What have we learned on getting public services to poor people? What’s next?

Ten years after the World Development Report 2004, the ODI’s Marta Foresti reflects on the past decade and implications for the Marta Forestifuture

Why do so many countries still fail to deliver adequate services to their citizens? And why does this problem persist even in countries with rapid economic growth and relatively robust institutions or policies?

This was the problem addressed by the World Bank’s ground-breaking 2004 World Development Report (WDR) Making Services Work for Poor People. At its core was the recognition that politics and accountability are vital to improve services, and that aid donors ignore this at their peril. Ten years on, these issues are still at the heart of the development agenda, as discussed at the anniversary conference organised jointly by ODI and the World Bank in late February.

As much as this was a moment to celebrate the influence of the WDR 2004 on a decade of development thinking and practice, it also highlighted just how far we have to go before every citizen around the world has access to good quality basic services such as education, health, water and electricity.

health careLet’s begin with what we learned from WDR 2004 and what we know better today as a result of the work of the last ten years. First off is the role of information in improving accountability for service delivery. As Leni Wild suggests in her reflections on the conference, there has been real progress in understanding not only what types of information can be used and by whom, but also in how information can foster accountability. Ten years on, there is widespread agreement that while important, information alone rarely leads to improved services, and a growing awareness that it is incentives that matter if politicians and service providers are to act on information and data. In other words, information is a necessary but not sufficient condition for change.

Related to this, Ruth Levine of the Hewlett Foundation was among those who noted the progress made in the past decade in the research and quality of evidence on service delivery. This is the result, in part, of greater interest and investment in impact evaluation and randomised control trials (RCTs) that provide vital insights on what works to improve services in different contexts and – to a lesser extent – on why. However the mood at the conference was not one of hype around RCTs and other experimental approaches: much as they provide relevant evidence, they fail to explain the complex relationship between contextual factors, institutional arrangements, programmes and their outcomes. Lant Pritchett from CGD summed this up neatly in his blog last November: ‘RCTs are one hammer in the development toolkit and previously protruding nails were ignored for lack of a hammer, but not every development problem is a nail.’

Shanta Devarajan, Director of the WDR 2004, reminded us of one of its key lessons: that money alone is not enough to fix public service delivery problems and that, by extension, aid plays only a minor role. Countries undergoing fast economic growth, such as Nigeria, still fail to provide access to education to many poor girls and even Brazil – seen as a world leader on improving services to the poor – faces trade-offs between a pro-poor tax system and improved education and health.

Despite the influence of WDR 2004 on development thinking and practice over the past ten years, thorny issues remain that still need attention and, most importantly, far more debate. This will demand open minds and a real desire to break down disciplinary barriers, a step-by-step approach, experimentation with new ideas, and a willingness to acknowledge and learn from failure.

The first thorny issue is the role of the private sector in delivering services, which was a much debated theme: the evidence may showFree-healthcare-007 promising results and outcomes, but can we really expect the private sector to substitute for improved public institutions? And what are the implications for the long-term sustainability of services for the poor? Most importantly, where states are weak, their markets are also often weak, casting doubt on the notion of markets as a short cut to accountability. Public and private provision is not a matter of ‘either/or’: they are inter-related and this close relationship requires more analysis.

Lant Pritchett put forward the second challenge for the next ten years: public services should be for all, the poor, of course, but also the middle classes. When service delivery is abysmal right across the social spectrum, the focus on the poor might miss important opportunities to identify a significant and powerful constituency for change amongst the ‘elites’.

The third thorny issue is human behaviour and all the assumptions that surround it. The forthcoming WDR 2015, Mind and Culture, focuses on social norms and behaviour and there is much expectation that behavioural economics (which, as Ruth Levine reminded us, used to be called psychology) will shed some light on our preconceptions about how we attempt to induce better behaviour among politicians, as well as service providers and ourselves.

But I am not convinced that this alone will get us to the root of how political incentives work, let alone broader questions about risk-taking individuals and their chances of thriving in fundamentally risk-averse bureaucracies. We need to look at the role of social and political organisation, and in particular the kind of organisation that permits collective action to unblock processes of reform and change.

