This briefing note aims to provide some practical guidance on how different services can offer differing opportunities and challenges for improving service performance through increased accountability and, especially, citizen engagement. It illustrates an approach to identifying these opportunities, using examples from two services: curative health care and urban networked water supply. This approach can be used to map where, when and how social accountability mechanisms may be effective in improving service performance.
Key findings:
- Despite progress in the delivery of public services over the past two decades, in many developing countries the average citizen continues to suffer from gaps in provision and poor performance of even the most basic services, like health care or access to water. Performance of these services depends not just on resources and the capacity of service providers but on their relationships with users (i.e. citizens) and different levels of government – what demands providers face and how they are monitored and supported. There is rising interest in the potential of social accountability to shape these relationships and improve the delivery of public services. Understanding of social accountability is becoming more sophisticated, with an increasing appreciation of the major role context plays in shaping accountability relationships and outcomes, and so the need to adapt strategies accordingly. Too often support for social accountability remains generic, and does not distinguish between the different opportunities and constraints faced within and across different services.
- The idea that services are distinct seems obvious, but often the implications for accountability are not clearly understood. Consider how a service such as hospital health care raises different issues of power and accountability compared with urban water supply. Patients place themselves individually in 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. Recognising that sectors and specific services have distinct bundles of characteristics can therefore be of clear value. Differences between services may contribute to explanations of their politics and performance, and similarities or complementarities may generate opportunities for cross-sectoral learning.
- The following characteristics of a service affect politicians’ and users’ incentives and ability to hold providers to account, and internal organisational monitoring: the nature of the good (public or private); market failures’ (inefficiencies in pricing, access and exclusion); task-related characteristics; and demand characteristics.
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