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Does community monitoring improve public services? Diverging evidence from Uganda and India
16 September 2008
Stuti Khemani, Human Development and Public Services Research
Research brief
The push toward community monitoring of public service delivery in development projects is based on the notion that local oversight will raise the social accountability of public service providers and thereby improve the quality of services. Diverging results from evaluations of two community monitoring programs in health and education suggest that local monitoring does not guarantee better service delivery.
Recent research has found strikingly different impacts of two ambitious efforts to improve human development outcomes by mobilizing communities to improve public services. One in health in Uganda succeeded in improving services in public health clinics, while another in education in India had no impact on public schools, although it did improve learning outcomes through a private initiative that bypassed the public education system.
Community monitoring led to improved quality of health delivery in Uganda
In 25 randomly selected communities local NGOs organized meetings between community members and health service providers of public clinics around the quality of care provided at these clinics. Quality of care was measured through prior surveys of citizen perceptions on the performance of the public clinics and compiled as “citizen report cards.”
Compared to 25 randomly selected “control” communities where no such discussion of “citizen report cards” took place, in intervention communities both provider attendance and quality of service measures (including wait time and quality of care) improved. The final result was an increase in the immunization rate and a substantial drop in child mortality in the communities where the mobilization interventions occurred.
The evidence suggests that health services improved as a result of greater activism by the community in monitoring health clinics and demanding improvements, most likely through existing beneficiary-control institutions called Health Users Management Committees (HUMCs).1
Community monitoring did not lead to improved quality in public education in India
A leading education-focused local NGO mobilized communities around the issue of learning in 195 randomly selected villages in the north Indian state of Uttar Pradesh (UP). It facilitated a local platform for information sharing on the quality of schools and how to improve them through agencies like the Village Education Committee (VEC) that operates much like the HUMCs for health services in Uganda.
Volunteers from the village prepared “report cards” on the reading ability of children. These report cards were shared with the public school teachers and local government representatives in village-wide meetings.
Post intervention studies found no difference in community participation, teacher effort, or learning outcomes in public schools between the treatment villages and the 85 randomly selected “control” villages (no mobilization efforts).
However, in the 65 villages (among the 195) that were offered access to a teaching tool to improve reading skills through additional classes outside the public school system, the scores for reading increased. Children who could only decipher alphabet letters at baseline and attended the reading classes were more than twice as likely to be reading words and stories when surveyed one year later (graph). A large number of local youths volunteered for training in the use of the new tool, and they held more than 400 reading classes across 55 villages that involved almost 7,500 children (more than 130 children per village). 2,3
A large number of factors may affect the performance of community monitoring
The success of the private initiative that bypassed the public education system suggests that collective public action to hold public providers accountable is constrained. The beneficiary-control institutions in India and Uganda, the VECs and the HUMCs, are similar in structure, both were largely inactive at baseline, and both had only indirect influence, largely in the form of complaints from parents and clients about non-performing teachers and health workers. Any action against them would have to be taken by a senior bureaucrat. Of the two institutions, the VEC had larger direct powers to recruit additional teachers and approve or reject their contracts for renewal.
So what accounts for the different outcomes in the two countries? The following factors may partly explain the difference.
Variation in NGO activism in the interventions. In Uganda, the local NGOs seemed much more active in pressuring the health care providers to improve performance than the education NGO in India. For example, the facilitators in Uganda directly negotiated with the dispensary staff before involving the villagers, and the villagers who became involved were hand-picked by them. Because the community served by each health clinic is almost ten times larger than a village in India, the activist role for external facilitators may have been more scalable. In India the focus was on community-led engagement.
Differences between health and education services. The non-delivery of health services is more easily and reliably observed by an individual (“I was entitled to that service but I did not get it”) than the non-delivery of good teaching (what constitutes effective teaching?). Indeed, the anticipation of services might spur individual action in health clinics, since people could start demanding the services they did not know they were entitled to. This kind of individual action may be less effective in the case of education. Monitoring the quality of teaching requires parental visits to the classroom to observe teacher effort and performance. Moreoever, one parent’s complaint may go unheeded by a teacher unless it sparks complaints from the parents of other students.
Differences in country political economy. Teachers in UP are politically powerful and therefore resistant to social or bureaucratic reproach. If larger political obstacles constrain service delivery then localized collective action is more difficult to accomplish. Mobilizing citizens at the level of electoral jurisdictions may be more promising in the Indian political economy context, by providing information for comparisons and benchmarking service delivery performance across jurisdictions, thereby putting public pressure on politicians to improve the quality of services.4
The contrasting results in Uganda and India underscore the importance of continuing to experiment with information interventions in different socio-political contexts.
Notes
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Martina Bjorkman, and Jakob Svensson. Forthcoming “Power to the People: Evidence from a Randomized Field Experiment of Community-Based Monitoring in Uganda.” Quarterly Journal of Economics.
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Abhijit V. Banerjee, Rukmini Banerji, Esther Duflo, Rachel Glennerster, and Stuti Khemani. 2008. “Pitfalls of participatory programs: evidence from a randomized evaluation in education in India.” World Bank Policy Research Working Paper 4584, April.
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Abhijit V. Banerjee, Rukmini Banerji, Esther Duflo, Rachel Glennerster, and Stuti Khemani. 2006. “Can information campaigns spark local participation and improve outcomes ? A study of primary education in Uttar Pradesh, India.” World Bank Policy Research Working Paper 3967, July.
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Stuti Khemani. 2007. “Can Information Campaigns Overcome Political Obstacles to Serving the Poor?” In The Politics of Service Delivery in Democracies: Better Access for the Poor, ed. Shantayanan Devarajan and Ingrid Widlund. Expert Group on Development Issues, Ministry for Foreign Affairs, Sweden. (Download the report)
Stuti Khemani is a Senior Economist in the Development Research Group (Human Development and Public Services Team). Her research interests include the political economy of public policy choices, and institutional reforms for development. She is currently working on how institutions of decentralization and local monitoring may strengthen political incentives for quality services.
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