World Development Report 2004: Making Services Work for Poor People

World Development Report 2004: Making Services Work for Poor People

On Tuesday, April 6, 2004, at 10 am EDT (1400 GMT), Ritva Reinikka, Co-Director of the World Development Report 2004 Making Services Work for Poor People and Manager of the World Bank’s Public Services Research Program, took your questions on the 2004 WDR and on providing services to the poor.

Prof. Vrajlal Sapovadia:
Do you think that Self Help Groups may be a force to improve service delivery? How SHG can work in motivating, uniting people to share their views and make them enable to monitor proper service delivery? How this can be used as not only check on government but assist them?
Ritva Reinikka:
As is the case so often, it depends. For example, in the Jamaica Social Investment Fund, self-help did not necessary empower the poor, as elites dominated the selection process. But once the investments were completed, most people were happy. The Fund also appeared to have improved trust and capacity for collective action, although gains are greater for more educated individuals. In other contexts, where social divisions are deep, it may be difficult to sustain positive social benefits in long term. Sometimes self help can show poorly-performing public sector agencies the way to improve or set them a higher standard.
Endalkachew:
Hello Ritva, Though the main elment of the debate is its effect, i.e. enabling the poor to have strength in his voice as well as in policy making essues, how could this can be hapen with out the debate, that you said it "False"? Thanks,
Ritva Reinikka:
I am more for the Bank information than voice. What the statement meant to say is that just focusing on the private-public debate, or private-public dimension, may not be that useful. One size does not fit all, but maybe eight sizes, or more sizes, do. In other words, services can be made to work through the public sector or the private sector, depending on the context. The key thing is that services work, not an ideological position.
Rizwana Siddiqui:
I do aggree with you that that real issue is whether the mechanism that delivers services strengthens poor people's capability But private provision is very expensive so how we can think that they are working for the poor, In case of NGO, or other organisation financed by International donors can help the poor but again quation is are they providing services at the large scale that poor will benfit from it significantly. i dont think so. But there are issues other than cost, which we should take into account are as follows. Take the example of health services. In public hospital what poor face is 1. Long waiting hours, If poor has too spend full day at the public hospital to take medcine for 'fever', he or she has to forego their work and wages. in case of women someone accompany her so there is double waste of time. 2. uinavailablity of medicines especially for poor 3. Nepotism, if you know someone you are well take care off. the main problem is of governances and mangement. Take example of education, a large number of students are enroled there, what is the precentage of pass-out and how many of themm reached to high paid jobs. How many complete their eductaion. In a survey some people report that they left school because they dont like the method of teaching. In private schools fees are very high that are agin not approach able for the poor. So i think the real poroblem is the management and goverenance issue which can help the servicces to work for poor. Private VS public is also important as governemnt can subisdize their education provision if they are really working better than public schools. currently I am working on poverty issues and developed a model to test hypotheses: Income, public or rpivate provision of social services important in the satisfaction of basic need. I am using district level data. Instead of using public expenditure i developed a public policy/private and combined index for social services, education, health services and sanitation and clean water supply. I hope i will get something siginificant out of that model. I will send you results as soon as i will complete.
Ritva Reinikka:
Rizwana Siddiqui highlights eloquently many of the problems of service delivery through the "long route" (where the state is involved). The extent to which NGOs can replace failing or absent public services depends on the country. In Bangladesh, NGOs have assumed a major role in education, micro finance, and other areas. Often these providers have to recover their costs from users to the extent they do not receive subsidies from donors or the state. Sometimes donor aid can create incentives to NGOs which are less committed to improving people's welfare. Or, sometimes NGOs operate in a small scale only. Your results are most welcome, please send them when they are ready!
usman Habila Maisamari (partial-Deaf):
DO DISABLEDS IN DEVELOPING COUNTRIES DESERVED BOTH SCHOLARSHIPS AND EMPLOYMETS FROM THE WORLDBANK AS A MEANS OF HELPING THEM TO FIGHTS THEIR UNFORTUNATE NATURE?
