Image: Water, Ghana photo by Arne Hoel / World Bank.
In governance circles, service delivery is often discussed as if it raised common issues across service sectors as diverse as health, education, water and sanitation. Yet within sectors, debates about governance issues are quite distinct.
Is this just a matter of perspective or do different sectors really present different political problems and opportunities?
There are indeed common policy problems that run across services. For example, it is much more difficult to improve their quality than to extend access to them (by building schools, clinics, and water networks). Reviews of the political economy literature have found that services face common conditions for good performance. These include political commitment, good monitoring, effective sanctions, systems of local accountability, and strong political incentives to provide services.
But the profound diversity of issues between services is very striking.
In drinking water supply, for instance, a major policy concern is that badly directed subsidies lead to over-consumption by the least needy and to under-investment in water supply for the poorest.
By contrast, it is difficult to mobilise policy-makers and providers to address sanitation at all, although it is well known to be the most important contributor to personal and public health.
In health care, high cost treatments for some diseases are often prioritised while other diseases and more cost-effective measures are neglected.
In most countries education is a policy priority. Yet the quality of much public education remains poor and potential learners continue to be excluded.
Together with Claire Mcloughlin at the University of Birmingham and colleagues at ODI, I have been involved in research on why services perform differently even in the same political and economic context.
The outcome? That services themselves shape the incentives, power and accountability of the main actors, whether they be politicians, policy-makers, delivery organisations, or users.
The idea that services themselves have a political character may seem far-fetched. But consider how a service such as hospital health care raises different issues of politics and accountability compared to urban water supply. Patients place themselves individually into the care of doctors and nurses, often knowing little about their treatment, and unlikely to feel empowered to dispute it. On the other hand, water-users have a good idea of what they should expect from the supplier; they share their daily experience of the service with other users, and can represent their opinions at a neighbourhood level.
These differences are political in the sense that they affect relations of power between politicians, providers and users: patients are likely to feel less empowered than water-users.
Our research has developed a framework for comparison by piecing together the available evidence on the political effects of what we describe as ‘service characteristics’ – that is, the features that can be used to distinguish between services.
For example, services that are privately consumed (such as household water connections as against mains sewerage) will tend to enhance opportunities for political patronage. More visible aspects of services (such as the construction of clinics rather than staff training) are likely to attract greater political prioritisation.
Monopoly (as in piped water supply), inequalities of information and professional discretion (as in health care) can all strengthen providers’ dominance over users. On the other hand, the frequent and predictable use of a service (like schools) operating in a limited territory gives communities the opportunity to organise and make demands.
Such characteristics help to explain why some services for some people receive more attention. They also suggest possible policy responses and organisational reforms.
We put the service characteristics approach to the test in a series of consultations with sector specialists in education, health, water and sanitation. The broad conclusion was that the approach could help specialists both to make sense of sectoral debates and to discover opportunities for learning between sectors. For example, ways of enabling community participation can be shared between strongly client-oriented services like health centres and schools.
Start by recognising the experience of practitioners in health, education, water and sanitation. Our final assessment suggests that doing it this way round can help lever political economy analysis out of its ‘governance silo’.
It will encourage dialogue between governance and sector specialists, helping them to understand why different services present quite different opportunities and constraints.
And, by giving us a better-grounded diagnosis, it will also give us a fuller picture of the policy responses and organisational reforms that are likely to work in any particular service.
This guest post is an expanded version of the author’s opinion piece for ODI (28 May 2014).
