Trust, Voice, and Incentives: how to improve education and health services

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Girls sitting exams in the Middle East
Bill Lyons / World Bank

A new World Bank report addressing the widespread dissatisfaction of citizens with the delivery of essential public services and calling for accountability in public service delivery in the Middle East and North Africa (MENA) region was released a few weeks ago.

The statistics in Trust, Voice, and Incentives: Learning from Local Success Stories in Service Delivery in the Middle East and North Africa  are grim, as nearly three quarters of MENA students are scoring “low” or “below low” in international student performance tests and one third of the public health clinics in MENA countries lack essential medicines and staff.

The good news, however, is that the report also sheds light on local success stories in health and education where, against serious odds, a number of clinics and schools have managed to deliver quality services to citizens. The examples from Jordan, Morocco, and the Palestinian Territories highlight the power of collaboration and mutual trust between citizens and public servants to produce better results.

Principal Abla Habayeb
Principal Abla Habayeb
In a small village near the city of Jenin, the Kufor Quod Girls’ Secondary School is one of the top performing schools in the region, despite tight budgets, an extremely volatile political situation, and the restrictions in the centralized education system of the Palestinian territories.

Principal Abla Habayeb says that building strong relationships with the local community with the common goal of focusing on the students is key. 

She partners with the local community to provide the best possible school environment for students, and strives to maintain a motivating work environment with rewards for teachers who are committed to the school’s high standards.

The essential ingredient of trust has increased, as parents feel more secure and satisfied with what their students are learning in school and the results they are achieving.

The report challenges many common misconceptions and simplifications about service delivery. For instance, service delivery is not just a technical or public resource issue;   despite adequate resources in some countries, the quality of services is simply not there.

The broader political, administrative, and social institutions in which the public sector operates and the incentives that they generate impact the performance of providers to deliver services well. Poor performance results in low trust in the state and its public institutions. 

This results in a low-level equilibrium trap, where citizens don’t engage with the state through formal channels to demand accountability and the problem is exacerbated when citizens opt out and turn to wasta (personal relationships) and pay informal fees to survive.

What are the lessons learned from the governance perspective? 
  1. Citizen engagement, in its many forms, is critical.  Whether it’s the use of white flip charts in public spaces to record questions about public services in Jordan or hotlines for citizen feedback in urban centers in Egypt, creating the space for citizens to engage and listening to their voices and engaging in meaningful dialogues to create new cultures of trust and higher performance standards for civil servants is essential.
  2. Accountability, both formal and informal, must be truly meaningful to citizens in order to break the cycle of poor performance. If teachers and doctors are evaluated by the people they are meant to serve, a stronger relationship will be established between civil servants and citizens which can help boost community engagement.
  3. Performance: when performance improves, so does citizens’ trust in institutions, which in turn shapes engagement. If social norms and formal and informal accountability incentivize public servants to raise their performance, new cultures of excellence are created. This fosters a favorable environment for increased collaboration and cohesion, and helps to boost citizens’ trust in public institutions.
  4. Trust is at the heart of it all. For citizens to play a positive role in the cycle of performance - to engage and demand accountability to enhance public institutions and service delivery - they need trust.  Without trust in public institutions, citizens circumvent the state and further weaken the cycle of performance.  How can governments earn the trust of their citizens? By translating words into deeds and demonstrating real results on the ground. As the report shows, possible quick wins exist, especially when learning from local success stories.
How can we raise the bar on performance and build on local solutions to inspire reforms?  I think the key words in the title of this worthwhile report - trust, voice, and incentives – are certainly good places to start.


Mario Marcel

Senior Director, Governance Global Practice

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