Reforming institutions for service delivery : a framework for development assistance with an application to the health, nutrition, and population portfolio

Abstract

World Development Report 1997: The State in a Changing World (report no. 17300) argued that institutions-the rules of the game that govern production and exchange-shape a country's prospects for sustained market-led growth. The author provides an institutional framework for service delivery, an essential component of state capability. He applies this framework to an evaluation of Bank support for service delivery in the health, nutrition, and population sector. He argues for greater institutional pluralism in the ways the World Bank does business in infrastructure, rural, and social sectors, but cautions against making efficient service delivery an issue of"state versus market."The Bank and its clients face the challenge of fitting menus of"better practice"delivery options to maps of institutional reality. In the health, nutrition, and population sector, the Bank should (1) unbundle and categorize essential health and clinical services according to goods characteristics and (2) integrate country knowledge into operations through upstream assessments of state, political, and social institutions. Overall, the Bank has made progress toward a"goods characteristics"approach, particularly in infrastructure and some rural services-but it has lagged in the social sectors, where support remains largely technocratic. Cross-sector comparisons reveal four generations of support for service delivery. First-generation support focused mainly on physical implementation of projects. Second-generation interventions, which characterized most social service interventions, focused on improving the financial and organizational viability of implementing agencies through technical assistance. Third-generation support was marked by significant unbundling of service delivery activities and clearer links to goods characteristics. In irrigation (1982-94), telecommunications (1980s-present), and transport (1990s), the one-size-fits-all monopoly model gave way to a range of options based on greater private sector and citizen participation in delivery. These included leases, concessions, outsourcing, and contracting as well as building, operating, transfer, and turnover schemes. Fourth-generation interventions are works-in-progress and represent efforts to develop new governance arrangements that systematically combine competition, voice, and hierarchy in the design, delivery, and monitoring of Bank projects. The Bank has a poor track record building country knowledge of institutional endowments that affect service delivery. The author identifies concepts and tools valuable for sector specialists'operations.Enterprise Development&Reform,Public Health Promotion,Health Economics&Finance,Decentralization,Health Monitoring&Evaluation,Governance Indicators,Poverty Assessment,Environmental Economics&Policies,Health Monitoring&Evaluation,Health Economics&Finance