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9 Survey Tools for Assessing Performance in Service Delivery

9 Survey Tools for AssessingPerformance in Service DeliveryJan Dehn, Ritva Reinikka, and Jakob SvenssonIt has become increasingly clear that budget allocations, when usedas indicators of the supply of public services , are poor predictors ofthe actual quantity and quality of public services , especially in coun-tries with poor accountability and weak institutions. At least fourbreaks in the chain can be distinguished between spending meantto address efficiency and equity concerns and its transformationinto services (Devarajan and Reinikka 2002). First, governmentsmay spend on the wrong goods or the wrong people. A large por-tion of public spending on health and education is devoted to pri-vate goods, where government spending is likely to crowd out pri-vate spending (Hammer, Nabi, and Cercone 1995). Furthermore,most studies of the incidence of public spending in health and edu-cation show that benefits accrue largely to the rich and middle-class;the share going to the poorest 20 percent is almost always less than20 percent (Castro-Leal and others 1999).

9 Survey Tools for Assessing Performance in Service Delivery Jan Dehn, Ritva Reinikka, and Jakob Svensson It has become increasingly clear that budget allocations, when used

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Transcription of 9 Survey Tools for Assessing Performance in Service Delivery

1 9 Survey Tools for AssessingPerformance in Service DeliveryJan Dehn, Ritva Reinikka, and Jakob SvenssonIt has become increasingly clear that budget allocations, when usedas indicators of the supply of public services , are poor predictors ofthe actual quantity and quality of public services , especially in coun-tries with poor accountability and weak institutions. At least fourbreaks in the chain can be distinguished between spending meantto address efficiency and equity concerns and its transformationinto services (Devarajan and Reinikka 2002). First, governmentsmay spend on the wrong goods or the wrong people. A large por-tion of public spending on health and education is devoted to pri-vate goods, where government spending is likely to crowd out pri-vate spending (Hammer, Nabi, and Cercone 1995). Furthermore,most studies of the incidence of public spending in health and edu-cation show that benefits accrue largely to the rich and middle-class;the share going to the poorest 20 percent is almost always less than20 percent (Castro-Leal and others 1999).

2 The first three chapters inthis volume discuss benefit incidence , even when governments spend on the right goods or theright people, the money may fail to reach the frontline serviceprovider. A study of Uganda in the mid-1990s, using a Public Expen-diture Tracking Survey (PETS) the topic of this chapter showedthat only 13 percent of nonwage recurrent expenditures for primaryeducation actually reached the primary school (Reinikka 2001).The considerable variation in grants received across schools wasdetermined more by the political economy than by efficiency 6/25/03 12:41 PM Page 191equity considerations. Larger schools and schools with wealthierparents received a larger share of the intended funds (per student),while schools with a higher share of unqualified teachers receivedless (Reinikka and Svensson 2002).

3 Third, even when the money reaches the primary school or healthclinic, the incentives to provide the Service may be weak. Serviceproviders in the public sector may be poorly paid, hardly ever mon-itored, and given few incentives from the central governmentbureaucracy, which is mostly concerned with inputs rather than out-puts. The result can be a high absenteeism rate among frontlineworkers. The Quantitative Service Delivery Survey (QSDS) theother instrument featured in this chapter is a useful tool for get-ting at these issues. A Survey in Bangladesh, described later, showedthat the absenteeism rate was 74 percent for doctors in primaryhealth care centers (Chaudhury and Hammer 2003). 192 JAN DEHN, RITVA REINIKKA, AND JAKOB SVENSSONBox Agencies, Measurability, PETS,and QSDSThe organizational structure of public sector agencies involves multi-ple tiers of management and frontline workers.

4 Multiplicity is also akey aspect of the tasks they perform and the stakeholders they example, primary education teaches young children to read andwrite, and it also teaches social skills, instills citizenship, and so different tasks and interests at each tier may compete with eachother for limited resources in a finite time period. Moreover, the out-put of public Service agencies is often difficult to measure, and sys-tematic information on specific inputs and outputs is rarely availablein developing countries. In many cases management information sys-tems are unreliable in the absence of adequate incentives to maintainthem. On closer observation, the characteristics of public Service agen-cies and the nature of their tasks explain why traditional Tools forpublic expenditure analysis alone may not be adequate for evaluatingperformance.

