so punish absence. In Udaipur, India a member of the community was paid to
check to attendance of health care professionals; they found low rates of atten-
dance but nothing was done by the local community with this information.
Just because the majority of the population of a typical developing country
are poor and the poor would benefit from good public services, we cannot
jump to the conclusion that an empowered and democratic local community
will lead to better public services. Chapter 6 noted that incentives faced by
politicians mean that there will be an inherent problem in delivering ‘good
services’. It is generally much harder for politicians to take credit for ‘health
status’ or ‘teaching quality’ than for clearly observable inputs like cutting the
ribbon when opening a new building. Hospitals, for example, tend to be prior-
itized because, first, large facilities are prominent so politicians get more plau-
dits for opening a big hospital than a small rural health centre, and second, it is
much easier to take the credit for the construction of facilities than for their
successful functioning. The former is visible and can be accompanied by a
single visit from a ribbon-cutting politician; the latter depends on the sustained
efforts of many different actors. The resulting misallocation of resources
means that too little is spent on traditional public health measures like vector
control, sanitation and hygiene education, or improving the functioning of
public-service facilities, and too much on building facilities and employing
health care workers.
Such empowerment may have little impact if it runs up against powerful
countervailing forces. Teachers may be well connected. In India, for example,
they are unionized; many are politically influential and can resist such local
pressures. Educated and literate teachers may be intimidating opponents for
poor and illiterate village people who want to improve their children’s educa-
tion. This is the big lesson from Acemoglu and Robinson’s (2006) book Why
Nations Fail. Bad (or what they term extractive) institutions, they suggest, are
likely to persist. At the expense of the rest of society, extractive institutions will
strengthen an elite minority who will then acquire the incentives and resources
to organize, mobilize and control political power to ensure the perpetuation of
their elite status. This takes the form of a vicious circle. Prosperity, they argue,
requires that institutions be transformed from extractive to inclusive and it is
not easy to do so. Nations cannot then rely on economic growth automatically
leading to better institutions as suggested perhaps by the historical studies of
Chang and modernization theory.
Don’t get too hung up on democracy
It is self-evident to many that democracy is a good thing and so promoting it
should take priority over efforts to influence other deep determinants of
growth. Typical is Amartya Sen who argues democracy itself is a good thing in
that it enhances freedoms but is also a vital means to promote wider growth and
development. Famously Sen (1982) pointed out that no substantial famine has
300 Patterns and Determinants of Economic Growth