![Page 1: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/1.jpg)
Decentralization and service delivery
![Page 2: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/2.jpg)
The problem
• Disappointing health and education outcomes, especially for poor people
![Page 3: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/3.jpg)
Outcomes are worse for poor peopleDeaths per 1000 births
Source: Analysis of Demographic and Health Survey data
![Page 4: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/4.jpg)
Outcomes are worse for poor peoplePercent aged 15 to 19 completing each grade or higher
Source: Analysis of Demographic and Health Survey data
![Page 5: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/5.jpg)
The problem
• Disappointing health and education outcomes, especially for poor people
• Increasing public spending is not enough
![Page 6: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/6.jpg)
Increasing public spending is not enough
* Percent deviation from rate predicted by GDP per capitaSource: Spending and GDP from World Development Indicators database. School completion from Bruns, Mingat and Rakatomalala 2003
![Page 7: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/7.jpg)
Increasing public spending is not enough
* Percent deviation from rate predicted by GDP per capitaSource: Spending and GDP from World Development Indicators database. Under-5 mortality from Unicef 2002
![Page 8: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/8.jpg)
The problem
• Disappointing health and education outcomes, especially for poor people
• Increasing public spending is not enough
• Services failing poor people at local levels
![Page 9: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/9.jpg)
• Resources fail to reach frontline service providers
– Bulky state administrations soak up bulk of the resources
– Leakage: in Uganda, only 13 percent of non-wage recurrent spending on primary education reached primary schools
– Mismanagement: in Nigeria, community health workers often don’t get paid
The real problem for policy:Services failing poor people
![Page 10: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/10.jpg)
The real problem for policy:Services failing poor people
• Service quality is low for poor people
– Bangladesh: Absenteeism rates for doctors in primary health care centers: 74 percent
– Zimbabwe: 13 percent of respondents gave as a reason for not delivering babies in public facilities that “nurses hit mothers during delivery”
– Guinea: 70 percent of government drugs disappeared
![Page 11: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/11.jpg)
The solution: Decentralize?
• Increasing accountability for local services
• Decentralization to locally elected governments—analyzing potential impact within a framework of accountability
![Page 12: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/12.jpg)
Poor people Providers
A framework of relationships of accountability
![Page 13: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/13.jpg)
Poor people Providers
Policymakers
A framework of relationships of accountability
![Page 14: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/14.jpg)
Mexico’s PRONASOL, 1989-94
• Large social assistance program (1.2 percent of GDP)
• Water, sanitation, electricity and education construction to poor communities
• Limited poverty impact – Reduced poverty by 3 percent– If better targeted, could have reduced it by
64 percent
![Page 15: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/15.jpg)
PRONASOL expenditures according to party in municipal government
Source: Estevez, Magaloni and Diaz-Cayeros 2002
![Page 16: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/16.jpg)
Poor people Providers
Policymakers
A framework of relationships of accountability
![Page 17: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/17.jpg)
Absence rate among teachers
Country Rate (percent)
Ecuador 16
India 25
Indonesia 18
Papua New Guinea 15
Peru 13
Zambia 17
Uganda 26
![Page 18: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/18.jpg)
Poor people Providers
National policymakers
Decentralized service delivery
Local policymakers
![Page 19: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/19.jpg)
Poor people Providers
National policymakers
Fiscal issues
Local policymakers
![Page 20: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/20.jpg)
Fiscal Issues
• Expenditure assignments– Loss of economies of scale
– Concurrent responsibilities can lead to duplication, confusion, and evasion
• Financing—tax assignments, intergovernmental transfers, borrowing– Soft budget constraints
– Tax inefficiencies and inequities
– Political distortions in resource distribution
![Page 21: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/21.jpg)
Poor people Providers
National policymakers
Administrative responsibilities
Local policymakers
![Page 22: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/22.jpg)
Poor people Providers
National policymakers
Capacity constraints
Local policymakers
![Page 23: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/23.jpg)
Poor people Providers
National policymakers
Political issues
Local policymakers
![Page 24: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/24.jpg)
Political Issues
• Why do services fail poor people even in democracies where politicians depend upon their support to gain and remain in office?
• Political market imperfections
– Information constraints
– Social polarization
– Credibility of political promises
![Page 25: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/25.jpg)
Do information problems improve with decentralization?
• Voters better informed about local public goods
• Easier to monitor local services
• Easier to coordinate rewards/ punishments when policy dimensionality is reduced
• In Uganda and the Philippines, voters rely on local social networks for information about local govts., and on national newspapers for national govts.
• In Nigeria, uncertainty about fiscal resources available to local govts.
• In India, voters hold state governments responsible for local services
![Page 26: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/26.jpg)
Does social polarization reduce with decentralization?
• Decentralized units more homogeneous
• Some local communities even more polarized (within-village inequality in India very high)
• Local elites find it easier to mobilize and “capture” public resources
![Page 27: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/27.jpg)
Does political credibility increase with decentralization?
• Proximity and reputation breed credibility
• In young democracies, politicians build credibility by targeting their “clients”
• Combination of social polarization and young democracy make local politics particularly “clientelistic”
![Page 28: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/28.jpg)
Political Issues
• Why do services fail poor people even in democracies where politicians depend upon their support to gain and remain in office?
• Political market imperfections– Information constraints
– Social polarization
– Credibility of political promises
• Political Institutions and Electoral Rules
![Page 29: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/29.jpg)
Political Institutions and Electoral Rules
• Non-pivotal/non-swing voters get neglected under centralization (Eg. Bolivia)
• Lower barriers to entry increases political competition
• National political parties determine objectives and incentives of local governments
• Proportional representation and district magnitude more significant determinants of service delivery incentives
![Page 30: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/30.jpg)
Poor people Providers
National policymakers
Transition dilemmas
Local policymakers
![Page 31: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/31.jpg)
EDUCO Program in El Salvador
• Parents’ associations (ACEs)– Hire and fire teachers– Visit schools on regular basis– Contract with Ministry of Education to
deliver primary education
![Page 32: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/32.jpg)
EDUCO promoted parental involvement…
Source: Adapted from Jimenez and Sawada 1999
…which boosts student performance
![Page 33: Decentralization and service delivery. The problem Disappointing health and education outcomes, especially for poor people](https://reader036.vdocuments.us/reader036/viewer/2022070416/5697c0301a28abf838cda845/html5/thumbnails/33.jpg)
Conclusion
• Services fail when accountability breaks down
• Decentralization can overcome or exacerbate accountability failures
• Institutional design should address political market imperfections:-- provide more relevant information-- de-emphasize social polarization-- build credibility for public services