The idea that citizens can directly contribute to strengthening the governance and quality of service delivery has been gaining momentum. The recent globabl uprisings, from revolutions in Egypt and Tunisia to the Occupy Wall Street movements here in the US, have highlighted the important role that individuals play in demanding more accountable governments and policies.
I recently participated in a seminar in Santiago de Chile on ‘Conditional Cash Transfers and Human Rights’. A few years ago I would have wondered what could possibly be the link between the two. Not anymore.
- human development
Child malnutrition may not be apparent to parents, especially if other children in the village look the same. Similarly, it can be hard for parents to recognize when their children are doing poorly in school. And – sad, but true – badly trained health staff and teachers too often miss these things, as well. Fixing this disconnect in perceptions may be one way improve health and education outcomes.
We like to think of doctors and teachers as knights in shining armor, focused purely on our well-being, without regard for profit or other personal interests. The reality, we know, is more complicated. Doctors, teachers, and even World Bankers, are motivated by a range of internal and external factors, from altruism through to self-interest.
In Cambodia, similar to many developing countries with considerable service delivery challenges and weak regulatory environments, the first choice for health care is often a private medical provider. But despite the overwhelming popularity of such facilities – in Cambodia, more than 76 percent of health care visits in 2005-2006 were to private providers according to the most recent Demographic and Health Survey -- research and interventions mainly have focused on public sector health services.
I want to share something puzzling that has troubled me for some time: Why don’t development agencies use results-based financing more consistently as a way of supporting stronger governance in developing countries? Let me explain the source of this puzzle and give you my personal take on the issue.