The Technical is Political: Sectoral Characteristics That Influence Local Service Delivery

 LPSI News posted by Administrator
 June 20, 2014

 A Government Official at Work: The Technical is Political
  

LPSI News, June 2014 - Although the concept of improved public service delivery is central to human and economic development, we sometimes fail to acknowledge that different public services have important sector-specific differences in how they are delivered at the local level, which are inherent to the nature of each specific public service. Yet, these service characteristics often have important implications for the interaction between the service provider and the client, the composition of expenditures in each sector, and may help explain the political dynamics of particular services.

These issues were recently examined by a series of studies led by Richard Batley and Daniel Harris at ODI, including a synthesis paper as well as analyses of sectoral issues in health, education, water and sanitation. The studies find that specific service-specific characteristics influence the incentives and accountability of key actors in service provision, including elected politicians, policymakers, providers, as well as potential and actual users. In particular, service characteristics may enhance or limit the likelihood of competitive provision; impact the access to and exclusion from services; influence the monitorability of services by policymakers and managers; and reduce or enhance users' capacity to organize demands from public service delivery units / public service providers.

What does this mean in the health sector? Harris, Batley and Wales (2014) argue that health care services display a number of characteristics that means it is not a good or service like any other. Service-specific characteristics that transform the "technical" into "political" in the health sector include the following:

• The direct user-provider accountability relationship is strongly affected by characteristics that are particularly acute in the health sector. Health services are usually used individually and infrequently. The relative privacy within which health services are provided reduces the space for public or social accountability. Furthermore, the ability of local residents (patients) to hold their (public) health care providers accountability is limited by the particularly acute incidence of information asymmetry in the health sector (residents are unable to assess the quality of care, as they lack the professional expertise of the health care provider).

• Heterogeneity of need can create coordination and accountability challenges. The need and demand for health care services varies considerably across geographic space and across income groups. This makes it difficult to monitor whether the level of service provision (e.g., the number of out-patient attendances) is caused by poor service delivery (supply) or low need/demand for health services.

• Improved performance in health services may need to come from within. Because professional dominance limits the possibility for external accountability, improved performance in health services may need to come from within (e.g., as a result of improved motivation of health workers).

• Visibility, attribution and therefore political salience are flexible attributes. Because the provision of health services is more private and less visible than other publicly-provided services (e.g., roads, schools), it is harder for (local) politicians to claim credit for the provision of health services.

• The idea of intrinsic 'lootability' helps explain service delivery politics. Medical supplies are an important input into health services. In addition, because there is a high willingness to pay for health services when a patient needs acute care, health services provides important opportunities for health care providers (and those who supervise front-line service providers) to extract a "fee" for (publicly funded) services or medicines.

The service characteristics in the education sector have different implications for the relationship between key stakeholderso in the sector. Harris, Batley, Mcloughlin and Wales (2014) argue that education services similarly display a number of characteristics that transform "the technical into political" in the education sector:

• Market failures require intervention to maximize social returns to investments in education. Households are likely to under-provide education because they do not take into account the social benefits of education. For this reason, primary education is often compulsory, which is not the case for most other publicly-provided services. This may limit the strength of the demand for educational quality (and therefore, limit the potential for social accountability).

• Access to education services can be contested because excludability benefits some actors. Unlike some other public services (parks, roads), public education services are excludable. The potential for excludability affects power relationships between those who want to access education (such as students, parents or guardians) and those who control access (usually but not exclusively government bureaucrats, head teachers and teachers) as it creates an opportunity for rent-seeking behavior.

• Education services tend to be strongly territorial because services are jointly consumed by users in a particular location. The territorial nature of education may reduce the level of competition in the provision of education services and may reduce accountability.

• Certain features of the sector may facilitate or obstruct user accountability. Since educational outcomes are 'co-produced' by students, teachers and parents, it is difficult to pin-point the cause for weak educational outcomes (thus reducing accountability). However, reduced information asymmetry in education that can alter the balance of power and influence between actors. The severity of information asymmetries varies across different users, since 'the more experience you've had with education yourself, the better you are able to judge the quality of the education that your children are receiving'.

• Education often has political salience, but not necessarily for reasons that would lead to improvements in outcomes. Public education is important to the public sector to the degree that basic education is an important ingredient in nation-building. In addition, teachers and their unions also tend to be important political players in their own right. As a result, the political salience of education is not necessarily translated into improvements in education outcomes.