From the Ground Up: Improving Government Performance with Independent Monitoring Organizations

Chapter 4: Examine the spending

50 Once resources make it out of the treasury and through the bureaucracy, they end up in the hands of service providers, where they finally have the chance to improve lives. Determining whether they actually do is the next step for independent monitoring organizations. Are there enough resources to do the job? Are they being used efficiently and effectively? Are services widely available? When most people think of improving government services, these are the sorts of questions they usually ask. The point where resources become services is also the point that provides the most tangible sense of how well a government is using its resources. Analysis of service delivery is also where the skills, interests, and “ear to the ground” orientation of independent monitoring organizations are most valuable. The first three organizations highlighted in this chapter studied absenteeism. Independent monitoring organization analysts live in the areas that they study, so they are able to show up unannounced at a school or clinic to record absenteeism and can check their findings with a follow-up visit the next day—or three months later. All the organizations highlighted in this chapter developed standard forms and methods to record absenteeism , but they also supplemented these with nonstandardized interviews and focus groups in local vernaculars. Depending on the politics, they could operate either under the government’s radar or in close and mutually bene ficial collaboration with the government. And using these techniques, all three discovered astonishing rates of absenteeism. In three Ghanaian school districts almost half the teachers were absent at least once during the week analysts visited; in two districts in Buenos Aires students lose an average of 49 days out of the 180 day school year because of teacher absenteeism and Chapter 4 Examine the spending Examine the spending 51 school closures; and in one Kenyan district absenteeism among healthcare workers reached 25 percent, costing the government more than $1 million a year. This chapter also describes the work of two independent monitoring organizations that examined the efficacy of government spending in other ways: by measuring the adequacy, equity, and financing of services and the satisfaction of beneficiaries . Their studies also highlight important advantages to independent monitoring organizations’ work. Analysts from these organizations began their work already knowing, in detail born of long experience, how the programs they were investigating operated and what needs they were supposed to fill. One study demonstrates that an independent monitoring organization need not produce only negative findings . The organization found that several Guatemalan programs intended to keep children in school are poorly and inefficiently funded but are otherwise equitable and satisfy most beneficiaries. The other discovered that many Polish hospitals are able to provide quality care without going into debt and analyzed four cases that suggest ways for indebted hospitals to control their costs. Together the five organizations in this chapter exemplify the book’s central theme: independent monitoring organizations bring many advantages to the monitoring and analysis of service delivery. Although gathering the data and following the money are vital steps, examining spending provides the clearest picture of the effectiveness of government service delivery—and, not coincidentally—some of the clearest examples of these advantages. Center for Democratic Development, Ghana This chapter begins with three studies about absenteeism—two of teachers, one of healthcare workers. The first is from Ghana’s Center for Democratic Development (CDD). Like all low-income countries, Ghana has very limited resources to devote to education, and the global recession means that resources have become even scarcer. In 2004 Ghana spent approximately $300 per student, more than 98 percent of which funded teacher salaries, leaving only $5.40 to cover the remaining costs of educating each student.1 Teacher absenteeism therefore wastes most of the money Ghana spends on education, and with few other educational resources, there is no substitute for a missing teacher. Moreover, because knowledge accumulates over time, students’ knowledge and future potential are degraded exponentially when they do not have regular access to a teacher.2 CDD’s goal was simple: to understand the extent of and reasons for teacher absenteeism .3 The results are appalling: in one week CDD analysts found that 47 percent of teachers in the surveyed schools were absent at least once. But CDD analysts did not stop there, digging deeper into the reasons for absenteeism. Many turned out to 52 Chapter 4 be...