MINISTRY of FOREIGN AFFAIRS/DENMARK GROSS NATIONAL HAPPINESS COMMISSION/BHUTAN
Joint Evaluation of Danish-Bhutanese Country Programme 2000-09
Thematic Paper on Local Service Delivery
Lham Dorji Centre for Bhutan Studies
August 2010
Table of content
1. Introduction 1 2. Overview of decentralisation reforms and impacts on local service delivery system 1 2.1 Underlying framework 1 2.2 Introduction of DYT and GYT Acts and amendments over time 2 2.3 Participatory approaches to planning 3 2.4 Resource allocation 3 2.5 Service delivery trends 3 3. Policies and programmes aimed at improved local service delivery 5 4. Service delivery outcome 7 4.1 Education services and outcomes 7 4.2 Health services and outcomes 9 4.3 Agriculture and environmental services 16 4.4 Governance 19 4.5 Communication 20 5. Challenges on improved public service delivery 20 5.1 Mandates and responsibilities 21 5.2 Capacity of local government 22 5.3 Participatory planning 24 5.4 Service delivery 25 6. Recommendations and conclusion 27 6.1 Access to services 27 6.2 Decentralisation 28 6.3 Civil society 30 6.4 Accountability 30
Annex 1: Prevalence of deprivation across five dimensions, by region Annex 2: Various livestock service centres (1998-2008) Annex 3: Number of ICT facilities (2000-08)
Abbreviations and acronyms AHB Annual Health Bulletin BHU Basic Health Unit CBO Community-Based Organization CBR Crude Birth Rate CBS Centre for Bhutan Studies CSO Civil Society Organization DSP Decentralisation Support Programme ECCD Early Childhood Care and Development EPI Expanded Programme on Immunization FYP Five-Year Plan GAO Gewog Administrative Officer GDP Gross Domestic Product GNH Gross National Happiness GNHC Gross National Happiness Commission HDI Human Development Index HR Human Resource HRD Human Resource Development HRO Human Resource Officer HTF Health Trust Fund IMR Infant Mortality Rate LGDP Local Governmnet Development Programme MDG Millennium Development Goals MoE Ministry of Education MoF Ministry of Finance MoH Ministry of Health NEC National Environmental Commission NFE Non-Formal Education ODA Official Development Assistance ORC Out-Reach Clinic PHCB National Population and Housing Census (2005) RCSC Royal Civil Service Commission RGoB Royal Government of Bhutan RIARD Rapid Impacts Assessment of Rural Development RIM Royal Institute of Management RNR Renewable Natural Resources USD US Dollars VHW Village Health Worker
Bhutanese terms Chimi Representative of village at National Assembly (up until 2008) Dzongdag District administrator Dzongkhag District (there are 20 in Bhutan) Dzongkhag Yargye Tshogdu (DYT) or District Development Committee Dzongkhag Tshogdu (DT) Gewog Administrative block (there are 205 in Bhutan) Gewog Yargye Tshogdu (GYT) or Gewog Gewog Development Committee Tshogde (GT) Gup Elected representative at gewog level Maangmi Deputy to gup Tshogpa Representative of a village
Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09
1. Introduction This thematic paper is prepared as a part of the Joint Evaluation of Danish-Bhutanese Country Programme which is guided by the following overall objectives: 1. To assess and document the relevance and effectiveness of Danish support to poverty reduction and democratisation in Bhutan 2000-09, and 2. To consolidate and enhance the sustainability of the outcomes achieved through learning and adjustments to the cooperation during the last programme period 2009- 13 and beyond. The Danish bilateral assistance to Bhutan in its present form will gradually be phased out from 2013. It is anticipated that the collaboration will gradually be replaced by other forms of collaboration such as business-to-business joint activities and various kinds of cultural and non-governmental programmes. This paper summarises the current state of local service delivery in Bhutan and the challenges this face. It further elaborates the assessment made in the synthesis report and should be seen as a supplement to the thematic paper on decentralisation and local empowerment. Hence, while the latter focuses on achievements and challenges faced by the decentralisation process, the present paper is primarily concerned with the population’s access to basic services. This paper draws on the relevant official documents, donor reports and field interviews to evaluate the policies, practical challenges and development of decentralised local service provisions in Bhutan. It focuses primarily on the service delivery in education, health, governance and renewable natural resource sectors, key priorities of the Bhutan-Denmark Country Programme. First, the general analysis of how decentralisation reforms have contributed to improving local service delivery is made within the context of the country’s overall development policy framework. Second, it examines the policies, programmes and financing mechanisms of service delivery. Third, the progress and outcomes of decentralised service delivery is assessed. Fourth, it identifies the general issues and challenges of improving decentralised local service delivery system. Finally, the paper concludes with recommendations for raising the local service delivery performance.
