Report Launch December 9, 2011 ODI, London

Report Launch December 9, 2011 ODI, London

Outline Rationale Concepts and assumptions Reform strategies Information interventions Grievance redress Looking ahead 2

Rationale: Why focus on accountability? The idea that users of HD services (health, education, social protection) can hold providers accountable is of growing interest. Governance, accountability, and human rights; Focus on results, value for money, and approaches to service delivery that include beneficiaries; Involvement of civil society, donors; ICT innovations; WDR 2004 and a growth of experiments and some evaluations. 3

Social accountability and service delivery Source: World Development Report, 2004. Social accountability = efforts to inform citizens and channels for them to use information to hold service providers accountable long route and short route 4

Why should this work? People can influence policy makers (e.g. spending decisions, quality of services), program managers and providers (e.g. effort) Requires access to information ( transparency ) & opportunities to use it ( participation and redress ) Information: timely, relevant, credible (e.g. access-toinformation laws, information campaigns, scorecards) Opportunities: turn information into action (e.g. vote, file complaints, user oversight, choice)

A Simple Typology Strategies Intended Goals Examples Access to information Grievance redress mechanisms Influence policy Make providers accountable Influence policy Enable users to enforce standards/rights Access-to-Information laws Information campaigns Report cards Scorecards Social audits Redress in line ministries (e.g. hotlines) Independent redress institutions Courts

Assumptions along the way 1. People have the ability and incentives to access and use information about service delivery. But citizens may have other priorities and information asymmetries in HD complicate judging performance. 2. People are willing to use information and redress channels to pressure policy-makers and providers. But citizens may be reluctant to challenge authority. 3. Policy-makers and providers will respond to citizen influence. But changing behaviors and incentives is difficult and takes time. 7

Access to Information 1995: 22 countries have Access-to-Information Acts 2008: number increases to over 80+ Case Study: India adopted and passed its RTIA in 2005 Citizens file over 2 million requests for information in the first two ½ years following RTIA adoption Among poor households only 4% of citizens are aware of rights under RTIA Men account for 90% of RTIA users Individuals who used RTIA to get food ration cards were nearly as successful as those who paid a bribe.

Information Campaigns Information campaigns can provide: Information about rights and the content of services, including: Rights and entitlements, service standards, budgets and financing, and the organization of services. Information about the quality and performance of service providers 9

School Information Campaigns in India Campaigns to inform the community about its oversight roles in public schools & the services to which children are entitled. 8-9 meetings in a village over 2 months Pandey, Priyanka et al. Community Participation in Public Schools: Impact of Information Campaigns in three Indian States. South Asia Human Development. Presentation. World Bank. 2007.

Impact on Inputs & Student Learning REGION Teacher Attendance Teacher Activity % Received Uniform UP 11 % Unchanged 18 % (girls) MP Unchanged 30% 14 % (general caste) Participation rate of parents in school inspections Scholarships Students received.11 33 % (general caste).02 26 % (SC/ SC) Improvement in Reading 27 % (Grade 3) 14 % (Grade 3) Karnataka Unchanged Unchanged N/A Unchanged N/A 15 % (Grade 4) Pandey, Priyanka et al. Community Participation in Public Schools: Impact of Information Campaigns in three Indian States. South Asia Human Development. Presentation. World Bank. 2007.

Informing Citizens: China Equipping patients in China with information about proper antibiotic usage reduced antibiotic prescription rates and drug expenditures. Simulated patients with cold/flu symptoms who informed doctors about their knowledge of antibiotics had a 25 percentage point lower probability of receiving antibiotic prescription compared to patients who did not say anything (Currie, Lin, and Zhang 2010). Patient knowledge also decreased drug expenditure by 39.97 RMB. 12

Citizen Report Cards in Pakistan Child and school-level report cards to parents and schools, with discussions Potentially highly competitive context: multiple government and private schools in each village Parent Card 1: Child Info Child score and quintile Child s School score & quintile Child s village score and quintile Quintile described as needing a lot of work to very good

Pakistan: What happened? Student learning and enrollment 0.10-0.15 sd increase at the level of the village. Improvements in both private and government schools Worse performing private schools achieved highest gains 5 % increase in village enrollment, driven by government schools School fees Dropped by 21 percent in private schools Higher performing schools show largest fee reductions couldn t increase quality any more School-level investments Increases in textbooks Decreases in break-time for teachers