Ritva Reinikka:
The World Bank does not directly provide scholarships and employment, but assists governments and other stakeholders to implement programs that do both. Many countries have policies to ensure that their citizens with disabilities have equal access to services. Where services fail, as too often is the case, they often fail the disabled too. The World Bank has recently put a new emphasis on disabilities and there is a growing portfolio of Bank projects that includes people with disabilities. Improving the quality of this projects is a high priority.
Sitanshu Singh:
Hi, I am from India and own my own consulting firm (Aquon Consulting - www.aquon.com) providing services in Entrepreneurship, Corporate Finance, Environmental Services, Information technology. My question: In your opinion how can a PPP (Public Private Participation) structure be made into a success, both in terms of Socio Economic Impact (providing employment, quality services, quality social life, basic amenities, healthcare) and bringing reasonable returns to the private investor. In my experiences citing one example when I had drafted the Information Technology Strategy Paper for the Government of Maharashtra, India (while working at Ernst & Young Consulting), the end objective of the paper was to limit migration of peoples talent from small rural towns to larger cities and create an conducive environment for private sectors to move funds and workings to smaller rural towns in a Govt-Private participation model. It has been a failure due to various reasons (i could cite these someother time!). THe same has been the experience at other times be it in Environmental services (CETP, etc) or entrepreneurship. How do you ensure that all the thinking and strategizing that people like us develop gets actually implemented in the way it should be. How do you beat the system when the same system is responsible for it!!
Ritva Reinikka:
This is indeed a fundamental question-and where there are unfortunately no easy answers! In your specific case, it would probably be useful to analyze why the effort did not succeed, given that many of the key relationships of accountability can have failed. That is, are the problems political? Or, are they perhaps in the incentives? Or, is it that the politicians and service providers are in a much stronger position than the users? Based on such assessments, one could then decide either to work on the failing aspect, or alternatively, leave it alone and focus on another stakeholder or relationship. Private-public partnership is often a long process, maybe reluctantly adopted, but that can deliver when resistance to reform is gradually overcome and positive results convince the users.
Salvador Cortes:
Ms. Reinikka is right about all the goals that public services should bring. The problem is how the WB convinces governments that this is right and that they should in reality accomplish it? From the desk of Ms. Reinikka to the village where these public services are gear to impact is a universe of distance so the challenge is bridging this abyss. And yes, public services should empower the users so they are able to receive better, more efficient (quality and cost wise), and less political services.
Ritva Reinikka:
One of the ways the World Bank tries to convince governments to improve service delivery is by choosing "Making Services Work for Poor People" for the topic of the 2004 WDR! The Report highlights reasons for failures and brings out successes. The 13 spotlights we have selected, such Kerala in India, a conditional cash transfer program, Progresa, in Mexico, universal primary education in Uganda, or the historical perspective of Norway, provide many such lessons. We hope that governments and others can learn from these cases. And we hope that the World Bank will also adapt its approaches, where necessary, when helping governments through finance and knowledge. For example, we collected systematic information on teacher and health worker absenteeism from large random samples in eight countries (including 19 states in India)-the very villages Salvador Cortes mentions-and brought this evidence to bear worldwide.
dr.k.k.arora:
Having worked in Zambia for 5yrs-very closely with loclas,since I was service provider-as a medical doctor,I feel that whole of African continent needs to be looked after carefully by providing practically free services at least in Education,Health andto some extent food.Children & elder population needs special attention.Is there any proposal still there for such and other underdeveloped/developing nations.I can contribute as a volunteer.Thanks.