2. Overview of decentralisation reforms and impacts on local service delivery system
2.1 Underlying framework The underlying framework of Bhutan’s development approach is the Gross National Happiness (GNH): Bhutan 2020: A vision for Peace, Prosperity and Happiness. The overarching goals of Vision 2020 are: the country should be able to sustain the rising cost of social sector investments, meet the growing physical infrastructure needs and raise living standard and the quality of life by promoting equitable access to improved quality of social services.1 Bhutan’s Vision 2020 has set the following goals between 2000 and 2020 (for the selected sectors): 1. The country to deliver healthcare services similar to other developing countries with drastic reduction in maternal and child mortality rate and improved integration of indigenous health service system.
1 10th Five-Year Plan Documents, Volume I, pp, 19.
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09
2. The education system to evolve and be able to develop culturally conscious children, being curious to learn and acquire skills and ready for employment. The other goals are to fully attain enrolment level at class X by 2012 and realize full adult literacy by 20172. 3. To develop the governance system with required institutions for democratisation and decentralisation processes; to strengthen the local governments that are capable of planning, carrying our management functions and delivering local services; and to fulfil both national and local priorities and aspirations through efficient, transparent and accountable governance mechanisms3. 4. The environment sector to maintain the forest coverage of not less than 60% with protected national parks and richer biodiversity, and sustainable use of natural resources for socio-economic development.4
2.2 Introduction of DYT and GYT Acts and amendments over time Decentralisation reforms have changed the state-people relationship from the providers- recipients to the ‘partnership one’. Since the introduction of Dzongkhag Yargay Tshogchung (DYT), district development committee in 1981, ordinary people increasingly took part in drawing of five-year plans (FYPs). They were not only engaged in identifying their needs and priorities, but also in implementing the programmes. The institution of Gewog Yargay Tshogchung (GYT), gewog development committees, in 1991 further shifted the service provision points from the central to local governments. The GYT Act (2002) established three categories of functions for the GYTs: regulatory, administrative and financial. In terms of regulatory functions, the GYTs were given power to monitor sanitation standards, environmental management, livestock disease control, housing management and development of local enterprises and promotion of co-operatives. The administrative functions of GYTs were to identify, prioritise, formulate and monitor gewog plans with the administrative and technical support from the dzongkhag sector staff. The GYTs were to manage a wide-range of development activities like temple management, water supply schemes, irrigation channels, footpaths, mule tracks, farm roads, suspension bridges, Out-Reach Clinics (ORCs), micro-hydels, community schools, award of contract works and emergency relief measures. The financial powers of the GYTs were to approve the annual budget, outsource development works (costing above Nu. 50,000), re-appropriate budgets, collect rural taxes, raise funds, and review expenditures. The financial power has been limited to the rules and regulations of the Ministry of Finance (MoF). However, the GYTs enjoyed limited scope to fund the public services through taxes and other revenues. They relied on the Government’s annual grants. These grants used to be channelled through dzongkhag administrations. The grants were given as per the approved local programmes. The MoF used to issue the GYTs the budgeting guidelines and ceiling for each activity or sector during the planning process itself. The GYTs used to submit the plans and budgetary requisitions to the DYTs, which after reviewing them would forward them to the central government. The MoF would hold annual negotiations with the DYT members in the presence of the representatives of the sector ministries involved mainly to review and comment on the feasibility and implementation modalities of each programme.
2 Ibid. p. 20. 3 Ibid. p. 20. 4 Ibid. p. 20.
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09
The three year rolling budget was introduced in 2002-03. The GYTs were given spending discretions as measures to strengthen fiscal decentralisation. However such ‘fiscal discretion’ was considered unsatisfactory. The expenditures were subjected to auditing by the Royal Audit Authority.