5 Because the Public Expenditure Tracking Survey (PETS)and Quantitative Service Delivery Survey (QSDS) can bring togetherdata on inputs, outputs, user charges, quality, and other characteris-tics directly from the Service -providing unit, more can be learnedabout the linkages, leakage, and the way spending is transformed and above the problem of vague output measures, the exis-tence of multiple principals reduces the agent s incentives, becauseactivities often desired by the principals to realize their 6/25/03 12:41 PM Page 192 Survey Tools FOR Assessing Service DELIVERY193goals are substitutes for each other. Similarly, when some task out-comes are verifiable and others are not, it may not be optimal to pro-vide explicit incentives for any tasks, as the agent would otherwisedivert all effort from unverifiable to verifiable tasks.

6 In education, forexample, exam results would be disproportionately emphasized overaspects that lend themselves less easily to monitoring and measure-ment. Incentive schemes are most suitable when outcomes are clearlydefined, observable, and unambiguous, and become weak when nei-ther outcomes nor actions are observable, such as in a typical govern-ment ministry. Public Service providers also often lack the introduction of competition does not in itself guaranteebetter Performance , it places greater emphasis on other and QSDS can increase the observability of both outputs andactions and thereby provide new information about the complextransformation from public budgets to services . Tailored to the spe-cific circumstances, these Tools can help identify incentives and shedlight on the interactions to which these incentives give rise, such ascollusion and bribery.

7 They can also illuminate the political economy,such as the effect of interest groups. The novelty of the PETS-QSDS approach lies not so much in the development of new methods ofanalysis per se, but in the application of known and proven methods(microsurveys) to Service :Bernheim and Whinston (1986); Dixit (1996, 1997, 2000).Fourth, even if the services are effectively provided, householdsmay not take advantage of them. For economic and other reasons,parents pull their children out of school or fail to take them to theclinic. These demand-side failures often interact with the supply-side failures to generate a low level of public services and humandevelopment outcomes among the chapter argues that microeconomic-level Survey Tools areuseful not only at the household or enterprise level but also at theservice provider level to assess the efficiency of public spending andthe quality and quantity of services .

8 The two microlevel surveys dis-cussed here, the PETS and the QSDS, both obtain policy-relevantinformation on the agent(say, a district education office) and theprincipal(say, the ministry of finance or a parent-teacher associa-tion) (box ). Similarly, repeat PETSs or QSDSs can be used astools to evaluate the impact of policy 6/25/03 12:41 PM Page 193 Key Features of PETS and QSDSG overnment resources earmarked for particular uses flow withinlegally defined institutional frameworks, often passing through sev-eral layers of government bureaucracy (and the banking system)down to Service facilities, which are charged with the responsibilityof exercising the spending. But information on actualpublic spend-ing at the frontline level is seldom available in developing PETS frequently carried out as part of a public expenditurereview tracks the flow of resources through these strata to deter-mine how much of the originally allocated resources reaches eachlevel.

9 It is therefore useful as a device for locating and quantifyingpolitical and bureaucratic capture, leakage of funds, and problemsin the deployment of human and in-kind resources, such as staff,textbooks, and drugs. It can also be used to evaluate impediments tothe reverse flow of information to account for actual primary aim of a QSDS is to examine the efficiency of pub-lic spending and incentives and various dimensions of Service deliv-ery in provider organizations, especially on the frontline. The QSDScan be applied to government as well as to private for-profit andnot-for-profit providers. It collects data on inputs, outputs, quality,pricing, oversight, and so forth. The facility or frontline serviceprovider is typically the main unit of observation in a QSDS in muchthe same way as the firm is in enterprise surveys and the householdis in household surveys.

10 A QSDS requires considerable effort, cost,and time compared to some of its alternatives surveys of percep-tions, in particular (box ). As the example of Uganda, discussedlater, demonstrates, the benefits of quantitative data can easily off-set the Tools explicitly recognize that an agent may have a strongincentive to misreport (or not report) key data. This incentive derivesfrom the fact that information provided, for example, by a healthfacility partly determines its entitlement to public support. In caseswhere resources (including staff time) are used for other purposes,such as shirking or corruption, the agent involved in the activity willmost likely not report it truthfully. Likewise, official charges mayonly partly capture what the Survey intends to measure (such as theuser s cost of Service ). The PETS and QSDS deal with these dataissues by using a multiangular data collection strategy that is, acombination of information from different sources and by care-fully considering which sources and respondents have incentives tomisreport and identifying data sources that are the least contami-nated by these incentives.


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