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?

World Bank, 2003, ‘Making Services Work for Poor People: World Development Report 2004’, World Bank, Washington D.C. 
How can countries accelerate progress towards the Millennium Development Goals by making services work for poor people? How does the integration of poor people into determining the quality and quantity of  services they receive ensure higher success rates? The 2004 World Development Report from The World Bank looks at successful innovations and failures to guide policymakers on improving the delivery of basic services.
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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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Chand, V., 2004, ‘Reforming Public Services in India: Drawing Lessons from Success’, World Bank, Washington D.C.
What examples of good practice have emerged from public service reforms in India? This paper from the World Bank surveys examples of successful innovations in service delivery and makes recommendations for policymakers. Political commitment, well-integrated, accountable administrative bodies and support from civil society are key to ensuring effective change. The Indian government should promote security of tenure within the civil service, broad political consensus for change, and the dissemination of lessons learnt by public service reformers.
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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.

Batley, R., 2004, ‘The Politics of Service Delivery Reform’, Development and Change, vol. 35, no.1, pp. 31-56
Have policy makers and citizens in developing countries played a significant role in reforming their service delivery systems? This article, published in Development and Change, examines the process of public service reform and identifies its leaders, supporters and resisters. It argues that the involvement of international lenders and donors can undermine accountability in that process and lead to disappointing outcomes.
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Joshi, A., 2006, 'Institutions and Service Delivery in Asia', Paper presented at Asia 2015, March 2006, 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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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.

Pearson, M., 2004, ‘The Case for Abolition of User Fees for Primary Health Services’, report to UK Department for International Development (DFID), DFID’s Health Systems Resource Centre, London.
Should user fees be abolished for health care? This paper by the UK Department for International Development's (DFID) Health Resource Centre, looks at whether DFID should campaign for the abolition of user fees and be prepared to meet the costs. It argues that while the cost of health care is hindering progress towards the Millennium Development Goals (MDGs), user fees are not the main barrier to access. It thus questions the value of a DFID policy promoting a worldwide abolition of user fees for basic health in poor countries.
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Hutton, G., 2004, ‘Charting the Path to the World Bank’s ‘No Blanket Policy on User Fees’’, report to UK Department for International Development (DFID), DFID’s Health Systems Resource Centre, London.
Should user fees be abolished for healthcare and education? This paper from the UK Department for International Development (DIFD) looks at the history of fees in Africa. The recent move towards free services by some countries has led to a large increase in their use. If the Millennium Development (MDGs) goals are to be met, this process should be expanded. However, any decision to abolish fees must be made with a long-term vision, not only of financing, but also of planning.
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Bitran, R. and Giedion, U., 2003, ‘Waivers and Exemptions for Health Services in Developing Countries’, Social Protection Discussion Paper Series, World Bank, Washington D.C.
Can a system of user fees in health care be compatible with the goal of preserving equitable access to services? Is the use of waivers the way forward? This study from the World Bank assesses health care systems in Asia and Africa and argues that the key to success is in the design of waiver systems.
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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.

World Bank, 2005, ‘Scaling Up Service Delivery’, chapter 3 in ‘Global Monitoring Report, Millennium Development Goals: From Consensus to Momentum’, Washington D.C
Good health, gender equality, literacy and primary education are at the core of the Millennium Development Goals (MDGs). Achieving them depends largely on how governments spend their money. This chapter from the World Bank’s Global Monitoring Report 2005 assesses progress so far and outlines the challenges ahead. These challenges include increasing the number of teaching and medical staff, ensuring sustained funding to expand education and health care, and improving governance and accountability to ensure effective service delivery. Of these, poor governance is the greatest threat to MDG progress.
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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 relevant section of the GSDRC Topic Guide on Politcal Systems.

Robinson, M., 2007, ‘Does Decentralisation Improve Equity and Efficiency in Public Service Delivery Provision?’, IDS Bulletin vol 38, no. 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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Ahmad, J. and Devarajan. S, 2005, 'Decentralization and Service Delivery', Policy Research Working Paper no. 3603, World Bank, Washington D.C.
Dissatisfied with the systematic failure of centralised approaches to delivering local public services, a large number of countries are decentralising responsibility for these services to lower-level, locally elected governments. What problems have been encountered with decentralising service delivery and how can these challenges be overcome? This paper provides a framework that explains both why decentralisation can generate substantial improvements in service delivery and why it often falls short of this promise.
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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.

Chapman, K., 2006, 'Using Social Transfers to Scale Up Equitable Access to Education and Health Services', Background Paper, Scaling Up Services Team, DFID Policy Division, Department for International Development, London
How can social transfers support the scaling up of health and education services and outcomes for the extreme poor? Are social transfer schemes cost effective? This paper, by the United Kingdom Government Department for International Development (DFID), reviews research, programme documents and grey literature to consider the impact of social transfers, particularly cash transfers and vouchers, on access to health and education services. It finds that social transfers do increase poor people’s access to health and education and can make a broader contribution to human development outcomes. Nevertheless a number of factors need to be considered when assessing policy options.
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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 (DFID), GHK International, London
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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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).

MacDonald, M., 2001, ‘Developing Gender-Sensitive Local Services’, report from a One World Action and British Council seminar, 28-29th June 2000, London 
How can we ensure that basic services are gender sensitive? This report from One World Action and the British Council looks at the processes by which services could be better tailored to men and women. It argues that services that respond to gender differences contribute towards gender equality and equity in general.
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