One of Oxenbury’s illustrations for We’re Going on a Bear HuntWhich leads me to my final – and most important – point:  the politics of it all. The conference ended with a clear indication of what the future holds: politics is not only part of the problem, but also of the solution. Working around politics rather than with it does not work: meaningful education reform cannot happen despite teachers’ unions, but in negotiation with them. Equally, efforts to stimulate the voice of citizens and their demand for services only work when they are met with equal efforts to better understand the incentives and decision-making logic of the politicians and civil servants responsible for the delivery of those services. As Alison Evans put it, via Michael Rosen’s iconic bear hunt: ‘We can’t go over it, We can’t go under it; Oh no, we have to go through it’

Above all, there is a need for a healthy dose of humility about the role of external actors in what are, fundamentally, domestically driven political processes.

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5 Responses to “What have we learned on getting public services to poor people? What’s next?”
  1. Matt Davies

    The point about “behavioural economics” is interesting. Robert Walker’s work on Shame and Poverty points to how the concept of shame is inherent among people living in poverty in both north and south, acting as a powerful obstacle to accessing services. There was a very intresting UK based study that looked at how fear of accessing services, shame and being judged, acted as a strong barrier to people in poverty in the UK accessing services (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2465616/). My organisation’s recent participatory research also found that actual, as well as perceived, discrimination by service providers led to people in poverty shying away from public services (full report due soon, interim here: http://www.atd-fourthworld.org/Towards-Sustainable-Development.html).

    As well as better understanding incentives and decision making logic of politicians. we must also better understand those of people on the receiving end of public services and work with them, and service providers to address the many obstacles and barriers that the works above identify.

  2. Cornelius Chipoma

    Thank you for your post and kindly excuse the length of my response. I want to begin with your final remark – “Above all, there is a need for a healthy dose of humility about the role of external actors in what are, fundamentally, domestically driven political processes.” My sense is that what we are faced with is a spectacular failure to learn, particularly complex lessons. Our silo way of learning is at odds with the multidisciplinary way in which people live their everyday lives – they simultaneously are political, economic, social, psychological, philosophical etc. In contrast, we are more sound bite-driven, thriving on hunches (symptoms) which we escalate into formulae. As Matt Andrews et al. (2012) argue, we are looking for ready-made solutions (best practice syndrome) and not trying to learn how to solve problems from different starting points.

    Revving the current charm with experimental learning, Savedoff et al. (2006) asked ‘when will we ever learn?’ That is, to base social funding decisions on credible information about what works. The fact that social programming has gotten by, spending billions while surviving merely on counting outputs (political smoke-screening) is truly a travesty. Indeed, activities such as training and capacity building, which have predominated social programming, while gobbling up huge amounts, have been the least compelling in their ability to effect institutional change.

    There are two parts to this blatant misuse of resources. The first is a minimalist mentality. What we do must be consistent with our efforts (that is how development agency strategic documents are written). Sadly that is also how thoughts about impact are formulated (the effect that we can cause). So development has a ‘quick-fix’/‘flavour of the month’ approach. The second aspect has to do with a failure to work across disciplines to learn in a fuller manner. Why do some schools (even systems/organizations) do better than others? So rather than what works, we need to better understand why (unpacking the ‘black box’ although I prefer unpacking ‘blind spots’ of evaluation). In Zambia, we have a curious situation whereby community schools, given their poor resourcing (no trained teachers, textbooks, infrastructure etc.) do relatively better than public schools. The community schools are actually a case of the ‘passive poor’ providing their own services.

    Fundamentally though, I think what is stunning is the gap between bare minimum performance of service delivery and what is actually obtaining (way below minimum). For example, successive national assessment results have shown that children in Zambia have consistently underperformed despite the resources spent by the government and donors. The issue of concern here is not a lack of evidence but a failure to learn from available information and carryout remedial action. So the idea that policy makers can be handed scientifically derived information that will lead to good decisions is overrated. So yes, experts now have more information about what works but the policy makers do not because of legitimacy/ownership issues.

    In the early 1990s, I carried out research on the micro-projects designed to ease the social impacts of economic structural adjustment funded by the European Union and the World Bank. The approach involved channelling funds directly to support local communities to undertake small social projects that addressed immediate social concerns. Working through the district development coordinating committees, the World Bank Social Recovery Project and European Union Micro-projects reached out to communities orienting them in how to develop project proposals that had the support of their members. In line with the strictures of participation, communities were required to contribute materially (upfront 25 percent contribution to the total cost) and set up democratically elected and sex-balanced management committees to implement funded projects.

