PROTOCOL: Participation, inclusion, transparency and accountability (PITA) to improve public services in low- and middle-income countries: a systematic review.

Abstract

The sustainability of global development investments depends on strong institutions, citizen engagement, accountable governments, and equitable economic growth (World Bank, 2017). Goal number 16 of the Sustainable Development Goals explicitly recognises the importance of the development of effective, accountable and transparent institutions at all levels, and of ensuring responsive, inclusive, participatory and representative decision-making at all levels (UNDP, 2016). In the Paris Declaration on Aid Effectiveness, donor and partner countries committed to improving their mutual accountability and transparency in the use of development resources, with partner countries further committing to systematically involve diverse stakeholders in national development priority setting processes (OECD 2005). Many development challenges, such as poor service delivery, corruption and slow growth, persist because of the political context around them; they are as much about power dynamics as they are technical challenges. Improving the governance of public institutions and service delivery has long been a central tenet of strategies for achieving or supporting development; World Bank World Development Reports since the late 1990s have included elements of improving governance as central to their theories of change (Grindle, 2004). In the decades since, mainstream approaches to realising good governance have shifted in focus, away from privatisation of service delivery and towards a focus on increasing the engagement of constituents, particularly vulnerable groups, with public institutions and service providers in such ways to increase the effectiveness, appropriateness, and quality of service delivery. The 2004 World Development Report (WDR) highlighted the insight that public spending on service delivery in developing countries often primarily reached the better-off minority of citizens; for example, in India, curative health subsidies were primarily going to the richest 20 per cent of the population, who received three times the subsidies of the poorest 20 per cent (World Bank, 2004). This insight remains pertinent. For example, a recent evaluation of an e-governance intervention in India that aimed to improve transparency in a fiscal transfer system for a social benefits programme suggested that while the intervention was successful at reducing leakages, the savings did not translate into improved outcomes for beneficiaries (Banerjee et al., 2017). One of the authors later posited that this may have been because the intervention did not empower the ultimate beneficiaries to ensure that financial gains from reduced corruption were converted into increased outcomes for the poor (Page and Pande, 2018). There are many definitions of governance. For the purposes of this review, we use the recent definition employed by the World Bank, where governance is defined as “the process through which state and non-state actors interact to design and implement policies within a given set of formal and informal rules that shape and are shaped by power” (World Bank, 2017). Where characteristics of good governance are weak or absent from public processes and service delivery, the effectiveness and sustainability of development interventions is likely to suffer (World Bank, 2016). Barriers to access to public services for vulnerable groups exacerbate inequality, with potential long-term repercussions for a society's development (Easterly, 2007). Fraud and corruption are pervasive across low- and middle-income countries, and the negative consequences on quality of life and core development outcomes are well documented (Svensson, 2005; Molina et al., 2016). Where state and public actors cannot be effectively held accountable, a culture of impunity develops that normalises fraud and rent-seeking practices. The World Bank's World Development Report 2017 highlighted key repercussions of power asymmetries, including: exclusion of large portions of society from services, institutions or resources, which is correlated with violent conflict: elite and/or interest-group capture of policies in order to serve interests, resulting in poor targeting and ineffective or inappropriate policies, which can lead to poor or stagnant growth, condemning economies to an under-developed state; and clientelism, which often leads to rent-seeking and poor service delivery, which have long-term repercussions on societies’ growth (World Bank, 2017). Despite the decades of acknowledgement of the importance of good governance, progress has been slow; the Worldwide Governance Indicators show limited to none or even negative progress on key governance indicators amongst aggregates of low and lower-middle income countries from 2006 to 2016 (World Bank, 2018). The repercussions of continued governance failures are high, and well documented; for example, in Nigeria, unabated corruption led to the squandering of billions of dollars by the National Petroleum Company, jeopardizing the country's long-term growth potential and financial stability (World Bank, 2017). Approaches to improve governance have generally either focused on mechanisms to strengthen the effectiveness and institutionalisation of public institutions, or on external pressures to improve service delivery despite weak institutions. While each approach has yielded valuable insights, translating insights from theory into practice has been challenging. There is some evidence that at times, failures could be due to an over-emphasis of the demand side of governance by service users, citizens and civil society, which ignores the constraints faced on the supply side by politicians, bureaucrats and service providers (Brinkerhoff and Wetterberg, 2015), or of the power of information (Wibbels and Keohane, 2018). More recently, insights are emerging into the value of