service providers. Second, beneficiaries must be able to influence providers,
for example by punishing absence. The latter may be particularly difficult in
practice. Switching to an alternative (private) provider will be constrained by
affordability and such a shift is unlikely to have much impact as salaries are
paid to service providers by the state or central government regardless of how
much service they actually provide. Many control strategies are possible, rang-
ing from putting the beneficiaries in charge of hiring and firing the providers or
deciding how much they should be paid, to more limited proposals, such as
having the beneficiaries monitor and report provider absence. Making teachers
accountable to a school committee/body of parents is the standard example.
The beneficiaries may be better informed about shirking if they come from the
same community as the service provider, and to the extent that the service is
valuable to beneficiaries they should be more willing to reward or punish the
agent. In Udaipur, Rajasthan, a member of the community was paid to check
once a week on unannounced days, whether the auxiliary nurse-midwife
assigned to the health sub-centre was present in the centre and if not there,
whether she could be found in the village. A parallel system (a monthly visit by
a member of the survey team on the same day) confirmed that this system of
local monitoring was properly implemented. External monitors and commu-
nity members found similar absence rates (44 per cent and 42 per cent). The
problem arose with the use of this information – paradoxically, local commit-
tees made no attempt to impose an external reward system for the nurse-
midwives based on this monitoring. A similar scheme in Kenya, where
members of the community monitored and reported on teacher absence, had a
similar negligible impact.
In many cases people have long-established low expectations about public
service provision so households have little desire to invest time and energy in
hopeless efforts to improve them, and in any case have long ago opted instead
for the private sector. This is happening in India where between 1993 and 2002
95.7 per cent in urban and 24.4 per cent of the increase in total primary school
enrolment occurred in private schools (Kingdon, 2007:186). A similar pattern
is occurring in health services with even the poorest turning to private provi-
sion. Incentives are therefore needed alongside efforts to increase the demand
for public services, to ensure the continuation of worthwhile monitoring. This
may include incentives for children to attend school such as direct cash
payments or school meals. A scheme in Kenya that awarded scholarships for
girls based on national end-of-year test results reduced teacher absence in
programme schools by about one-third (Banerjee and Duflo, 2004).
Private-sector provision
It is claimed by some that public-sector services in many developing coun-
tries are irredeemably broken and we should look instead to the private
sector. In much of the developing world responsibility for education has been
transferred to the private sector through the rapid growth of private schools
Education and Health 129