Increasing the Accountability of Essential Services to Local Communities
Education, health, and water services are central for the eradication of poverty and the achievement of the Millennium Development Goals. There is increasing recognition that strengthening the accountability of services to local communities and end users is essential in addressing service delivery failures.[i]
Innovations in “social accountability”—measures that employ information and participation to demand fairer, more effective public services—have proven to be impactful. “Social audits” in India have led to exposure and recovery of substantial amounts of misappropriated resources, and have been incorporated into the national employment guarantee scheme. A recent randomized controlled trial found that a “community score card” intervention applied in health clinics in Uganda reduced child mortality by 30 % in one year.[ii]
Law and rights, however, are strikingly absent from the social accountability literature. Social accountability interventions tend to focus exclusively on the nexus between community and service provider, or between community and local government. They have tended not to address the possibility of remedies from the broader network of state authority in the event that local pressure fails.
The protection of rights and the pursuit of remedies is, on the other hand, the core business of legal aid and legal empowerment programs. But those programs have thus far tended to focus more on intra-community disputes and less on failures in public service delivery.
Our hypothesis is that a synthesis of these two approaches—social accountability and legal empowerment—could better integrate accountability for service delivery into national governance structures, and lead to significant improvements in the delivery of essential services.[iii]
Namati is presently partnering with the World Bank Justice for the Poor team in Sierra Leone to test this hypothesis, in an experiment that will involve both community paralegals and village health committees.
Namati is also partnering in Sierra Leone with the Ministry of Local Government, the Ministry of Health, the Poverty Action Lab, and the World Bank Justice for the Poor Program on a randomized controlled trial to test two mechanisms for improving the accountability of health services: compacts between clinics and communities, and nonfinancial awards for clinic staff based in part on the feedback of end users.
We are exploring further work on accountability of essential services in other countries.
community-based monitoring in Uganda,” Quarterly Journal of Economics 124/2 (2009), pp. 735–769.