system-based approaches that look at both the supply and demand sides of governance as actors in a single system, drawing on power analyses and social network theories (Mcloughlin and Batley, 2012; Fox, 2014; Halloran, 2015; Wibbels and Keohane, 2018). USAID's Democracy, Human Rights and Governance (DRC) Center identified participation, accountability, transparency and inclusion (PITA) as critical principles that could be incorporated into interventions within and across sectors to improve development outcomes, and in line with the Doing Development Differently global initiative (USAID, 2016). We define participation as efforts to involve citizens in the design, monitoring and delivery of policy and programmes upstream (Quick and Feldman, 2011). Transparency is a “characteristic of governments, companies, organisations and individuals of being open in the clear disclosure of information rules, plans, processes and actions” (Transparency International, 2009: 44). Accountability is the concept that individuals, agencies and organisations are held responsible for executing their powers according to a certain standard downstream (McGee and Gaventa, 2011). Finally, inclusion means a particular focus on marginalised and vulnerable citizens in policy and programming upstream or downstream (Quick and Feldman, ibid). A recent evidence gap map (EGM) on interventions for state-society relations highlighted a number of interventions to improve governance (Phillips et al., 2017). These were broadly grouped into interventions for inclusive political processes and leadership (e.g. community-driven development, electoral monitoring, and quotas for women and minority representation in political institutions), and interventions for responsive and accountable institutions and service delivery (e.g. audits, land reform and public servant performance incentives). Many good governance interventions are designed to improve service delivery for citizens. This is often done through interventions that embody one or multiple PITA characteristics, which seek to address power dynamics between the state, civil society and citizens to make service delivery more effective and equitable (USAID, 2016). PITA characteristics influence the functioning of the social contract and its systems throughout each of the three accountability domains, and thus, good governance interventions may target one or more of these (Figure 1). For example, within the political system domain, the PITA characteristics have a direct impact on who has access to the electoral systems and who can contest the policy arena. Elected officials must exercise some basic level of downwards accountability towards the constituents who elected them (or, in non-democratic states, who grant them legitimacy), and sideways accountability to their fellow statesmen through the checks and balances built into the system. PITA interventions targeting this domain tend to focus on creating a fair system. Within the internal system domain, PITA interventions tend to focus on creating an efficient system, such as through improving the upwards accountability of officials and service providers to management, or through improving the relevance of service provision at local levels through decentralisation. Finally, in the external engagement domain, the PITA characteristics of a service or institution mediate the means through which it engages with citizens, civil society, and business/interest groups. These PITA interventions aim to address a more diverse set of system attributes, primarily the relevance, effectiveness and inclusivity of the service delivery system, and are further differentiated from those in the previous domains through their reliance on soft power. PITA interventions throughout the three domains of good governance Source: Authors The effectiveness of interventions that target the PITA characteristics within one domain will be mediated by the context of the other domains as well, the power relations and constraints, and also by other interventions aiming to improve good governance and service delivery, particularly those that target service delivery supply chains. There is increasing scholarship that suggests that while interventions improving the PITA characteristics of public services and institutions, particularly in the external engagement domain, may be necessary for achieving sustainable improvements in service delivery and a stable social contract, they may not be sufficient (e-Pact Consortium, 2016). On the other hand, while interventions that target strengthening PITA characteristics within internal institutional systems may be sufficient for improving governance within the system, the impact of those governance improvements may not reach the ultimate beneficiaries (citizens/service users) without the incorporation of interventions strengthening the system's external PITA characteristics (Page and Pande, 2018). While recognising the interactions of PITA interventions across each domain and with complementary good governance and service delivery initiatives, it has been pointed out that to attempt to cover the entirety of good governance interventions in a single review would be “exceedingly ambitious” (Sáez, 2013). Thus, this review will analyse the value-add of interventions in the third domain, external PITA interventions targeting public service and institution engagement with citizens. External PITA interventions can be implemented as stand-alone interventions or as part of a larger programme working to strengthen governance and service delivery. They may be implemented either on the supply or demand side of service delivery, or may target both simultaneously, such as a public audit process that trains community members on tools to hold public officials accountable, and works with public officials to increase their understanding of the importance of downwards accountability and transparency. As in that example, the interventions may strengthen one or multiple PITA characteristics