2.3 Participatory approaches to planning The 8th FYP (1997-2002) was the first plan which saw real involvement of the local people, especially at dzongkhag level in the ‘bottom-up’ planning and implementation with technical backup from the civil servants. Local consultations in development planning and local service delivery preceded the introduction of legal provisions of the GYTs and DYTs in 2002. The GYT and DYT Acts of 2002 and the elections of local heads (gups) in 2002 (on the basis of adult franchise) further led to administrative decentralisation, and raised the foundation for fiscal decentralisation. These altered the local administration system and mechanism for budget and resource allocations and for service provisions as the GYTs were given some discretion to take up activities of importance for local development and service delivery. The drafting of the 9th FYP (2002-07) was widely gewog-based. The GYTs assessed local needs, selected schemes for inclusion under sector programmes and carried out priority funding. The gewog plans were disaggregated at the dzongkhag and central levels, and the system of direct transfer of funds to the local governments was introduced by establishing ‘Letter of Credit Accounts’. A Decentralisation Support Programme (DSP) supported block grants allowing the gewogs full discretion on activities of the local priorities and needs. The central government managed some sector programmes to substantiate the local government’s efforts to improve service delivery and development. Some of the specific donor-funded programmes were managed as separate projects. They served as programme supplements for the local development and service delivery. In short, the system of local service provision and development was, more or less, based on the three-pronged intertwined approach.
2.4 Resource allocation The modality of resource allocation was drastically changed in the 10th FYP (2008-13). The dzongkhags and gewogs now receive formula-based annual grants from the central government. This formula considers geographic area, poverty incidence and population size of each gewog. The central sectoral agencies provide ‘earmarked grants’ to the local governments. The multi-year planning and budgeting system is prepared based on annual work plans with additional two years projection on programmes and budgetary targets. Among several objectives of Bhutan’s decentralisation policy like creating space for democratic participation, power devolution, local development, and enriching quality of life, one of its key goals was to provide equitable social infrastructure and quality services. Improving social conditions of the people through improved social service delivery was the main objective of the 9th FYP as well.
2.5 Service delivery trends The Human Development Index (HDI) trend for the country improved from 0.550 in 1998 to 0.613 in 2006 taking Bhutan from being a low human development country to becoming a medium one. The positive trend in HDI can be largely attributed to sustained higher
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09 investments in social sectors, the raise in local service delivery performance and the real income growth.5 The education and health sectors represent the realisation of decentralised service delivery. The management, monitoring and supporting of community schools and non-formal education programmes were decentralised to the community. The district education sector provided teachers and other educational resources, and was responsible for the implementation of all education activities from primary to higher secondary levels. The ‘innovation grants’ for the local level schools further contributed towards decentralised school planning and financial management system. In 2002, the management of health clinics and ORCs was decentralised to the GYTs with the support from the dzongkhag health sector. The district health sector managed hospitals and Basic Health Units (BHUs) while the construction of hospitals and BHUs were done by the central sector agency. The survey conducted by the Gross National Happiness Commission (GNHC) in 20076 proved that education was the most accessible service sector (98%) and health the second highest. The least accessible service sector was income generating supports, which calls for caution. Figure 1 shows the people’s perception re. the accessibility of various services. Providing access to services is one thing, but how satisfied the people are with the services is another critical dimension. The GNH Survey (2008) conducted by the Centre for Bhutan Studies (CBS) revealed the level of people’s satisfaction with various service delivery programmes. The nature of services were categorised into two: the education, health and environment sectors (in Category 1) and electricity, roads and employment sectors in (Category 2). The overall satisfaction with the first category was high; the satisfaction on the second category, particularly in rural areas was considerably lower than the satisfaction with social and environmental services. The urban people reported dissatisfaction with the provision of employment services. Table 1 provides the details of the survey. The people rated their highest satisfaction with the educational services, then provision of health services and environmental conservation services. These were the main sectors under Danida’s sector support programme in the 9th FYP. The area receiving the lowest level of satisfaction was the Government’s effort to reduce disparity or the gap between the rich and poor, to ensure employment opportunities and to reduce corruption. The decentralisation reforms has brought about significant changes in local development and improved local service delivery. However, the higher cost of service delivery to inaccessible communities as well as the context of poor management capacity and fiscal constraints was and is still a big challenge. This challenge can be put within the context of relatively diverse local contexts, availability of socio-economic infrastructure, coordination, and varying capacities of the GYTs.