Ritva Reinikka:
Even with important contributions by volunteers, it is unlikely that adequate resources-domestic or foreign-will be available for free services for all at all levels of education and health care, or food distribution. Governments and other stakeholders need to prioritize. Specifically, there is a need to balance protection of the poor, efficiency in allocation of resources, and the ability to guarantee that good quality services are actually delivered and sustained. At present, service quality leaves much to be desired in Zambia and elsewhere in Africa. In the case of primary education, I fully agree with Dr. Arora’s suggestion of free services. But fees for higher education may be appropriate, with an accompanying student loan program. Charging fees that balance distributional goals with efficiency may be necessary also in curative health care, if they crowd out staff time available for higher-priority public health activities. Sometimes, when the “long route” of service delivery functions poorly, fees may be necessary to obtain any services at all, or to generate “client power” over providers and thus improve services.
dr.k.k.arora:
Having worked in Zambia for 5yrs-very closely with loclas,since I was service provider-as a medical doctor,I feel that whole of African continent needs to be looked after carefully by providing practically free services at least in Education,Health and to some extent food.Children & elderly population needs special attention.Is there any proposal still there for such and other underdeveloped/developing nations?I can contribute as a volunteer.Thanks.
Ritva Reinikka:
Even with important contributions by volunteers, it is unlikely that adequate resources¾domestic or foreign¾will be available for free services for all at all levels of education and health care, or food distribution. Governments and other stakeholders need to prioritize. Specifically, there is a need to balance protection of the poor, efficiency in allocation of resources, and the ability to guarantee that good quality services are actually delivered and sustained. At present, service quality leaves much to be desired in Zambia and elsewhere in Africa. In the case of primary education, I fully agree with Dr. Arora’s suggestion of free services. But fees for higher education may be appropriate, with an accompanying student loan program. Charging fees that balance distributional goals with efficiency may be necessary also in curative health care, if they crowd out staff time available for higher-priority public health activities. Sometimes, when the “long route” of service delivery functions poorly, fees may be necessary to obtain any services at all, or to generate “client power” over providers and thus improve services.
OKORO IFEANYICHUKWU:
how can a poor rural community dweller who have farming as only skill and means of livelihood in a developing country like nigeria without good education,landed property or link with govt. benefit
Ritva Reinikka:
A large share of Nigeria’s national wealth is generated by oil and channeled as transfers through the public budget at the central, state and local levels. In principle, Nigerians should benefit from these resources in the form of access to public education, health, and other services. But the recent evidence, for example, from health care in Kogi and Lagos demonstrates that these services are of poor quality, or that health workers do not get paid even if funds are appropriated in the budget. The "long route" of service delivery through the state and thus services fail. Emerging democracy and elections are one way Nigerians hope to have their voice heard and services improved. But client empowerment, such as mass information campaigns on entitlements and citizen report cards, would probably deliver high returns. Local NGOs should definitely consider implementing them. The Report highlights several cases where they have been tried and succeeded.
Mark Sheldrake:
I concur with the general thrust of Ritiva's statement but, to what extent should the mechanisims that aim to empower the poor in the decision making process, also be part of and strengthen effective local 'governance'? Local Governance in this context involving the genuine partnership between all stakeholders (public - central and local, private and civil society), working collaboratively & synergistically within a community agreed strategy, facilitated through the democratically elected municipality.
Ritva Reinikka:
Indeed, local democracy and elections are a major trend in today’s world, including developing countries. In principle, elections-both central and local-provide citizens answerability (the right to receive relevant information and explanations for actions), and enforceability (the right to impose sanctions if information or rationale are deemed inappropriate). In practice, democracies vary greatly in both dimensions. Political incentives for improving service delivery depend on how well voters are informed about politicians’ contributions to their welfare. They depend on ideological or social polarization, both reducing the weight voters place on services. Or, on whether political competitors can make credible promises before elections. If democracy does not bring better services, other accountability tools can be used, such as citizen report cards, public expenditure tracking surveys, or participatory budgeting. But voice, or the relationship between citizens and politicians, is only one leg in the “long route” of service delivery (that is, where the state is involved instead of citizens buying services directly from private providers, which we call the “short route”). Much depends also on incentives that policymakers are able to provide to service providers. If the “long route” fails, then empowerment of clients or the “short route” becomes crucial.
