Service delivery

Pro-poor service delivery: introduction

Effective provision of basic services can contribute to state legitimacy and is vital for poverty reduction. Despite this, access to services in developing countries is highly constrained. Failures in service delivery are a key reason that people fall into poverty, for example through ill health. In contrast, good service provision helps people to transition out of poverty, for example through education. There is a clear need to strengthen service delivery systems in developing countries to improve quality and expand access.

This introduction includes resources on making service delivery pro-poor and managing service delivery reform to improve effectiveness and accessibility.

Page Contents:

Where is a good place to start
Public service reform
Political and institutional barriers to reform
User fees
Scaling up services
Decentralisation
Equity of access
Gender and service delivery

Where is a good place to start?

Sheng, Y.K. et al, 2007, ‘Access to Basic Services for the Poor: The Importance of Good Governance’, Asia-Pacific MDG Study Series, United Nations Economic and Social Commission for Asia and the Pacific, United Nations Development Programme and Asian Development Bank
What role can good governance play in attempts to implement the Millennium Development Goals and eliminate global poverty? This report, part of the Asia-Pacific MDG Study Series, argues that removing physical, legal, financial and socio-cultural barriers matters as much as monetary aid. Including more service providers - in the formal and informal sectors, and through civil society organisations and traditional institutions - will support this effort. Moreover, working towards good governance creates cycles of empowerment that will increase the efficiency and effectiveness of services and empower the poor to become agents of their own development.
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Public service reform

‘Public Service Reform’ has gone through three waves. The first wave began in the mid –80s and focused largely on structural reforms in the context of the World Bank and IMF’s structural adjustment programmes. The second wave followed from the mid-90s and focused on capacity building, for example, improving staff skills, management systems and the work environment. The third wave has been dominant since 2000 and emphasises the importance of improved service delivery.

There are two main approaches to reform aimed at improving service delivery: a market based approach which emphasises choice as a basis for improvement, or a co-governance approach that views increased voice as a basis for improving services.

Batley, R. and Larbi, G., 2004, ‘Changing Approaches to Public Sector Management’, Chapter 2 in ‘The Changing Role of Government: The Reform of Public Services in Developing Countries’, Palgrave, Macmillan
What is the theory behind the new trends in public service reforms? What are the pragmatic rationales for change? This study by the International Development Department at the University of Birmingham reviews both the theory and practice of public service reform, including neo-classical and new institutional economic theories. It describes the more pragmatic rationales for change in the management of public services and provides an overview of the new approaches to public sector management.
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Joshi, A., 2008, 'Producing Social Accountability? The Impact of Service Delivery Reforms', IDS Bulletin, Volume 38, Number 6, pp. 10-17
Which types of state reform improve public services and citizen engagement? How can accountability mechanisms improve service delivery? This Institute of Development Studies (IDS) paper draws on the polity approach, which suggests that the organisation of state institutions influences who engages in collective action and around what issues. Collective action is essential for the poor if direct accountability is to work. Successful cases of social accountability are often the result of alliances that cut across class and public-private divides.
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MacPherson, E., 2008, 'Invisible Agents: Women in Service Delivery Reforms', IDS Bulletin, Volume 38, Number 6, pp. 38-46
Overwhelmingly it is women who access and use public services to meet household needs. New Public Management (NPM) emphasises empowering end-users as agents of accountability, and has influenced public service delivery reforms. This Institute of Development Studies (IDS) paper argues that the generic notion of end-users of public services found in NPM-inspired reforms is mistaken. It hides the constraints women face when accessing services, which can limit their efficacy as agents of accountability. Reformers need to consider gender power relations when designing service delivery reforms.
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Political and institutional barriers to reform

The reform of basic services cannot just be viewed as a technical or financial exercise. The main barriers to reform are political and institutional, including weak state capacity, elite capture, centralised systems and poor accountability mechanisms. Many different actors are involved in reform, for example donors, civil servants, elites and citizens, and they play key roles in either driving or impeding progress.

