue 3
To what extent has non-state provision (NSP) of basic services operated within supportive policy environments? How could governments improve their collaboration with non-state providers (NSPs)? This paper, published in Public Administration and Development, surveys case studies of non-state provision of education, healthcare and sanitation services in South Africa, Malawi, Nigeria, Pakistan, Bangladesh and India, and finds that, while policy is now generally in support of NSP, practice is more often unsupportive and relationships are surrounded by mistrust. Nevertheless, enhanced operational engagement between governments and NSPs - in the form of strong, independent regulatory bodies and joint ventures - could promote better services for poor communities.
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Larbi, G., 2006, ‘Opportunities and Challenges in Enabling Non-State Providers of Basic Services: Case Studies and Lessons from Nigeria’ paper prepared for the workshop ‘The Politics of Service Delivery in Democracies: better access for the poor’, 27-8th April, Stockholm
What is the role of non-state providers (NSPs) in service delivery, especially in relation to the poor? What is the policy environment in which NSPs operate and to what extent do governments support and engage with them? This paper from the University of Birmingham’s International Development Department presents findings from a study of small-scale water, health and education NSPs in Nigeria.
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Privatisation

There are different levels of privatised service provision including public private partnerships and total private ownership. Private service provision in developing countries has been hindered by weak regulation and low investment. Privatisation has also been criticised for reducing accountability and equity for the poor.

Bayliss, K., and Kessler, T., 2006, 'Can Privatisation and Commercialisation of Public Services help Achieve the MDGs?', Working Paper 22, Brasilia, United Nations Development Programme, International Poverty Centre, Brazil 
Basic services are essential to reducing poverty and improving quality of life. Should these services be provided by the state, or the private sector? This paper, based on a UNDP project on privatisation and poverty reduction, examines the impact of market-oriented reform policies on the delivery of basic services in developing countries. It argues that reliance on private sector provision will not address the central challenges of public sector delivery. Market-led policies also fail to contribute to the MDGs and often reduce the likelihood of achieving them. The debate over public service reform must be focused on poverty reduction, and the State has to assume central responsibility for the provision of essential public services.
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PPP’s and contracting

Public Private Partnerships (PPP’s) are a system where government services are funded and operated through a partnership between government and a private company or citizen based organisation. PPP’s are used extensively in developed countries which has led to their increased use in developing contexts.  Contracting is a type of PPP. With careful design and management, contracting can bring benefits to the state including increased efficiency and the transfer of risks and costs to the private sector. 

Ayee, J. and Crook, R., 2003, 'Toilet Wars: Urban Sanitation Services and the Politics of Public-Private Partnerships in Ghana', IDS working paper 213, Institute of Development Studies, Brighton
Do public-private partnerships actually realise the improvements in service provision that their proponents claim? This paper for the Institute of Development Studies examines the impact of the new forms of partnership between the public authorities and private/citizen-based organisations on urban environmental sanitation in the two largest cities of Ghana, Accra and Kumasi. It traces the history of public toilet policies in the two cities and analyses the factors that contributed to their failure in poor neighbourhoods.
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Batley, R. and Larbi, G., 2004, 'The Experience of Contracting', Chapter 7 in The Changing Role of Government: The Reform of Public Services in Developing Countries, Palgrave
Contractual arrangements for service delivery are common across sectors in developing countries. But why are governments so reserved about moving towards longer-term and deeper contractual arrangements? This study by the International Development Department at the University of Birmingham suggests that governments have usually chosen measurable activities for contracting, embarking on short-term contracts which present fewer problems of capacity and resistance. It finds that more qualitative services are rarely contracted out and often present problems.
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Abramson, W., 2004, ‘Contracting for Health Care Service Delivery: A Manual for Policy Makers’, Jon Snow Inc, Boston
What are the benefits and limitations of using contracts for health care service delivery? What steps are key to good contract management? This guide by John Snow Inc. provides a short overview for healthcare policy makers of the benefits and limitations of contracting, focussing on performance-based contracting, and describes the steps that are key for good contract management. Contracting can only succeed if prerequisite conditions relating to political and legislative context and the public sector’s capacity to manage the process exist.
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Schwartz, J. and Bhushan, I., 2004, ‘Cambodia: Using Contracting to Reduce Inequity in Primary Health Care Delivery’, HNP Discussion paper, Reaching the Poor Programme Paper no. 3, World Bank, Washington D.C. 
What is the equity impact of using private sector contracts for the delivery of primary health care as an alternative to government provision? This World Bank paper uses pre- and post-intervention data from a large scale contracting experiment in rural Cambodia between 1998 and 2001. The results suggest that poor people living in contracted districts were more likely to receive primary health care services than similarly circumstanced people in government districts.
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