Chirantan Chatterjee:
I am a business analyst working with the Economic Times Intelligence Group, The Economic Times - India. When i look at the kind of penetration social entrepreneurship has in India - or for that matter in the most deprived economies of the world, i wonder. Is this the end of the world of Large Organisations and the start of small and medium enterprises. Are we moving to from MNCs to SME led economy. And maybe someday to an individual/entrepreneur drive economy. Your comments please. Thanks and Best Regards Chirantan
Ritva Reinikka:
Large enterprises are probably always needed, as individuals or households seldom achieve economies of scale necessary for productivity gains. In service delivery, if large (public) provider organizations, or the entire “long route” of service delivery, that is, politics and incentives, fail, then social entrepreneurs emerge to fulfill the demand by clients. But the poor may not be able to access private services or may receive poor quality. Therefore, the public sector cannot relinquish its role entirely even if the private sector is the main service provider. The public sector has a responsibility to regulate. An example from Bangladesh illustrates this point. When the government failed to fulfill its public responsibility of monitoring water quality, an arsenic crisis resulted. Another example detailed in the World Development Report is health care in India where the public sector suffers from high staff absenteeism rates (43% on average), and the private sector often offers poor quality services. Measures to improve the “long route” are necessary, but must be complemented by client empowerment, such as citizen report cards introduced by the Public Affairs Center in Karnataka.
Roger Mbuga:
Should emphasis on service delivery focus on strengthening the institutions and frameworks that underpin the overall process?
Ritva Reinikka:
This is precisely what the WDR is about. When services fail across the board-say, when health worker absenteeism is 43 percent as in India, or leakage of funds is 87 percent as it was in nonwage education spending in mid-1990s in Uganda-this is an institutional problem, not a management problem. The Report suggests that there are three key institutional relationships of accountability between citizens/clients, policymakers and providers. They are voice (or politics), incentives to provide good services, and clients’ power over providers. When these relationships of accountability are all strong, public services work well. When the "long route" fails, that is, when the politics are clientelistic and incentives to deliver services are weak (no monitoring, poor information), services usually fail. Although difficult, client empowerment through, say, mass information or citizen report cards, becomes important in these situations.
leslie:
Why are there so many conditionalities attached to the PRSP's prepared by HIPC countires or any LDC. Don't you think that these conditionalities constrain the achieving of the goals of the PRSPs? Also, why haven't the IMF/World Bank endorsed policies to ensure that HIPC countries are not vicims of WTO patent laws which makes necessary pharmaceuticals unaffordable
Ritva Reinikka:
The PRSP actually represents a different approach to increasing citizen voice and improving service delivery. It relies on a domestic process and deliberately not on donor conditions. By conditionality, donors tried in the past to replace a weak citizen voice in disciplining policymakers. Yet, donor conditions are fundamentally different from citizen voice, which is diffuse, after-the-fact, and a long-term process. As Leslie seems to imply in her question, traditional conditionality did not work very well. The Report highlights empirical evidence of that. But it is important to note that the PRSP is not about conditionality, but participation. There has been major progress in the WTO regarding pharmaceuticals. Specifically, the WTO made a very important decision in favor of least developed countries in 2001 when it decided that at least until 2016, least developed countries could elect not to enforce patents that might affect the procurement of medicines. Furthermore, all developing countries could issue “government use licenses” to make (or purchase) and distribute a medicine without the consent or approval of the patent holder. And all countries¾developed, developing, and least developed¾are permitted to authorize "parallel imports" of medicines. This means that the procurement authority can shop for the lowest priced patented medicines available on the market in any country, purchase those medicines in a foreign country, and import them without the consent of the patent holder in its own country. In other words, WTO offers flexibility to HIPC and non-HIPC countries to improve better access to drugs. The World Bank has recently issued a Technical Guide to set principles and provide advice to countries scaling up antiretroviral program on procurement of medicines and supplies. Our lawyers is also drafting model legislation that countries can adopt in order to ensure that their national legal frameworks enable the use of the flexibilities offered by TRIPS (the WTO Agreement on Intellectual Property Rights) and related declarations.