Joshi, A., 2006, 'Institutions and Service Delivery in Asia', paper presented at Asia 2015, March, Overseas Development Institute, London
This working paper, published by the Institute of Development Studies and the Overseas Development Institute, argues that institutional problems constitute the main barriers to the reform of basic services in Asia. Increased efforts are needed to improve access, quality and sustainability, and to promote citizen engagement in the delivery of basic services. Moreover, effective and responsive service delivery can also lead to governance dividends by reinforcing citizen’s confidence in public authority.
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Whitfield, L., 2006, 'The Politics of urban water reform in Ghana', Review of African Political Economy, Number 109, pp. 425-448
How does the interaction between domestic political systems and the aid system affect democratic governance? This article from the Review of African Political Economy examines the Ghanaian government's policy of private sector participation (PSP) in urban water reform. It illuminates the pervasive role of donors in policymaking, the embeddedness of the aid system and how donors affect the process of bargaining between the state and citizens.
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User fees

Charging citizens for using public services, or imposing user fees, has always been controversial. User fees have been heavily criticised for excluding the poor from accessing services and for not producing the expected rise in revenue to finance basic services. However, some research finds that in certain contexts user fees do improve access and can build accountability between providers and users. Many donors are now choosing to decide whether to support user fees on a case-by-case basis, depending on local circumstances.

Fredriksen, B., 2009, 'Rationale, Issues and Conditions for Sustaining the Abolition of School Fees' in Abolishing School Fees in Africa: Lessons Learned in Ethiopia, Ghana, Kenya and Mozambique', World Bank and UNICEF, pp 1-44
What is the rationale for abolishing school fees and what challenges is such an initiative likely to face? This chapter by Birger Fredriksen argues that removing school fees is necessary for sub-Saharan Africa to achieve its enrolment objectives and to stimulate further educational improvements on the continent. For the initiative to be effective, abolition of school fees must be implemented in coordination with other reforms targeting quality, access, and financial sustainability.
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Scaling up services

Improving the coverage of quality basic services is a major concern for states and donors. Some of the challenges to ensuring national, equitable coverage are a lack of skilled personnel, the prevalence of HIV/AIDS and unsustainable financial provision.

Bourguignon, F. and Sundberg, M., 2006, 'Constraints to Achieving the MDGs with Scaled-Up Aid', UNDESA Working Paper, no. 15, United Nations Department of Economic and Social Affairs, New York
What are the macroeconomic and structural challenges associated with scaling up aid? This paper from the United Nations Department of Economic and Social Affairs (UN-DESA) explores six aspects of financing for scaling up public service delivery, using a dynamic model applied to Ethiopia. Under certain circumstances, the Millennium Development Goals (MDGs) could be achieved by 2015 but this will require large levels of grant financing and careful attention to the allocation and sequencing of investments.
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DFID, 2008, ‘Scaling up basic services: effects of budget support on social sector results’, DFID Africa Human Development Advisers’ Retreat, February, Department for International Development, London
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Decentralisation

It has been argued that decentralisation can improve service delivery, primarily by increasing user participation, facilitating local responsiveness and encouraging accountability. However, other research questions these assumptions, arguing that challenges at the local level, such as mixed political incentives, weak capacity and limited financial resources, can mean that decentralisation does not automatically lead to service delivery improvements.

For a fuller discussion of decentralisation, please see the GSDRC Gateway Guide on Decentralisation and Local Governance.

In 2007 the Institute of Development Studies published a special edition of IDS Bulletin focusing on decentralisation, which includes the article below:

Robinson, M., 2007, ‘Does Decentralisation Improve Equity and Efficiency in Public Service Delivery Provision?’, IDS Bulletin vol 38:1
To what extent does decentralisation produce improvements in service delivery for the poor? This paper from the Institute of Development Studies (IDS) argues that political and institutional decentralisation do not currently contribute to increases in either equity or efficiency. However, a poor record on service delivery so far does not rule out scope for improvement. The challenge for proponents of democratic decentralisation is to specify methods by which equity and efficiency can be achieved under decentralised forms of service delivery.
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Schanke, L. and Lange, S. (eds), 2008, ‘Decentralisation and Gender. Coordination and Cooperation on Maternal Health Issues in Selected District Councils in Tanzania', Chr. Michelsen Institute, Bergen
How do Local Government Administrations (LGAs) in Tanzania coordinate and cooperate to reach gender-related goals? This study, published by the Chr. Michelsen Institute, identifies good practices in examining how five district councils cooperate with local communities, civil society organisations and the private sector to improve maternal health, and how well different departments within district councils coordinate their work. Structural problems, partly linked to financial issues, impede sustainable cooperation between local government and civil society. Cooperation with the Department for Community Development is central to enhancing participation and including lower local government levels.
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Ahmad, E., Brosio, G., and Gonzalez, M., 2009, ‘Uganda: managing more effective decentralization in Bolivia’ in Does Decentralization Enhance Service Delivery and Poverty Reduction? eds. E. Ahmad and G. Brosio, Edward Elgar, Cheltenham, pp. 192-222
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Inchauste, G., 2009, ‘Decentralization in Bolivia: has it made a difference?’ in Does Decentralization Enhance Service Delivery and Poverty Reduction? eds. E. Ahmad and G. Brosio, Edward Elgar, Cheltenham, pp. 161-191
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Equity of access