    Substantively, this approach served two key purposes: The first purpose is that resources could be channelled directly to the beneficiaries. This approach was essentially driven by a mistrust of bureaucracy (particularly a desire to circumvent corruption) and linked to efforts to rethink government (mostly reducing spending). The second interest amounted to democratic engineering, creating and supporting micro polities the sum of which would help to build momentum towards decentralized and democratic governance. On both counts, however, the overriding assumption was that communities existed as cohesive groups working towards a shared goal especially as many of the social needs were perceived to be self-evident. The whole notion of community was in fact uncontested and the community entity itself was presumed to require just a little tinkering and some funds to create robust providers of social safety-nets. On the contrary, both perspectives imposed on a very complex local social-political dynamic without any real appreciation of the foundations for collective action (Chipoma 2003).

    At that time, social capital became the magical explanation for participation (steering huge sums of money). In my own research on the social projects I found witchcraft, family feuds, contests over land etc. all significant constraints on collective action. For this reason I thought ‘political’ rather than ‘social’ capital offered better insights into how communities got things done. I have extended this thinking to public service organizations (schools in particular) as functional or dysfunctional polities.

    I therefore want to speak cogently for the ‘passive poor’ and ‘passive development practitioners’, the foot soldiers who are caught between the proverbial ‘rock’ (contextual complexity) and ‘hard place’ (the charm of scientific method). I want to argue that the cause (the need for evidence) does not sufficiently justify the means (a narrowly defined learning agenda by essentially people disconnected from implementation). It is fair to say that the world of rigorous evaluation has a ‘tail wagging the dog’ feel to it. The penchant by evaluation practitioners, to reduce lived experiences to only logarithms, suggests arrogant confidence to successfully script a reality, through policy action, that is sanitized of the complex character of human behavior. Beyond the rationalist thinking – that drives the experimental method, institutionalist arguments (North 1990; Ostrom 1990) add much needed richness to understanding human action. As such, we need to build theories of change from a robust theory of human action. While context matters, delineating the essential elements of what evaluation practitioners describe as the ‘mechanisms’ that aid causation (Astbury and Leeuw 2010; Székely 2011; Elliot et al. 2012) is important in turning attention away from the intervention to the intervened.

    In other words, unlike immunization which as a one-off event, has long term impacts on wellbeing, sustaining the benefits of social interventions requires us to understand how continuous human influence maybe attained. For evaluation practitioners, this should not entail merely formulating more complex logarithms but going back to basics – good observation and experiential learning. In my time with USAID/Zambia, we found that exploratory approaches worked better for decision makers. We walked with ‘the system’ (travelled together in joint teams with the hierarchy from central ministry to school level) to learn experientially what the challenges were (avoiding expert knowledge which often alienates the actual doers).

    We used travel time (sometimes sharing transport to continue conversations and bond), and field visits as a kind of mobile workshop. We went after the whole system aiming to tackle it one system leader at a time. While this sounds laborious, it is not necessarily slower than transplanting model solutions. When the system leaders connected with reality and experienced the ‘aha moments’ or ‘eyes opening’, the follow-on action was rapid. We aimed to touch hearts with new information and invigorate leadership. In dramatic fashion, I use the metaphor of jack hammering system inertia (our own too), to soften the ground for the seeds that we hope to plant. In the past, we have been happy to count our efforts but not looked back enough to see if what we planted had germinated.

    So in a behavioural economics way, a key task for development practitioners is to work as persuaders/‘nudgers’ (not ‘baiters’) so as to simultaneously support conditions for the successful adoption and sustained application of social interventions. The challenge is not necessary one of outsiders versus insiders but rather about whether or not we are willing to learn – but we fail to, consistently and miserably so.

    • Saeed Ahmed

      Dear Cornelius Chipoma,

      This is totally depend on good governesses in all countries,all political parties did not get new development program in own country thy did not get the polices about the development before peoples, but they think own benefits.In Asia and Africa a lot issues to the people living life, Growth population,is a main issues they have not control then main issues is a not perfect clear polices managed the education,health,environment,gender equality ,land-reform, not implement laws and not create news laws about economic development system and foreign polices they are not serving in their countries.

      Best Wishes

      Saeed Ahmed,Pakistan
      Email: sdahmed09@gmail.com

  3. marta foresti


    many thanks for your insightful comments. A lot of what you say resonates with our work on the the politics of sectoral reform, as well as with the work by Andrews and others. There is no way I can do justice to your comments here, and it would be good to discuss further perhaps by e mail. I particularly like your take/comments on evaluation, as I also agree that it is an area where much of what is emerging from research and practice about the importance of brokering. nudging, persuading and the rest of it is not reflected in current practices, let alone ‘gold standards’.

    Many thanks