Pakistan: What happened? Possible mechanisms Once relative standing is known, schools can no longer charge high prices Parents can demand that schools improve quality Schools can benchmark themselves against other schools and invest to improve their standing

It doesn t always work A randomized evaluation in Uttar Pradesh, India to assess impact of providing information about Village Education Committees (VEC) had no impact (Banerjee et al, 2010) No significant change in parent awareness or involvement, teacher effort, or student absenteeism after intervention A study in Benin to assess impact of community radio on education outcomes showed significant improvements in outcomes only due to increased household investments in education The schools did not alter their investments in education 16

Scorecards and Social Audits Social audits and scorecards engage citizens more directly by Collecting information from citizens and providers Holding face-to-face meetings between citizens and providers Communities identify problems and devise a draft action plan Action plan shared with providers and discussed publicly 17

Scorecards and Social Audits National Rural Employment Guarantee Act in India: The percentage of wage seekers who knew about NREGA increased following the information campaign and social audit Health scorecards in Uganda: Use of scorecards dramatically improved IMR, provider effort, and community-monitoring 33 % average reduction in IMR and a 20 % increase in utilization. Health worker absence decreased by an average of 13 p.p., waiting times fell an average of 12 minutes, and providers were 8 p.p. more likely to use equipment during their examination. 18

What works? Factors that may contribute to success Message framing Evidence from psychology and behavioral economics [schools in North Carolina] Method of delivery What tools? Who is invited to meetings and who invites? [Community monitoring in Indonesia] Message clarity How easy is it to understand the message? [Cambodia school report cards] 19

Grievance Redress Mechanisms Formal or informal channels used by citizens to express (dis)satisfaction with service delivery Primarily a (last resort) channel for individuals to complain but can also be a source of feedback to policy-makers. Within government agencies Independent redress institutions Courts 20

Do Citizens File Complaints? Education Health Moldova Tajikistan Georgia Poland Montenegro Mongolia Bulgaria Azerbaijan Latvia Belarus Bosnia-Herzegovina Ukraine Romania Slovakia Serbia Macedonia Russia Kyrgyzstan Turkey Uzbekistan Albania Croatia Lithuania Slovenia Kazakhstan Armenia Kosovo Estonia Czech Republic France Italy Great Britian Germany Sweden 0 5 10 15 20 25 30 35 Tajikistan Kyrgyzstan Montenegro Bosnia-Herzegovina Hungary Bulgaria Poland Serbia Croatia Romania Uzbekistan Latvia Azerbaijan Slovakia Moldova Macedonia Lithuania Ukraine Mongolia Turkey Russia Slovenia Kazakhstan Armenia Estonia France Czech Republic Kosovo Belarus Albania Great Britian Italy Germany Sweden 0 2 4 6 8 10 12 14 16 18 Source: LITS 2010 21

Grievance Redress in HD Social protection Used to manage targeting of social assistance programs (error, fraud & corruption) [Brazil Bolsa Familia] Health Complaints handling systems at various levels [UK NHS] OECD countries have independent 0mbudspersons covering health [New Zealand] Growing role of courts [Colombia] Education People complain using more direct channels such as headmaster or school board [India] Decentralization and school-based management [Mexico] 22

Review of WB Projects (FY05-FY10) Lots of language in project documents; More than half of projects include some reference to accountability Most in social protection in the Africa region Many scorecard pilots, especially in health (Nigeria, Cambodia, Burkina Faso, Dominican Republic, and others) Grievance redress/complaints mechanisms are mainly in social protection. Built into information systems in LAC conditional cash transfer programs Actual incorporation into project design is less prevalent (33 projects out of 353). 23

Social Accountability in Projects Keywords by Sector Type of Intervention 100% 90% 80% 70% 60% 50% 40% 30% 50 and more 25-50 15-25 5-15 0-5 13% 23% Information Campaign 34% Scorecards Report Cards Social Audit 20% 10% 20% Grievance Redress Mechanism 10% 0% Education Health SP Total 24

Summary Influencing policy makers and program managers is not straightforward Social accountability tools are unlikely to change provider behavior on their own Intermediaries such as civil society organizations and media can facilitate access to information and redress Design of interventions is especially important for improving effectiveness, technology is not a panacea. 25

Building an evidence base Looking Ahead Evaluate and consolidate experience, build on pilots Focus on long term sustainability of initiatives and how they affect policy Better understanding of long-run cost-effectiveness Supporting implementation How-to guides Support for designing evaluations Knowledge-sharing Working with multiple partners 26