Decentralization and Accountability for District Service Delivery in Madagascar

1. Decentralization and Accountability for District Service Delivery in Madagascar Derick W. Brinkerhoff Research Triangle Institute Presentation for: Conference on Governance and Accountability in Social Sector Decentralization World Bank Washington, DC Feb 18-19, 2004

2. Study background • Joint PREM/SDV & Madagascar Country Office. • One of a set of studies to support poverty-focused lending: input to PER & expenditure tracking surveys in health & education. • Data collected in May-June 2003 in two districts in Fianarantsoa province: Ambatofinandrahana & Farafangana. • Focus on decentralization, accountability, district-level incentives in health & education.

3. Study questions • What incentives/pressures favor or impede provision of decentralized health & education services for the rural poor? • What policies or administrative changes could improve the equitable delivery of services in the health and education sectors? • If more financial resources were allocated to the district level, how would service providers use these resources and who would they likely benefit?

4. Analytic framework • Accountability as key to service delivery effectiveness. • Accountability: obligation to provide information, enforcement/sanctions for compliance. • Three types: financial, performance, political/democratic. • Three purposes: • reduce abuse, • assure compliance with procedures & standards, • improve performance, learning, and responsiveness.

5. Madagascar in a nutshell • 18 ethnic groups, originally nobles vs. slave castes, high plateau vs. coastal groups. • History of strong central control; 1992 constitution provides limited decentralization, LGs receive earmarked transfers from center. • Recent political & economic turmoil– contested presidential election. • High levels of poverty, esp. rural. • Weak infrastructure.

6. Deconcentrated spending: health & education • Health: 46% of recurrent spending at the center, 40% at province/region, 14% at district. • Education: 31% of recurrent expenditure at the center, 56% at province/region, 13% at district.

7. Key findings • More remote facilities receive less supervision/oversight, receive fewer resources, have heavier workloads, & rely more on community participation. • More remote facilities are more likely to be understaffed & to have a higher percentage of staff who are either voluntary or paid by the community.

8. Selected data from education in Farafangana District • The farther from the district capital, the fewer teachers in each school and the greater the reliance on unpaid or poorly paid community-supported teachers (18% in schools 20km or less from the district capital, increasing to 41% plus beyond 20 km). • Number of pupils per teacher increases with distance from the district capital (avg 83 students per teacher in schools over 60 km from the district capital, avg 56 for those within 20 km). • Number of sections per teacher increases with distance and the physical assets (number of classrooms) declines. • Distance between the effective supervisory level (the ZAP) and the school increases with distance from the district capital.

9. Key findings, cont. • Facility staff spend large amounts of time away from their posts every month to attend meetings, collect paychecks, pick up supplies, etc. • Administrative dynamics & accountability pressures in both districts are very similar. • Standardized hierarchical relationships, uniform reporting procedures, & bureaucratic accountability demands are stronger than the impact of any regional differences between the two districts.

10. Accountability patterns • District/facility education & health staff face strong pressures for upward accountability internal to the health & education bureaucracies. • Major emphasis on financial accountability, driven by impact of public budgeting system, concern of all stakeholders on allocation & uses of financial resources. • Use of performance output indicators as accountability tools is weak and haphazard, though education is stronger than health.

11. Accountability, cont. • No independent monitoring in either health or education service provision. • Government’s civil service personnel management system offers little support to effective accountability. • Existing pressures to increase accountability are often linked to particular individuals. • Demand-driven accountability through local elected officials is limited by the deferential nature of relations between those officials & the rural electorate.

12. Discretionary decision-making • Degree of discretion SSDs & CISCOs have in making decisions is relatively limited. • Administrative burden of financial management & accountability is significant. • Hiring, promoting, & firing of staff are handled centrally. • Assignment of staff within districts is to some extent at the discretion of SSDs (except doctors) and CISCOs.

13. Political & governance factors • Government recognizes political need to reach beyond urban constituency to the rural areas, and need for demonstrable change in local service delivery. • Education examples: Caisse école, payment of school fees, FID-financed school construction. • President’s support for communes gives importance to mayors.

14. Politics & governance, cont. • Governance setting is not conducive to increased local accountability: endemic corruption, lack of transparency, few/weak CSOs, low citizen expectations, centralized control. • Establishment of effective accountability mechanisms will be a long-term process requiring new incentives, civic education, pilot programs, & capacity-building.

15. Accountability incentives • Health & education staff face weak incentives for innovation, discretionary decision-making, & outcomes-based management. Staff are noticed only in cases of errors or problems/complaints. • Targeting services on the poor is not an explicit management criterion for either SSDs or CISCOs. • In education, salary supplements for staff posted to remote facilities have recently been created.

16. Accountability incentives, cont. • Establishment of FAFs has provided incentive for increased engagement of local community leaders in education sector resource management, but has reduced the viability of the more independent FRAMs. • Donor resources are important sources of incentives.

17. Accountability capacity • Capacity for demand-driven accountability is weak: • Insufficiency of health and education staff; people are unlikely to press for removal or transfer if they cannot get a replacement; this increases with remoteness. • High levels of poverty, parents pull their children out of school for work. • Local people lack the capacity to assess educational outcomes and tend to focus only on physical facility, little basis to make judgments (similar problem exists for health outcomes). • Non-confrontational behavior characteristics of Malagasy culture, coupled with low expectations for service quality and availability, mean that people are unlikely to make demands on service providers.

18. Accountability capacity, cont. • Weak capacity and motivation in CISCOs & SSDs to exercise supervision; related to remoteness & accessibility of facilities. • Better supervision in education because of ZAPs, who tend to be physically closer to schools than CISCO staff.

19. Recommendations • Target resource transfers using remoteness and distance criteria rather than poverty. • Increase supervision and oversight visits to remote facilities. • Improve staff living conditions in remote facilities. • Modify accountability criteria to include positive recognition of, & positive sanctions for, performance & innovation. • In the transport sector, invest in rural roads.

20. Recommendations, cont. • Pilot test service satisfaction surveys. • Modify reporting forms in the health sector to include feedback from service users in the community. • Increase transparency and information dissemination, e.g., publicize resources allocated to health & education. • Reinforce community organizations related to social services.