Figure 1: Accessibility to different service sector (survey, 2007)
5 Ibid. pp. 13-14. 6 These survey findings have now been published with the title ‘Rapid Impacts Assessment of Rural Development’, 2007.
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09
Household Interview (responding 'Yes’ to access to service types)
120 98 94 93
Percentage Percentage
100Percentage Percentage 90 90 90 88 82 77 80 71 55 60 40 16 20
Agriculture
Education Education
Rural Credit Rural
Electricity
Livestock Livestock Generation
Health Health
Sanitation
Water
Forestry Forestry
Telephone Telephone 0 Roads Income
Service Types
Source: Rapid Impact Assessment of Rural Development, 2007, Planning Commission, GNHC.
Table 1: Perception Survey on ‘satisfaction’ with different service sectors Service Types Excellent Good Poor Education services 73 24 2 Healthcare services 72 25 1 Environment conservation and services 67 30 1 Electricity 57 28 14 Roads networks and services 49 36 14 Reduction of corruption 38 39 10 Employment opportunities 38 48 11 Reducing inequity 37 47 11 Source: GNH Survey, CBS, 2008
There was also a salient need to promote greater transparency, accountability and efficiency in local service delivery; and the need to represent the local interests and concerns at the national decision-making level in bringing equitable access to service and infrastructure. Decentralisation reforms were the important aspects of the Government’s effort to promote good governance. Many constitutional bodies were established to regulate and coordinate democratic processes.
3. Policies and programmes aimed at improved local service delivery The core principle of the country’s development planning has essentially focused on the fundamental objectives of achieving broad-based and sustainable growth, and on improving the overall quality of life through better service delivery mechanisms.7 The Constitution now mandates provision of free education to all school-going age up to class X; and to make technical and vocational education and higher education accessible to all on merit system. The Government adopted four-pillar approach to create enabling conditions for Gross National Happiness. The four pillars of GNH were cultural preservation, conservation of
7 10th Five-Year Plan Documents, Volume I, page, 20.
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09 environment, promotion of good governance and advancement of balanced socio-economic development. These pillars were fully attuned to the Millennium Development Goals (MDGs). The development principle adopted then was that ‘the best way to deliver basic public services to the people is through decentralised policy mechanisms and democratic local participation’. To fulfil this policy objective, the efforts were made to devolve and enhance the power, responsibilities, budgets and human resource capacity of the local elected government system. The Government long recognised that it could deliver efficient and cheaper local services only through its close association and partnership with the local people and other service providers. It emphasised community participation in decision- making, implementation and monitoring of the programmes. Firstly, the Government made tremendous effort to develop the democratic institutions of governance and effective legal system so that it could better respond to the needs and priorities of the people. The three main principles adopted to promote good governance were efficiency, accountability and transparency – all crucial to enhance the Government’s responsiveness to the needs of the people. Secondly, the Government focused on addressing structural problems and in prioritising social sector expenditures (health and education), promoting decentralisation and democratisation through strengthening of administrative and legal institutions (good governance), and private sector development and sustainable use of natural resources (environmental issues). Danida’s sector support programmes conformed to these policies and programmes. Thirdly, despite a low tax base8, the social sector received more than a quarter of the 9th FYP’s total budget. The country fulfilled its commitment to the Global 20:20 Compact that entailed every country to invest more than 20% in the social sectors. The health, education and other basic services were provided almost free. Fourthly, as a donor-dependent country, and to ensure sustainability of foreign aid, the Government prudently spent the donors’ money on poverty reduction through improved social service provision. The total Official Development Assistance (ODA) in the 9th FYP recorded the increase by more than 45%9, though ODA as a total percentage of GDP has gone down at less than 20% at present. Lastly, the Government initiated a Poverty Reduction Strategy Paper process as a part of the broader ongoing efforts to combat poverty. Its main objective was to strengthen the strategic framework for poverty reduction, improve donor coordination, and build support for new initiatives in public expenditure management.10 Recognising the difficulty of reaching the un-reached, the overall objectives of the 9th FYP were poverty reduction and effective mainstreaming of rural communities into the development process through the provision of improved and equitable services.11
8 While the Revenue and Tax Authority is the principal collector of taxes, dzonkhags generate a small revenue from local licenses and fees. 9 10th Five-Year Plan Documents, Volume I. 10 Department of Planning (2004). Poverty Reduction Strategy Paper, Cover Note the Ninth Main Document, p. 6. 11 Planning Commission (2006). Draft Tenth Plan (2008-13). RGoB: Thimphu.
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09
4. Service delivery outcome
4.1 Education services and outcomes Both education and health sectors represented progressive implementation of successful service provisions through a mix of decentralised and centralised approaches. The provision of free education was recognised as an effective tool of poverty reduction. The per capita recurrent costs of education continued to be relatively high due to the low teacher-pupil ratio and the high proportion of schools which have to cater to highly scattered settlements. The cost of transporting education materials to remote schools also remained exorbitantly high. The 9th FYP adopted the education sector as one of the main country’s strategic areas, allocating it the largest share of its resources. The increase in the resources (15% of total plan outlay) was possible due to a large portion of Danida’s support to this sector. The capital grant supported Ministry of Education’s effort to maintain a balance between the increased enrolment and infrastructure need, and to improve the learning environment and services of higher educational needs. Danida supported the construction of schools using Light Gauge Steel Framing on a pilot basis to minimise the use of timber, sand and stones, and to decrease time taken to construct schools. This project conformed to one of the six strategic objectives of the education sector’s strategy of realising Vision 2020 ‘to take advantage of new educational innovations and technologies to increase access to and improve the quality of education’. There has been a 72% increase in the number of schools between 2001 and 2008 and about 58% increase in the number of higher learning institutes. In the 9th FYP alone, 111 community and primary schools were established increasing the total primary enrolment from 93, 974 in 2003 to 106,100 in 2008.12 The same plan period saw the increase in Gross Primary Enrolment Rate from 81% to 112% and Nett Primary Enrolment Rate from 62% to 82%. There are now 355 community and primary schools. Figure 2: No. of primary and secondary schools and education institutes 2001 and 2007
600
523 500 489 502 447 458
Number 426 400 397 375
300
200
100
18 18 19 19 0 11 11 14 14 2001 2002 2003 2004 2005 2006 2007 2008 Year No. of Schools No. of Institutes
Source: Ministry of Education, 2009.
Figure 2 above depicts the increase in the number of schools and education institutes between 2001 and 2008. In the Rapid Impact Assessment of Rural Development, education
12 10th FYP Document, page 85.
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09 was perceived as the most accessible service (national average was 98%). The same assessment concluded that 71% of respondents perceived schools as accessible within a distance of one hour.
Rapid expansion in the number of schools from 375 in 2001 to 523 in 2008 indicated marked improvement in the accessibility to educational services. The number of students enrolled in the primary schools increased dramatically such as increase of the number of class X students entering class XI from 8,464 in 2002 to 16,155 in 2008. This double-fold increase was prompted by two main factors: Increase in the number of students at the primary and lower secondary schools and increase in the number of higher secondary schools. Many high schools have improved their infrastructure facilities with proper library rooms, computer facilities and laboratories. Table 2 shows the number of students in schools between 2002 and 2008. Table 2: Number of students enrolled in the educational institutions from 2002-08 (9th FYP) Schools 2002 2003 2004 2005 2006 2007 2008 Community Primary School 20,978 22,502 24,533 26,965 29,132 28,953 29,702 Primary Schools 28,849 26,168 26,508 25,879 25,745 23,585 22,813 Lower Secondary 41,985 46,856 48,089 48,995 50,576 48,716 48,706 Middle Secondary 19,194 17,735 20,775 20,641 21,236 29,829 32,292 Higher Secondary 8,464 11,268 10,865 13,145 14,414 14,963 16,155 Private Schools 3,813 4,631 5,218 5,763 5,421 6,148 7,444 Total 123,283 129,160 135,988 141,388 146,524 152,194 157,112 Source: Statistical Yearbook of Bhutan, 2006 & 2009, National Statistical Bureau.
The basic education completion rates have improved significantly to 54% and gender parity index of 1.02 for primary education. These successes had come about despite several challenges such as inaccessibility, dispersed population, low literacy, significant rural poverty and shortage of teachers and other educational facilities. However, the analysis of census data, 2005, revealed the education deprivation as the most common deprivation in the country. According to this analysis, 23% of school-going children in 2005 had not been enrolled in schools (Table 3).13 This was the situation in 2005, and definitely, the rate of education deprivation might have gone down in 2009, as many schools were opened in the south between 2005 and 2009.