of the ways public services and institutions engage with their constituents. Operationalising external PITA into intervention categories Source: Authors The intervention categories are described in more detail in (Table 3) in the Methodology section below. While most interventions contribute primarily to a single PITA mechanism as described above, there is often significant interplay between the PITA characteristics to which an intervention contributes. Though efforts have been made to make the definitions mutually exclusive, a single intervention may contribute to strengthening multiple PITA characteristics. For example, a public audit may improve the community's understanding of services the government can and cannot provide (contributing to transparency), while further allowing them an opportunity to pressure and apply informal sanctions to public officials should the audit uncover discrepancies in spending (contributing to accountability). More generally, interplay at outcome level often exists within transparency and accountability dimensions. For example, interventions to improve access to information about users’ rights to services (transparency) may aim, at an intermediate outcome level, to improve the way a service is governed (accountability). As noted above, according to the definition used in this review, eligible interventions that are designed to improve the access of a marginalised group of citizens (inclusion) to a decision-making process aim, at an intermediate outcome level, to improve the group's input into the process by providing increased opportunities for consultation (participation), or other aspects of monitoring service delivery (transparency and accountability). Indeed, the assignment of other intervention sub-types will vary depending on their particular iteration within a project. For example, officials may mandate a health care committee to increase access to health services for marginalised community members through community campaigns (contributing to inclusion) and/or to undertake health service monitoring (contributing to accountability). Thus, the ultimate assignment of a study looking at a health care committee intervention will depend on the structure and mandate of the committees within that project. We present a model showing an indicative, stylised theory of change for how the intervention may work (Figure 3). This preliminary theory of change developed for this systematic review draws on insights from the literature and programmatic best practices. In particular, the framework builds on the 2004 WDR (World Bank, 2004) theory of change, which articulated the importance of pro-poor governance practices that actively engage end users for effective outcomes, and Rahman and Robinson (2006) who articulated the importance of local ownership and long-term support. The assumptions and moderating factors draw on insights from Fox (2014), Page and Pande (2018), and the 2017 WDR (World Bank, 2017), among others. Intervention theory of change This review does not take a “rights-based approach” that views improvements in PITA characteristics as the end objective. While recognising the value of PITA characteristics in and of themselves, the focus of this review is on the value-add they bring to improving development outcomes through improved service delivery. It is unlikely that any single theory of change would be able to capture all the ways different PITA interventions affect good governance outcomes and service delivery. Thus, this review, at this protocol stage, attempts instead to hypothesise the main causal pathways through which PITA interventions targeting public services’ and institutions’ external engagement with citizens lead to improved development outcomes. Some interventions may contribute to all the pathways; others may only contribute to one. Similarly, as the focus is on the external engagement processes, while some interventions may have effects on other domains of the social contract such as electoral systems, they are not captured in this theory of change. The theory of change will be built out and developed in more detail through the evidence synthesis. We note here a useful distinction between the demand and supply side of governance. Implementers may target stakeholders on the demand-side of governance, such as through efforts to improve the capacity of civil society to monitor government service delivery, or the supply-side, such as by training public officials on pro-poor development planning. Other interventions may be geared to affecting both demand- and supply-sides, such as a participatory budgeting process in which government officials are trained on the value of participatory budgeting, while community members are trained and supported to participate in the process. Demand-side stakeholders: Community leaders; wider community members, especially marginalised groups; civil society groups Supply-side stakeholders: Public and civil servants; public officials; public service providers Context: Low levels of education and capacity amongst supply and demand side stakeholders; high turnover of supply-side stakeholders; resource poor communities; high levels of inequality; weak state capacity or reach; frequent access challenges, due to remoteness and/or insecurity; and endemic corruption The indicative theory of change presents the hypothesised causal chain for PITA interventions, from changed opportunities and capacities, followed by behavioural changes on both the supply and demand side of governance, ultimately leading to improved service delivery performance and enhanced quality of life outcomes for citizens. Beginning with the intervention on the left hand side, the figure follows a primary causal chain, with immediate, intermediate and endpoint outcomes indicated in boxes, and key assumptions in bubbles. The theory of change starts with critical assumptions of the design, inception and implementation phases: first, that the intervention designed is relevant and