The Hewlett Foundation Blog
February 28, 2014 — By Ruth Levine
I’m the sort of person who looks on the bright side, who sees the glass half full. But I cannot yet see the bright side of how governments in many African countries provide services to their citizens.
Here are some cold, hard facts: In Uganda, four out of every five grade school teachers are unable to pass a test of basic reading and math. In Nigeria, two out of every three doctors cannot diagnose simple ailments. If you go into a government health facility in Kenya, you’ve got only a 50 percent chance of finding essential medicines that haven’t passed their expiration date. With each school day, each clinic visit, a fundamental contract between governments and their citizens is broken.
It is not just for lack of money. These depressing figures stand in stark contrast to economic gains and greater spending on health and education. Nigeria’s GDP has grown annually in real terms by about seven percent in recent years, while Uganda’s economy has grown by about six percent and Kenya’s by four percent. Government revenues in many African countries are on the upswing, and so are education and health budgets—and yet the quality of social service delivery remains abysmal.
There is, however, a bit of good news in this otherwise grim story: thanks to some ambitious and creative efforts, both governments and citizens now know more about the quality of health and education than they’ve ever known before, and they’ll be able to track progress—or lack of progress—in the years to come. This knowledge comes from efforts like the Service Delivery Indicators (SDI) project, which collects and shares facility-level information about what teachers and clinicians know, what they do, and what inputs they have to work with. By focusing on provider knowledge and behaviors, rather than solely on inputs, SDI sheds light on service delivery breakdowns that result from dysfunctional governance at multiple levels and the lack of incentives for good performance.
Using a common methodology across countries to permit comparisons, the results of the SDI survey are a wake-up call, drawing both government and public attention to the quality crisis. When the Uganda results were released last November, for example, the government committed to establishing a task force to spearhead new public service reforms. In Kenya, a report of survey findings was launched in the midst of a teachers’ strike, sparking a flurry in the media about why Kenyan schools are failing. Basic descriptive information sends a powerful message.
Beyond what it measures, SDI is special because of its commitment to get the data—both in summary form and in full datasets for researchers’ use—into the public domain. Some 11,000 people have looked at the microdata, and should find it to be useful as a complement to other datasets that have information on health and education expenditures and outcomes, as well as demographic, policy and other variables. Citizen groups in Kenya are also using SDI data, along with other information, to raise awareness about the quality of services.
Regardless of the specific findings from the data analysis, just opening up the information contributes to better policy. When government officials know that citizens are aware of how bad things are across the country, there’s a better chance they’ll feel like they have to do something about it.
No, SDI alone can’t make clinics or schools work better. But it sheds light on the sheer scale of the problem, and serves as a spur toward the reform that is so obviously needed.
Much more on the quality of health and education services is being discussed today and tomorrow at the “Making Services Work for Poor People” conference organized by the World Bank and the Overseas Development Institute. Several sessions will be live-streamed here.