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Better services key to alleviate poverty: World Bank

Vimala Vasan

Dubai , Sept. 21

A WORLD Bank report has warned that broad improvements in human welfare will not occur unless poor people receive wider access to affordable, better quality services in health, education, water, sanitation, and electricity.

Without such improvements in services, freedom from illness and freedom from illiteracy - two of the most important ways poor people can escape poverty - will remain elusive to many.

The report was released in Dubai on Sunday as part of the Annual Meetings of the Boards of Governors of the World Bank and the IMF.

The World Development Report 2004, titled `Making Services Work for Poor People', says that too often, key services fail poor people - in access, quantity, and quality.

This imperils a set of development targets known as the Millennium Development Goals (MDGs), which call for halving of the global incidence of poverty and broad improvements in human development by 2015.

However, the report provides powerful examples of where services do work, showing how Governments and citizens can do better.

"There have been spectacular successes and miserable failures in the efforts by developing countries to make services work."

The main difference between success and failure is the degree to which poor people themselves are involved in determining the quality and the quantity of the services which they receive, according to it.

"Too often, services fail poor people. These failures may be less spectacular than financial crises, but their effects are continuing and deep nonetheless," the World Bank President, Mr James D. Wolfensohn, said.

"Services work when they include all people, when girls are encouraged to go to school, when pupils and parents participate in the schooling process, when communities take charge of their own sanitation. They work when we take a comprehensive view of development - recognising that a mother's education will help her baby's health, that building a road or a bridge will enable children to go to school."

The report comes at a time when rich countries have pledged to increase foreign aid and poor countries have pledged to improve their policies and institutions, to try to reach the MDGs.

"To accelerate progress in human development, economic growth is of course necessary, but it is not enough," the World Bank Chief Economist and Senior Vice-President for Development Economics, Mr Nicholas Stern, said.

"Mobilising to reach the 2015 development goals will require both a substantial increase in external resources and more effective use of all resources, internal and external. The report offers a practical framework for using resources more effectively."

The report said that even when poor people have access, the quality of services is distressingly low.

In random visits to 200 primary schools in India, investigators found no teaching activity in half of them.

Up to 45 per cent of teachers in Ethiopia were absent at least one day in the week before a visit; 10 per cent of them for three days or more.

A survey of primary health care facilities in Bangladesh found the absenteeism rate among doctors to be 74 per cent.

"Services can work when poor people stand at the centre of service provision; when they can avoid poor providers, while rewarding good providers with their clientele, and when their voices are heard by politicians, i.e., when service providers have incentives to serve the poor," said Mr Shanta Devarajan, Director of the World Development Report 2004, and Chief Economist of the World Bank's Human Development Network.

The report documents three ways in which services can be improved: By increasing poor clients' choice and participation in service delivery, so that they can monitor and discipline providers; secondly, by raising poor citizens' voice, through the ballot box and making information widely available.

Service delivery surveys in Bangalore, which showed poor people the quality of the water, health, education and transport services they were receiving compared to neighbouring districts, increased demand for better public services and forced politicians to act. Thirdly, services can be improved by rewarding the effective and penalising the ineffective delivery of services to poor people.

Providing communities with healthcare, education, and other services has been a contentious issue in many countries, with Government services pitted against large-scale privatisation.

The report said that while there are frequent problems with public services, it would be wrong to conclude that Government should give up and leave everything to the private sector.

Furthermore, private-sector participation in health, education, and infrastructure is not without problems - especially in reaching poor people. The extreme position that the private sector should do everything is clearly not desirable either.

"Instead of getting caught up in the public versus private services argument, the only issue that really matters is whether the mechanism that delivers key services strengthens poor people's ability to monitor and discipline providers, raises their voice in policymaking, and gets them the effective services they need for their families," Ms Ritva Reinikka, Co-Director of WDR 2004 and Research Manager for Public Services at the World Bank, said.

When policies and institutions are improving, the report said, aid should increase, not decrease, to realise the mutually shared objective of poverty alleviation, such as MDGs.

Simply increasing public spending - without seeking improvements in the efficiency of that spending - is unlikely to reap benefits.

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