Aleksi Hokkanen:
Dear Mrs Reinikka, I agree with your fundamental these. Despite the discussion related to market efficiency, free-rider problem, Pareto-efficiency, second-best theorem, public goods or utilitarism, the only thing that counts in the end of the chain, is whether people finally get the services they need. Especially I want to underline the difficulty in the concept of "serving the poor". In many countries the poor are stigmatised and people working in the "service delivery chain" -is it public or private- work mostly to their superiors, hierarchicals or to the rich who are respected. In my opinion the biggest challenge lies in the question how to strenghten the service oriented attitude and behaviour to be more pro-poor or at least guarantee some equity. Especially challenging it might be in countries that have had a collective delivery mechanism in the past.
Ritva Reinikka:
I fully agree with Aleksi that the most important issue is whether people, particularly poor people, ultimately receive good-quality services. This is why we need to put the client at the center of service delivery. A strong focus on outcomes is also important to the same effect. The Report suggests that both donors and recipients should learn more systematically about innovations and service delivery arrangements. For example, Progresa (conditional cash transfer program to households) in Mexico has been scaled up and expanded to other countries thanks to its success, which has been demonstrated in numerous impact evaluations. Without the evidence this may not have happened. To find out what works and what doesn’t is important for scaling up successes and shedding failures. What makes transition economies such a challenge is that all three relationships of accountability (using the WDR terminology: voice, incentives, and client power) were fundamentally altered during transition and therefore they're finding new ways of arranging these relationships.
Michael Grosspietsch:
Dear Ritva, Please share with us your opinion on tourism as a tool for poverty alleviation and sustainable development. Despite numerous acknowledged potential negative impacts (social, cultural, environmental and even economic), many officials in developing countries desire to further develop this globally leading services sector as engine for pro-poor growth. What is the World Bank’s position towards these intentions? Is the World Bank getting involved in tourism-related activities? Various small-scale initiatives have proven that tourism can indeed play a vital role in poverty alleviation. But in order to see the negative impacts reduced and the positive impacts increased on a greater scale, tourism planning and industry development in general need to have a pro-poor focus in national, regional and local institutions as well as the private sector. Can this be guaranteed under the current phase of liberalization (GATS etc.)? What in your view are the impacts of services liberalization on strategies of poverty alleviation through tourism? Focusing my personal work and research interests on any topic related to poverty alleviation through tourism, as well as the impacts of the liberalization on these strategies, I would like to get in touch with likeminded researchers, practitioners, consultants etc. Please contact me under michael.grosspietsch@gmx.net.
Ritva Reinikka:
Our report is not really about income generation or economic growth. Although both are very important for poverty reduction, and indirectly also for achieving human development goals. Please note, Michael, that the next WDR to be published in September this year focuses on investment climate, and will, hence, be closer to your question. But you are absolutely right that in many developing countries, such diverse countries as Kenya, Ecuador or Turkey, tourism is, indeed, an important earner of foreign exchange and engine of growth. While the World Bank is not lending in the area of tourism, tourism management does feature as an element in our environmental portfolio. Especially it features through operations which supports eco-tourism strategies with the objective of reducing the negative social and environment impacts.
Kashinath Sahoo:
In spite of continuous efforts of world bank to reduce the income inequality, it has widened in China and narrowed in India. What is the major reason behind it?
Ritva Reinikka:
Just to mention that the 2006 World Development Report will on “Equity and Development” and will for sure provide plenty of information on these two and other countries. The 2004 WDR we are discussing here focuses on improving service delivery. There are considerable inequities in access and quality of services across and within countries. Just a few points on India and China. Among developing countries, India’s income distribution is relatively equitable, and India is a kind of global laboratory for anti-poverty programs. Their effectiveness record is mixed, but, for example, the ‘Mid-day Meal Program’ at India’s schools, when combined with good quality instruction, is an effective “smart transfer” that provides a real incentive to poor families to keep their children in school, and out of poverty in the future. India has also launched reforms in liberalizing its economy, opening itself to competition and opportunities in the global market. Indians are benefiting from these changes, and the process continues. Even as economic growth reduces poverty, however, Indians would be wise to keep an eye on the country’s inequality, to ensure that it does not grow wider. India should protect its achievement of relatively egalitarian income distribution, and enhance it with measures that would improve opportunities for the poor. The experience of China over the last 25 years has been quite different. There, total inequality has increased, a major part of that increase being due to inter-regional disparities, as well as an increasing rural-urban divide. The latter is not a new phenomenon, whereas the former is new. Inter-regional inequality over the past half century has never been as high as it is today. What is more worrisome is that it is continuing to increase rather rapidly. A comparison with the experience of European countries and the US suggests it is either the lack of a well-integrated economy, with flexible national factor markets, or the absence of inter-regional redistribution mechanisms, that has prevented China’s tremendous growth performance and rising household welfare from being more equally distributed.