Reforms designed to improve participation do not automatically lead to improved access to services for poor people as there are often more hidden barriers that prevent people from using services, such as cultural traditions, gender issues, poverty, and physical distance from services. Groups who are often routinely excluded, such as rural communities or chronically poor people, often have to be specifically targeted to ensure that services are accessible for them. Many ‘demand-led’ approaches are emerging as successful mechanisms to tackle exclusion, for example voucher schemes, as they encourage providers to welcome previously marginalised groups.

Yazbeck, A., 2009 'A Menu of Pro-poor Policies' in Attacking Inequality in the Health Sector: A Synthesis of Evidence and Tools, World Bank, Washington, D.C., pp. 157-172
Several successful programmes addressing the problem of health care inequality have been documented in recent years. This chapter draws on 14 such case studies to suggest general lessons learned. It presents a menu of pro-poor policies, and identifies recurring themes and emerging 'rules of thumb'. Success in reducing inequality can be achieved through programmes that are: developed with an empirical and exploratory spirit; crafted with input from the poor; responsive to specific local realities; and continually evaluated and adjusted.
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Save the Children UK, 2008, ‘Making Schools Inclusive: How Change Can Happen’, Save the Children UK, London
What can NGOs do to promote inclusiveness in the school systems of developing countries? This book uses the experience of Save the Children UK and its partners to identify what changes are needed for school systems to become inclusive of all children, and how these can be leveraged. The experience of national education teams working for Save the Children provides insight into the approaches that have worked best.
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Komives, K. et al, 2007, ‘Utility Subsidies as Social Transfers: An Empirical Evaluation of Targeting Performance’, Development Policy Review, Vol. 25, No. 6, pp. 659-679
Do utility subsidies actually help the poor? This paper from the Development Policy Review argues that the average targeting performance of water and electricity subsidies is similar to that of other social transfer mechanisms using the same targeting method. The most common utility subsidies are consumption-based. These aim to subsidise low-volume users but primarily benefit the non-poor. Many geographically-targeted and most means-tested utility subsidies are progressive, but still exclude many poor households. Connection subsidies are an attractive alternative in low coverage areas, but they will only reach the poor if utilities extend network access to poor households and if households choose to connect.
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Marc, A., 2009, 'Delivering Services in Multicultural Societies', World Bank, Washington, D.C.
How can service delivery policies be designed and implemented so as to recognise and support cultural diversity? This book finds that long-term investment and strategies are needed. Basic principles include the importance of bottom-up and participatory approaches, deep institutional change, and ongoing policy adaptation. Poorly planned and under-resourced interventions can increase social exclusion. Governments should be prepared to meet the additional requirements of capacity building and institutional development.
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Gender and service delivery

Women and girls experience specific barriers to accessing services and to participating in service provision design and management. (Documents relating to gender are also mainstreamed throughout this guide).

Corner, L. and Repucci, S., 2009, 'A User's Guide to Measuring Gender-Sensitive Basic Service Delivery', United Nations Development Programme and United Nations Development Fund for Women, Oslo
How can gender-sensitive indicators be used to improve the relevance and quality of basic services for women? This guide offers suggestions and tools to help in developing and using appropriate indicators for various contexts. Sex-disaggregated and gender-sensitive indicators are essential for delivering gender-sensitive services that recognise the different roles, needs and situations of women and men. Indicators can also be used to challenge and inspire others to change their thinking on gender issues.
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Health, education, and water and sanitation: