Meeting the Millennium Development Goals: Improving Evaluation of Service Delivery and Understanding Caveats in Poverty Benchmarking Open Access
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The Millennium Development Goals (MDGs) target date of 2015 is rapidly approaching. Despite an increase in health and education funding, countries' inabilities to meet health and education goals (which make up more than half of the MDGs) put increased emphasis on the measurement of service delivery. The inabilities of countries in Sub-Saharan Africa to meet the target of reducing poverty by half has put emphasis on the importance of understanding how initial conditions impact a country's ability to meet this benchmark. This dissertation will add to this research. Chapter 2 introduces a new approach to the measurement of service delivery. This chapter introduces the Service Delivery Underperformance Index (SDUI) which measures the underperformance, or multiple inadequacies, in service delivery. Although there has been much work that has discussed how inadequacies in service delivery impact health and education outcomes no work has been done on the measurement of poor performance in the delivery of services. The measurement of the poor performance of service delivery can lead to identification of problems in the delivery of services and draw attention to them. The SDUI adapts the Alkire and Foster (2011) methodology used for poverty measurement to service delivery. The Alkire and Foster (2011) methodology is used because it allows the index to satisfy numerous properties that a measure of underperforming service delivery should have, including having a focus on underperformance, dimensional monotonicity, subgroup decomposability, and decomposability by dimensions and indicators. The possible dimensions and indicators of underperforming service delivery are discussed and it is shown how the Alkire and Foster (2011) methodology is applied to calculate the index using facilities as the unit of analysis. It is shown how statistical significance tests can be done to determine the statistical significance of the rankings determined by the SDUI. Chapter 3 uses the SDUI introduced in Chapter 2 to analyze underperforming healthcare delivery using data from Demographic and Health Surveys Service Provision Assessment. By applying the index, this chapter demonstrates how the SDUI can be used with a data source and how the inadequate delivery of services can be compared across countries and within a country. A cross-country comparison of healthcare delivery is done for Rwanda, Uganda, and Tanzania, where it is found that Rwanda has the best performing healthcare delivery despite being ranked below Tanzania and Uganda in terms of some health outcomes. A more extensive analysis of healthcare delivery in Rwanda shows that there are significant disparities in the performance of different types of facilities. The SDUI is used to evaluate facilities in Rwanda that did or did not participate in policies intended to improve healthcare delivery, and it is found that facilities that participated in community involvement performed better than facilities that did not. This observation calls for future work to be done using the SDUI as an impact evaluation tool to analyze how policies impact underperforming healthcare delivery. Chapter 4 applies the Service Delivery Underperformance Index introduced in Chapter 2 to the education sector of Papua New Guinea (PNG). By applying the SDUI to a country data source for the education sector, the index demonstrates its ability to make within-country comparisons of the delivery of education services and target facilities that are delivering the poorest services to populations for policy purposes. Results from this analysis show that there are significant differences in the delivery of education services across different managerial types. Because the education sector in PNG is highly decentralized, the SDUI is decomposed further to analyze rankings of different type of facilities and different managerial authorities within provinces. There are significant differences across managing authority and types of facilities depending on the province. The SDUI is used to evaluate facilities in PNG that did or did not participate in multigrade classroom use and that did or did not have community involvement. These are two policies that the government was interested in expanding at the time of the survey. It is found that facilities that participated in either policy performed better than facilities that did not. This observation calls for future work to be done using the SDUI as an impact evaluation tool to analyze how policies impact underperforming education delivery. Chapter 5 creates a framework to quantify the impact that poor initial conditions have on a country's ability to achieve inclusive growth, i.e. how much initial conditions affect a country's ability to reduce poverty given a level of growth. To do this, the framework calculates counterfactual poverty reduction when all countries are given the same initial conditions but still maintain their original growth rates. Results show that, due to initial conditions it is much more difficult for these countries to achieve inclusive growth. After equalizing initial conditions poorer countries are much more able to achieve high rates of poverty reduction given their original growth rates. This holds for different measures of poverty as well as different poverty lines.