Mkenda Selestine:
There is a problems in public service deliviring in almost developing countries, in case the service is offered by private companies the tariff will always higher than if it was offered by goverment this has lead to the poor not to afford the price of service which is offered by private.Thus has lead a poor people to suffer more. Those services which before were used to receive subsidies from goverment have been stoped, and the rate of unemployement is very high, to survive, people have decided to live in primitive way ,2000 years back before Jesus born , the developed countries has also decreased their aids to developing countries making life more bitter.Therefore to rduce the poverty by year 2025 its achild dream.
Ritva Reinikka:
Whether reducing poverty is a child dream? When we look at whether the Millennium Development Goals can be reached by 2015, which is 10 years earlier, we find that, based on the current growth projections, the goal of halving poverty can be achieved by all but one of the six developing region. In Africa, growth must double for the continent to reach this goal. But in education only two developing regions would reach the goal of 100-percent primary completion rate with growth alone. Regarding child mortality none of the regions can achieve the goal with growth alone. Public resources are therefore needed to complement growth, but too often public services fail poor people. As Selestine mentions, private service are costly, but often poor people have no alternative but to rely on them, as public service benefit the better-off, or simply do not reach the poor. The Report offers important lessons for successful service delivery arrangements and examples to help improve the efficiency of public spending in as many developing countries as possible.
Vivian:
Do you consider food banks and food-rescue programs effective hunger-relief mechanisms, specifically for South America? If so, what practical eligibility criteria should be used to determine that the food be distributed to the extremely poor?
Ritva Reinikka:
This is a very specific question and we did not really in the report focus on these types of emergency services, and therefore, I really cannot answer the specific question about South America. However, about the eligibility criteria, I would like to say that the evidence is, for instance, lower grade grains or lower quality foods. Often if they are used, they are often self targeted and they work best as these type of tools. So that's one piece of evidence that clearly is there to -- so instead of having elaborate eligibility criteria rather, a choice of the food to be distributed so that the food itself is self targeting, that has proven to work very well.
Manjith:
I feel the panchayat raj system being followed by India as envisaged by Mahatma Gandhi goes a long way in stemming corruption, by promoting participation of the lower strata of society in policy related issues. Q. Your opinion about the same & comment on revitalisation of the same with is as of today become less trasparent than originaly envisaged.
Ritva Reinikka:
The achievements of the panchayat raj are really quite impressive in many ways. Unfortunately, I'm not aware of any evidence or studies of its impact on corruption, so your observation poses an interesting hypothesis. Also, I think that any system, in a fast changing world, needs revitalization. I am aware of several transparency or accountability tools that have been pioneered in India, such as the citizen report cards in Karnataka. So, undoubtedly, there is generally a need for more transparency, and I would think that it would apply to the panchayat raj as well.
M. WINDFIELD:
Then it would be up to the poor people to register themselves with the goverment? Not only in goverment surveys. But in the voter registration of a country. For that would be the only way for the poor to discipline providers, and get them the effective services they need for their families. Regestering with a goverment, regardless of the perception of the goverment. Would be the only means for the poor to raise their voice in policymaking.
Ritva Reinikka:
This is an interesting point. I think there are several cases. One comes to mind from Egypt where really registering was a fundamental thing for many poor families and poor women, in particular. And there were several NGOs and other organizations who actually helped a lot in this registering process. I think voter registration is also an important thing, but registering is probably not everything. There are many ways for the poor to raise their voice, and for other actors such as policy makers, politicians, NGOs to be amenable for many means of raising their voice. Perhaps registering is quite important in some areas and that should be helped, but there are many other issues involved in raising the voice of citizens, not just registering, which can be important in some cases.