Table 3: Child poverty as multiple deprivations (2005) Incidence Number of children Of which experiencing Of which experiencing (prevalence) of in relevant age ‘severe’ deprivation, ‘less severe’ deprivation cohort % (Bristol Standard) deprivation, % (MDG standard) Education 145,411 23 27 Information 232,915 21 22 Shelter 232,915 20 35 Water 232,915 15 15 Sanitation 232,915 9 9 Food No data No data No data Health No data No data No data Total 232,915 Source: Population and Housing Census of Bhutan 2005, Office of Census Commissioner, 2006.
13 The author’s analysis of ‘Child Poverty and Disparity in Bhutan, 2008’. This study was a part of global child study funded by Unicef.
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09
There was also a significant rural urban disparity in education deprivation. About 28.4% of children in rural areas had not been enrolled in schools compared to 9.6% in the urban centres. The common reasons stated for non-enrolment were the non-affordability of nominal cost of uniforms and school fees, age factor and lack of income generating activities (poverty). The percentage prevalence of various dimensions of poverty by districts is given in Annex 1. Deprivation of education and access to information were two important dimensions of poverty affecting the Bhutanese children in 2005. The Government’s commitment to raise the enrolment rate has put immense pressure on already constrained teaching resources and other educational infrastructure at the secondary schools. The teacher shortage continues to be a major problem. There is also a significant need to maintain staff morale and improve teacher’s performance, especially in rural schools. Serious mismatch between school leavers and availability of secure employment opportunities has now become a critical concern for the Government. The Government’s effort to encourage them to take up vocational training has been seriously constrained by shortage of vocational training institutes. This leads to rising social problems such as youth problems manifested in the form of drug abuse and petty crimes in urban centres. In the 9th FYP, Early Childhood Care and Development (ECCD) had been given a priority, but except for a few centres in urban areas, extending ECCD to rural areas remained as a hurdle. The Government plans to promote the home-based ECCD programme. It has been trying to benefit from the progress made in non-formal adult education programme like developing post-literacy materials highlighting the theme of ECCD. The national adult literacy rate in 2005 was 53%, which by international standard was not so encouraging. The Government has been expanding access to non-formal education as measures to reduce adult functional illiteracy. Non-Formal Education (NFE) programme was considered successful; NFE Centres increased from 365 centres in 2003 to 747 centres in 2008. The number of NFE learners increased from 12,838 to 13,839 within the same period.
4.2 Health services and outcomes The government emphasised the health sector as fundamental to fulfilling the broad development philosophy of Gross National Happiness. The Constitution of the Kingdom of Bhutan, Article 9 Sections 16 and 21 states that access to free basic education and free healthcare are inalienable rights of all the Bhutanese. The Constitution provides for the provision of free, universal and pro-poor health policy. The Government’s health policy constitute the provision of free healthcare services to all citizens by promoting primary healthcare with an integrated and holistic mix of preventive, promotive and curative care services. One of the core visions of the health sector as reflected in the Vision 2020 is to ensure primary health care services, extending them to the population in the remotest part of the country through establishment of Out-Reach Clinics and drawing extensively from the community participation. The most important goals of the health sector and indicators in the 9th FYP are shown in the Table 4 below:
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09
Table 4: Specific Activities Goals and Indicators for the 9th Plan Indicators 9th FYP Targets Reduce Total Fertility Rate from 4.7 4 Reduce population Growth Rate from 2.5% <2% Reduce Infant Mortality Rate from 60.5 per 1000 30/1000 Reduce Under 5-Mortality Rate from 84 per 1000 <50/1000 Infant Immunization fully completed >90% Height for age (HA) from 40% 15% Weight for age (WA) from 19% 10% Reduce Low Birth Weight from 24% 12% U5 death due to pneumonia from 10% <5% Diarrhoeal Deaths for U5 from 13.3% <5% Reduce Maternal Mortality Rate from 225 per 100,000 live births 150 Source: Sector Overview, MOH, 2007. The Government’s emphasis until the 8th FYP was free primary healthcare coverage. However, despite achievement of 90% primary health coverage by 2002, the need to deliver health services to the un-reached population and achieve health equity remained a challenge. The remaining 10% of the population was the most inaccessible and vulnerable groups. It was difficult and expensive to deliver