Africa continues to face many challenges in achieving its development goals, and its unlikely that many of the countries in Sub-Saharan Africa will he able to meet the Millennium Development Goals (MDGs) by 2015 as expected. The failure to meet the MDGs is due in part to the limited amount of resources that are devoted to delivering social services such as education and health. Resources are necessary to build schools and health clinics, train and hire qualified service providers, and equip the schools and clinics with the essential learning materials for schools and drugs for health clinics. However, resources represent just one challenge that is not necessarily the most important. Recent evidence suggests that a crucial explanation for the poor human development outcomes is the poor governance in the delivery of social services.
A common response to accelerating the pace of human development has been to call for more resources. Donor countries especially have been called on to support poor countries in delivering social services more effectively and to more of their people. But while it is crucial for more developed partners to honor their commitments, it is not reasonable to expect them to donate significantly more resources over the next two years, given that many of their economies are still experiencing slow recovery after the global economic and financial crisis. But improvement on the MDGs is still possible, and it does not necessarily require more resources to make additional gains. In fact, evidence shows that there is only a weak connection between more resources and improved delivery of essential public services like healthcare and education. Thus, increasing resources without implementing reforms in the systems of service delivery may not boost the MDGs progress trajectory at all.
A large volume of empirical evidence suggests that the most important barrier to progress in the MDGs is weak accountability in service delivery. When providers and policymakers are not held accountable by the citizens, resources made available to deliver public services do not translate into desired outcomes. Instead, service providers engage in activities that better serve their own interests, often at the expense of the citizens. One of the most direct manifestations of this is the leakage of resources: a large fraction of resources meant to procure drugs and materials for clinics or books for schools are siphoned by bureaucrats for their own use. The outcome of such leakages is obvious--a lower quality and quantity of goods and services are made available to those who should be benefiting from them. Such behaviors have greatly undermined the achievement of the MDGs.
The other dimension of weak accountability is reflected by low provider effort. The manifestations of this aspect are shocking in many developing countries, particularly in Sub-Saharan Africa. Teachers and nurses do not show up for work, are not present in the appropriate areas when they are at work, or do not provide the services that they should be while they are there. Because they are not held accountable, they may even be abusive to the clients they are supposed to be helping. Thus, visiting service facilities can be an agonizing process for many people, and is. characterized by poor service delivery, delays and long wait lines. Moreover, while the failure of accountability in service delivery is detrimental to most of society, it is especially detrimental to the poor, who are disproportionately dependent on government assistance, are the most likely victims, and are least able to rebound from its effects. The poor often have no alternatives if they are denied medical treatment or a quality education. In addition to the fact that the poor have limited exit options from the publicly provided services, they also have limited capacity to hold the providers accountable.
We report on some recent data on service delivery in the health and education sectors in two African countries, Tanzania and Senegal, and on education only in Kenya. …