addresses an identified local need; second, during inception that wider community acceptance for the intervention has been sought and received from key social, religious and political leaders; and finally, that community mobilisation activities are undertaken during implementation. Similar to how the quality of PITA characteristics in the public planning and service delivery spheres contributes to strengthening the corresponding development outcomes, the strength and quality of the PITA characteristics of the intervention itself are suggested to contribute to its efficacy. The exact form of the intervention (Block 1) will vary widely, yet the majority aim to create an enabling environment for increased and mutually empowering interactions between service providers and citizens through changes to their knowledge, attitude and practices (KAPs). On the demand side, this may include efforts to improve citizens’ knowledge of the services to which they are entitled; their capacity to demand those services through key tools; and/or their sense of self-efficacy and empowerment to do so effectively. An intervention focused on a technical skill such as participatory budgeting may start with capacity building on budgeting processes and the role that citizens can play; interventions that aim to increase inclusion of marginalised groups often start with community campaigns to raise awareness amongst the target households. On the supply side, either in addition to demand-side efforts or independently, interventions aim to strengthen openness from and active engagement with supply-side stakeholders in efforts to improve service delivery. These may target the actors implementing or managing the service in question, but also other key stakeholders in the community and throughout the system. Seeking and attaining community acceptance prior to implementation is a widely-applied best practice for ensuring that development projects do no harm and that they will have sufficient buy-in from the community to be successful. There is some evidence that suggests that this may be particularly critical for PITA interventions. Securing buy-in from stakeholders at the point of intervention, upstream and downstream along the service delivery / good governance supply chain may create an enabling environment for PITA interventions to successfully navigate the social network and power differences within which the intervention is implemented (Mcloughlin and Batley, 2012). Different tools implemented as elements of PITA interventions may require different conditions to be effective; the synthesis process will aim to identify and these out. The context will also influence what works, how; for example, if a political player can increase his or her own personal power through framing an improvement in service delivery as a personal “win,” then she or he may be more motivated to work for its improvement (e-Pact, 2016). The first immediate outcome (Block 2) posits that through engaging in the PITA interventions, citizens will increase their engagement with State and public service officials. This is often an explicit aim of PITA interventions, as it is a critical precursor to the higher-level outcomes. Through the increased engagement, the next level of change (Block 3) posits that citizens develop a better understanding of processes, services, and the constraints faced by service providers, while simultaneously, service providers gain a deeper understanding of the needs of their constituents and appreciation for the engagement process. Power relations are dynamic; they can change quickly, both for the better and worse, and gains are not necessarily secure. A key assumption here is that supply-side actors are fully engaged throughout the process; otherwise, the attempts to increase soft power by citizens may be seen as confrontational rather than collaborative, which could de-incentivise service providers from the process to avoid being seen to give up any of their power (World Bank 2004). Where PITA processes are seen as collaborative, they can be mutually empowering, creating changes in the interactions between state and society that simultaneously give citizens greater input into the provision of the services they rely on, and strengthen the standing of the service providers in the community (Fox, 2014). Where interventions are unsuccessful at building coalitions to facilitate an enabling environment for change, they may not be successful at changing power relations, as actors may adapt to new systems (Halloran, 2015). For example, though advancements in the field of information and communications technology (ICT) offer exciting possibilities for strengthening external PITA characteristics, a change in technology that is not complemented by supporting interventions that create an enabling environment may fall flat (Hogge, 2010). As the power relations are shifting and engagement is increasing, a core intermediate outcome of the PITA interventions will emerge (Block 4): public service delivery will improve in efficiency, effectiveness, and equity. Once public officials and service providers are taking into account the input of community members, the selection and targeting of services will improve. This will improve the effectiveness and appropriateness of public service delivery. Inclusion interventions improve the equality of service provision, as they increase access to services and processes for the most vulnerable community members. Transparency initiatives increase the efficiency of public service delivery, as they streamline costs and processing times, and make it harder for politicians and officials to demand inflated payments for services. Finally, accountability initiatives can have direct benefits to the performance of public service delivery, as citizen feedback mechanisms such as Public Audits end with joint workshops between the service provider, citizen representatives, and other key stakeholders to come up with an actionable plan to which all parties