Service Delivery Indicators Initiative: Monitoring Health and Education performances in Africa

This blog, written by Ousmane Aly Diallo, is part of the Wikiprogress focus on its Africa Network.

After pilot tests in Tanzania and Senegal in 2010, the World Bank in partnership with the Kenya Institute for Public Policy Research and Analysis (KIPPRA) launched the Kenyan Service Delivery Initiative (SDI) on 12 July  2013. The initiative aims to assess the performance of Kenya in the domains of education and health and more importantly to determine if what is spent on these domains is reflected in human development outcomes.

Better monitoring of policies with reliable data

For some time now, the lack of reliable data and statistical capacity has been a problem in accurately establishing the progress in well-being as well as the impact of government policies in many African countries (read more). It has also been a priority for international organizations (See the Paris21’s NSDS Initiative as an example of strenghtening statistical capacity in developing countries). The SDI is meant to help governments determine what is working in their national education and health systems, where readjustments are needed and what has to be re-thought completely.

Basically, the SDI gives surveys to health and education providers in the host countries. Three main variables are present in theses questionnaires:

• education and Health Provider’s Abilities (What do they know?);
• their effort (What do they do?); and
•  the Availability of Inputs (What do they have to work with?). 

In Kenya, around 5,000 health practitioners and the education staff in 600 facilities were surveyed for the first SDI (here). The results show that public and private school teachers have the same likelihood of working, but those in the public sector are 50% less likely to be in a classroom teaching students. This is mainly due to the public school system having 20 days of teaching fewer per term. Also, only 35% of teachers showed a mastery of their subjects. When campaigning for basic education and attaining the parity between girls/boys in primary school, the low level of teachers' mastery is disappointing. Reinforcing the skills and mastery of teachers thus appears as important of an element as is children attending school.

In the health sector, over 29% of health providers were absent, and 80% of those absences were reported and sanctioned. Furthermore, only 58% of public health providers could diagnose 4 out of 5 common conditions such as diarrhea with dehydration or malaria with anemia. Additionally, the health providers used  less than half of the correct treatment actions to manage maternal and neonatal complications, and key drug availability for mothers remains a challenge (here). The latter result is particularly revelatory, since maternal health is one of the main health concerns in Africa. Therefore, knowing where the system fails is a step towards overcoming the barriers towards improvement. 

Being able to have this level of data is one of the SDI's main points since it gives a snapshot of what is not working and where the focus should be placed. 

Assessing the synergy between well-being and expenditures.

“We cannot manage what we cannot measure. We count what we value”. The initial reason for the deployment of the SDI can be traced back to this phrase. Although a substantial part of their budget is spent on education and health, the expenditures have not kept pace with the population's needs in most African countries. The World Bank estimates that developing country governments allocate, on average, a third of their budgets to education and health (read more). In a context of economic downturn and growing demand for transparency, assessing what teachers and help practitioners do in an average workday how well they are equipped and how they can be helped is a step towards higher societal well-being. Schools and health facilities are, more often than not, ill-equipped in terms of their infrastructure (particularly in rural areas) and competences. Additionally, in the fields of education and health “(…) if one considers the level of public funds invested in the process, then the glass becomes half-empty in the sense that a great deal of resources have been wasted in pushing reforms beyond what the existing capacity can command” (See here page 9).

The SDI is meant to help capture what is the cause of this discrepancy, determine how health practitioners and education providers are performing and establish corrective actions if need be.

Service Delivery Indicators and Open Data

One of the main contributions of the SDI is the provision of accurate data regarding the quality of education and health services to both decision-makers and citizens. Furthermore, since it is an Africa-wide initiative, it will help improve the quality of these services through comparisons and taking advantage of what has been done in high-delivery countries. The standardization of the indicators allows comparisons between states and sub-national entities. Sub-national regions with poor education and health infrastructure stand a better chance of seeing the quality of services being improved with the SDI Initiative.

Since the surveys are meant to be redone on a biennial basis, progress in this domain can be easily witnessed and monitored.

Transparency of public expenditures and accountability of governments to their citizens are likely to be two of the externalities of this initiative. The African Development Bank recently launched its Open Data Platform for Africa, which gives useful data on well-being and development issues for the 54 African countries, while giving flexibility and leverage to the user. These two initiatives give a better view of what needs to be done by  the policymakers and the citizens, as well as by the NGOs and international organizations. What matters to citizens and how to foster their well-being will be even more evident with this initiative.

Ousmane Aly Diallo