Access to quality services – in particular in health and education – has been recognized as fundamental for wellbeing and economic development (World Bank, 2003). However, in Africa and other developing countries, service delivery is often poor or nonexistent: schools and health clinics are not open when they are supposed to be; teachers and health workers are frequently absent from schools and clinics and, when present, spend a significant amount of time not serving the intended beneficiaries; equipment, even when available, is not used; drugs and vaccines are misused; and public funds are expropriated.¹ Unfortunately, poor people suffer the most when the public sector does not deliver.

Inadequate service delivery is also reflected in poor results in terms of health and education outcomes. In Africa, many health and education indicators are dismal. Given the rate of progress, current trends will not allow these countries to meet the 2015 Millennium Development Goals (MDG) targets (UNESCO, 2009).

To accelerate progress toward the MDGs, developing country governments, donors and NGOs have committed increasing resources to improve service delivery in social sectors. However, budget allocations alone are poor indicators of the actual quality of services in countries with weak institutions and systematic service delivery failures. Moreover, when the failures are systematic, there are no quick fixes and relying on governments to address them by themselves seems unrealistic, not least since many of these failures have largely been unaddressed for a long time. A complementary approach calls for empowering citizens and other actors to bring pressure on governments to reform the system. However, for this to work, citizens need to have access to hard evidence on service delivery performance. The Delivering Services Indicators is an attempt to start providing such information.

To date there is no robust, standardized data set to measure the actual quality of service delivery as experienced by the user in Africa. Existing indicators in social sectors are disparate and limited and focus is almost exclusively on development outcomes/outputs rather than on the service delivery systems that create those outcomes. In fact, no set of indicators exists for measuring constraints associated with the supply side of service delivery and the behavior of frontline providers, both of which have a direct impact on the quality of service citizens receive. Without consistent and accurate data on the quality of services, it is difficult for citizens or their governments to know which services are under-performing, consequently leaving little incentive for citizens and governments to act on.

The Delivering Service Indicators (DSI) seeks to provide a set of indices for benchmarking service delivery performance in education and health in Africa in order to track progress in and across countries over time. It seeks to enhance effective and active monitoring and evaluation of service delivery and to become an instrument of public accountability and good governance in Africa. One of the key objectives of the DSI Index is to help reduce the gap of information between citizens, service providers and the state, which is at the root of poor service delivery performance, rent capture and misappropriation of resources. Ultimately, the purpose of the DSI Index is to help policymakers, citizens, service providers, donors and other stakeholders in enhancing the quality of service provision and ultimately improve development outcomes. The perspective adopted by the DSI index is that of citizens accessing services and facing potential shortcomings in those services made available to them. The DSI index is thus presented as a Service Delivery Report Card on education and health. It seeks to measure the performance and quality of service delivery as experienced by citizens. However, instead of using citizens’ perception to assess performance it assembles objective and quantitative information from a survey of service delivery units, using modules from Public Expenditure Tracking Survey (PETS), Quantitative Service Delivery Survey (QSDS), Staff Absenteeism Survey (SAS), and Observational studies.²

The index takes as its starting point the recent literature on how to boost education and health outcomes in developing countries. This literature shows robust evidence that incentives aimed at influencing the choice of effort exerted and the type of individuals attracted to specific tasks at different levels of the service delivery hierarchy, are positively and significantly related to education and health outcomes. In addition, conditional on providers exerting effort and being motivated, increasing resources can have beneficial effects. Therefore, we suggest that the indicators focus predominantly on measures that capture the outcome of efforts and type (broadly defined) both at the frontline service unit and by higher level authorities entrusted with the task of ensuring that schools and clinics are receiving proper support as well as the provision of physical resources to the service delivery unit. This choice also avoids the need to make strong structural assumptions on the link between inputs, behavior, and outcomes. While the data collection effort focuses on frontline providers, the indicators will mirror not only how the service delivery unit is performing but also indicate the efficacy of the whole institutional system in health and education. Importantly, we do not argue that we can measure these incentives directly, but, at best, measure the outcome of the set of incentives and constraints, including various supply constraints that influence performance using micro data.

Over the past decade, new micro-level survey instruments (PETS, QSDS, SAS etc.), and dissemination tools like Citizen Report Cards, have proven to be powerful tools for identifying bottlenecks, inefficiencies and waste in service delivery, especially problems of resource leakage, delays, absenteeism, and inequities in the actual resource allocation. In the Ugandan education sector, for example, Reinikka and Svensson (2005, 2009) use a PETS approach to study the effects of a public information campaign aimed at empowering parents. They find a large reduction in resource leakage toward primary schools in response to the campaign. The introduction of a Citizen Report Card for Bangalore’s public agencies led to major improvements in public satisfaction and the agencies’ ratings. Similarly, corruption in the transactions between users and public officials declined markedly (Samuel, 2002). A randomized evaluation of a citizen report card intervention in the health sector in Uganda in 2005 concluded that the CRC led to significant improvements in the quality and quantity of primary health care provision and resulted in improved health outcomes in the communities (Björkman and Svensson, 2009).

This cumulative evidence provides grounds for hope that better information, particularly measurable and actionable indicators, will contribute to more accountability and transparency and ultimately to improved outcomes. The capacity to measure and compare key components of the main service delivery sectors over time and across countries should prove useful for various stakeholders. For citizens in particular, such information on public expenditure and service delivery performance would be especially valuable. As emphasized by CAFOD (2007), such information could help citizens: “keep an active eye on government’s progress and check whether policies are making a difference... help people give feedback to their government on the services they are providing... informed dialogue between government and citizens leads to more effective, fair and inclusive policies from which everyone benefits...” (CAFOD, 2007, p.i)

This concept paper is structured as follows. Section 2 presents the citizen’s perspective guiding the construction of the DSI Index and the main categories of indicators. It also presents the proposed indicators and the justification for their inclusion in the DSI index. Section 3 discusses the source of data to be used to construct the indicators. Section 4 presents the indicators’ aggregation process and country ranking mechanisms and section 5 briefly discuss how the data could be presented and the pilot survey. Section 6 concludes.

1. Chaudhury et al. (2006) and Reinikka and Svensson (2004), among others, provide systematic evidence of public service delivery failures. For additional evidence, see World Bank (2003).
2. PETS trace the flow of public resources from the public budget to the intended final users through the administrative structure, as a means of ascertaining the extent to which the actual spending on services is consistent with the intended outcomes envisaged when budgets are allocated. QSDS examine activities and services at the provider level and the incentives and behavior of various agents in order to assess performance and efficiency of service delivery on the frontline. SAS focuses on the availability of teachers and health practitioners on the frontline in order to identify incentive problems and inefficiencies in resources utilization. An observational study aims at measuring the quality of services, proxied for by the level of effort exerted.