Tamo Chattopadhay:
Dear Dr. Reinikka, I welcome the focus of WDR 2004 on making services work for the poor. I also agree with your argument that public vs. private is a false choice. However, what concerns me in the ever-increasing emphasis on ‘efficiency’ of resource allocation and ever-vanishing discussion about ‘sufficiency’ of resource commitment (nationally, as well as internationally). Isn’t there a threshold of resource sufficiency, below which no degree of efficiency can make anything work? As important as efficiency arguments are, why do you think forums like WDR 2004 are not discussing the sufficiency issue with as much emphasis?
Ritva Reinikka:
This is a really important question. But it does not have to be such a stark trade-off. What we are saying in the WDR is that additional resources and increased efficiency in their use (improved service delivery) are complementary. When reforms increase the positive impact of public spending, the stronger becomes the case for additional resources. And such reforms, of course, should improve the efficiency of all spending. The choice of the 2004 WDR topic reflects the fact that too often service fail poor people. For example, in Guinea 48 percent of public spending on health goes to the richest 20 percent of population. Leakage of nonwage funds in education in Africa ranges from to 50 percent to 87 percent. Or, doctor absenteesim in Bangladeshi health clinics is over 70 percent. Rectifying the institutional problems underlying these statistics would go a long way to improving services for poor people. And additional resouces would be that much more effective!
Klaus Hornetz:
Donors in the past have much focussed on increasing “coverage” or “quality” of services and largely contributed towards the expansion of (health) services networks. At the same time, many studies in poor countries have shown the difference between user charges “officially” requested by public health services and “real” charges, which may be up to 5 -10 fold the official price. Like for example in many West African countries, this problem is letting people turn wherever possible to private service providers (with high but predictable prices), and you find public health services virtually “empty”. At the same time the majority of poor people hat no access to any health services at all. Many development programs for example to establish community based financing systems appear to ignore these facts. How could “pragmatical” solutions to this problem look like?
Ritva Reinikka:
I think Klaus' observations are spot on. We highlight many such examples in the Report as well, and indeed illegal fees in public services can be a big problem in many countries. I think the Report reminds us that governments are not always able to deliver or sustain services no matter how desirable they might be. We focus on market failures and equity issues and see an important role for government in addressing them. And indeed, governments do have an important role here. But when governments lack ability of do this, due to weaknesses in the key relationships of accountability, other ways to make services work should be tried. I do agree with Klaus that often donors or others don't take these failures into account. We offer a few pracmatic solutions or experiences on ways to increase client power over providers. One is information. During the process of working on the Report, we increasingly came to the conclusion that mass information, that is, lowering the cost of information by users about fees, entitlements, or performance is fundamental. This can be done trhough newspapers, radion and so on. Another pragmatic solution we highlight is the citizen report cards, which have been successful in places like Karnataka and elsewhere in India. A totally different scale of these interventions is required!
Kevin Keyes:
It does not sound like you believe the poor should appreciate the help and assistance we provide them. In fact it seems you believe that there is a right to provide free services to people that refuse to help themselves and continue a generation of economic slavery. Where in the history of the world has your belief and approach ever succeeded?
Ritva Reinikka:
I think many of the services we are talking about, health and education in particular, can be important means of escaping poverty. I don't think anybody really wants to be in poverty very willingly. As poor people are not able to pay for services, many governments and countries have exemption policies in place. The objective is really to give poor people a chance to escape poverty by building their human capital through education, and maintaining their labor by being healthy, and so forth. So, we do believe that it is very much in society's interest to try and facilitate poor people's access to these services, so that they could escape poverty.

Thank you for participating in the discussion.

For the complete text of the 2004 World Development Report, please see:
World Development Report 2004: Marking Services Work for Poor People

Discussion Transcript
Read the World Development Report 2004 - Making Services Work for Poor People



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