can be held to account for how they will address the major issues identified and improve service delivery. The key assumption here is that institutions have the capacity to respond to priorities requested and issues raised by constituents. This is a critical assumption, because in its absence, the interventions risk doing harm by having a negative consequence on perceptions of State effectiveness resulting from raised and then unmet expectations. For example, the 2017 WDR highlights the risk that investments in service provider capacities may not be enough to improve service delivery, if power relations within the institution are not addressed (World Bank, 2017). Further, depending on the structure of the intervention, improvements may be related to a one-off change in the situation that is not sustained; many PITA interventions are designed as experiments, whose study design may capture short-term gains that revert back to the baseline conditions with time. Fung et al. suggest that transparency interventions contribute to improvements only when the information provided becomes embedded in the decision-making process (2005). In some cases, PITA interventions, particularly those that focus on improving access to services for marginalised groups (I), may not lead to the active, empowered engagement between citizens and service providers that leads to mitigated power differences and improved services. However, they could still lead to increased use of public services, particularly amongst vulnerable populations (Block 5). This comes about as a direct result of Inclusion and Transparency (information dissemination) interventions, but also through the other PITA interventions; as communities are mobilised to engage with their local government and services, they become more invested in the services that they are attempting to improve. And thus, they are more likely to take advantage of those services, as they understand the importance of ensuring high quality service provision for themselves and their families. However, increased access for marginalised groups is not a given outcome of PITA interventions; there likely needs to be concerted, targeted efforts to reach and engage these groups in order for the impacts to reach them (E-Pact Consortium, 2016). Similarly, interventions targeting services where changes are relatively immediate and visible may be more likely to encourage buy-in and support from supply-side actors (ibid.). The joint effects of changes from Blocks 4 and 5 lead to improved development outcomes for citizens (Block 6). These will vary by sector targeted, and by project duration. It is increasingly thought that PITA interventions, through the immediate outcomes increasing engagement with government and public officials and mitigating the power differences, can have a positive impact on perceptions of state effectiveness when services and development outcomes improve as a result (World Bank, 2017) (Block 7). As citizens engage with public processes and services, they learn more about the constraints under which these institutions operate. As they see increased responsiveness of public officials, and subsequent real improvements in the quality of services they receive, their perceptions of State effectiveness and legitimacy will increase. This is particularly critical in fragile and post-conflict Sates, where the State may still be vying with other actors for legitimacy over governing and control. The social contract, wherein the state and citizens negotiate the granting of power and legitimacy in return for service provision, is a complex system that is being constantly renegotiated as actors at various levels within and outside of the government interact and negotiate for their own individual power and accountability, within frameworks of collective power and accountability. Thus, it is both the context within which good governance interventions are implemented, and also at the heart of the systems and services that said interventions aim to improve. There is some evidence that the relationship between politics and service delivery is two-way: the political context influences service delivery, but service delivery also influences politics, particularly state legitimacy (Mcloughlin and Batley, 2012). Thus, all good governance interventions in some way influence the social contract between the state, its institutions and service providers, and the citizenry; on the other hand, good governance failures often stem from fragmented social contracts (World Bank, 2017). This perspective also draws on the ideas of a social accountability ecosystem developed by Halloran (2015). In the majority of PITA programmes, the PITA characteristics interventions are add-ons to core interventions and outcomes in a public service sector, such as health or agriculture. In the long run, all three intermediate outcomes contribute to sustaining social and economic outcomes of communities (Block 8). The key assumption here is that sustained support is provided to the institutions or service providers charged with maintaining the implementation of the PITA intervention, such that it becomes institutionalised. As noted above, power differences are dynamic and constantly evolving. Thus, a short-term project may well change outcomes in the short-term, but without proper support those gains may easily be lost. Thus, sustainability mechanisms must be built into the PITA programme design, to support communities and service providers on the road to sustainable participatory, inclusive, transparent and accountable public service delivery and public management. The context in which this theory of change, or elements of the same, are implemented has strong ramifications on the ways in which the interventions must be designed, implemented and supported in order to ensure success. Common key characteristics are noted in the box below the theory of change, alongside the key stakeholders from both the supply and demand side of governance. Governan