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Submitted by Elizabeth Stuart on
@Anon - here's a link to Oxfam GB's 74-page 2009 report and accounts. Also a link to our Accountability Report @Shanta We absolutely agree that accountability is key, and Oxfam supports partners around the world to carry out vital budget tracking work which allows ordinary people to ensure that expenditures committed by developing country governments - such as funding for local schools - are actually delivered. Here's a link to a report on a local accountability in Malawi, a programme supported by Oxfam. But we need to take a step back in this debate. The reason that health and education services are failing poor people is not a 'series of accountability failures in the service delivery chain', but because countries have been unable to deliver an adequate system - that is health and education that is free and universally accessible - in the first place. In other words, there needs to be something to be held account for before we reduce the focus to a simple one of accountability. The key reason for this systemic failure is that financing is inadequate: the lack of consistent, predicable aid flows have had a critical impact on the state's ability to deliver basic services. This, of course, is the fault of donor countries (in fact, IDA flows are relatively predictable, as the Bank gives a fairly high proportion of its aid in the form of budget support, which allows the finance, health and education ministries to plan for recurrent expenditures such as teachers' or nurses' salaries - although I should add that FTI funds are slow to disburse, which is highly problematic). But another reason for the failure is that donors including the World Bank are not promoting publicly financed- and delivered-health services, which the WHO, Oxfam, and countless others have clearly shown is the only model for health and education systems that will reach the poor at scale in a sustainable manner. Key roles that the World Bank has to play in the above is one, supporting developing country governments to, over time, develop the infrastructure of a public health system and two, provide alternative financing to governments so that they can remove user fees which prevent the poor from accessing services. Once you have the correct system in place that will provide health and education that is free at the point of delivery, of at least a basic quality, and that can be scaled up to provide a nationwide service, then you can focus on accountability that the system is delivering that which it should. It’s important to underline that while not wanting to negate the issue of corruption in service provision, health systems are by their very nature complex and poor accountability and corruption can be a problem regardless of whether services are privately or publicly provided. The process of contracting providers has significant potential for corruption, both in the context of securing tenders and the provision of services themselves. Even if contracts are awarded fairly regulated private providers in the public interest is exceptionally difficult, even in developed nations. A report commissioned by the Government of India, for example, found that hospitals contracted and subsidized by the state to provide free treatment to poor patients was failing to do so. Finally, of course, developing country governments must also increase the proportion of their national budgets that is spent on health and education.