healthcare services to them. The rise in demand for specialised medical services also posed the Government with a new burden of expanding tertiary care facilities and services. Hence, the country is beginning to face the problem of epidemiological transition with an increasing incidence of health problems caused by the change of life-style and general modernisation. Domestic sources finance more than 50% of recurrent expenditure. However, the question of sustaining healthcare financing, particularly those aimed at promoting and protecting the health of specific population sub-groups, mothers and children looms at large. In the 8th FYP (1999-2002), the expenditures on the health sector increased in real terms with the average growth of 18%. The Ministry of Health (MoH) continues to receive, on average, 10-12% of the total government budget. The Health Trust Fund (HTF) is seen as a potential source of future healthcare financing. At present, more than 75% of its target capital of USD 24 million has been mobilized for HTF. The MOH has been emphasising the delivery of quality health services, enhancing health standards, strengthening human resource capacity, improving management of information system, and promoting health research and their uses. The Annual Health Conference 2005 adopted 100% institutional delivery as its core objective. The efforts to increase the availability of Emergency Obstetric Care for pregnant women in all hospitals and Grade I BHUs have been made. The healthcare services at the villages are maintained by Village Health Workers (VHWs), drawn from the communities and are supported by ORCs and BHUs. The Government accorded the highest priority to the provision of proper water and sanitation facilities. The water supply schemes involved 25% of cost-sharing by the communities in terms of labour and materials, 15% by the Government and the rest from the donor funding. The rural water schemes were managed and maintained by the trained care- takers, normally drawn from the communities. The health sector plans were made by the communities with the support from local health workers. The GYTs used to deliberate on them and submit to the DYTs which further would submit to the central ministry for approval and resource allocations. GNHC (formally Planning Commission) was the central agency to coordinate the plans. The MoF coordinated resource allocation. The delivery of healthcare was done through inter-sectoral interactions;
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09 the central ministry coordinated with other ministries and municipal governments through multi-sectoral task forces. The main partners in the health sector were India, Danida, Unicef, United Nations Population Fund (UNFPA), World Health Organization, Japan, and the World Bank. Figure 3: Trend in healthcare service coverage (1985-2008)
Health coverage (%)
100 90 80 70 60 50 40 30 Percentage 20 10 -
85 90 91 99 00 01 04 05 08 19 1988 1989 19 19 1992 1997 19 20 20 2002 2003 20 20 2006 2007 20 Year
Source: Ministry of Health and National Statistical Bureau.
Remarkable achievements have been made in expanding healthcare service coverage with physical access to primary healthcare maintained constantly at 90% (since 1997). Figure 3 shows the trend maintained in terms of primary healthcare services from 1985 to 2008. With about 756 health facilities including training institutes and 519 ORCs, 30 hospitals and 178 BHUs across the country by 2008, access to primary, secondary and tertiary healthcare services has improved substantially. Table 5 provides the details of health facilities by year (from 1998 to 2008).
Table 5: The number of health facilities (2000-08) Indicators/Year 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Hospitals 28 29 29 29 29 29 29 29 29 30 Indigenous hospital 1 1 1 1 1 1 1 1 1 1 Indigenous dispensaries 11 13 17 19 19 21 21 21 21 26 Training institutes 3 3 3 3 3 3 3 3 3 3 Basic Health Units (BHU) 145 168 168 166 172 176 176 176 178 178 Out-Reach Clinics (ORC) 454 454 461 455 440 476 485 514 519 519 Total health institutions 642 668 679 673 664 706 715 744 751 757 Source: Ministry of Health and National Statistical Bureau.
About 13% (2,214) of the total civil servants (17,178) are now employed in the MoH. Between 2002 and 2008, the staff intake into health has almost doubled. Table 6 shows the growth in health personnel from 2004 to 2008. The number of doctors has increased to 171 in 2008 from 135 in 2004. 90 doctors are serving in dzongkhags. The annual increase in the number of doctors and nurses between 1997 and 2008 has led to a decrease in the number of population per doctor or nurse (as depicted in the Figure 4).
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09
Table 6: Growth in health personnel from 2004 to 2008 Health personnel 2004 2005 2006 2007 2008 Doctors 144 145 150 154 171 DHOs/ ADHOs 23 22 22 37 38 Health Workers 201 171 229 232 425 Basic Health Workers 171 210 173 173 na Sister and Nurses / B.Sc Nurses 522 538 587 559 567 General Nurse Midwife/Staff Nurses 183 202 200 255 Na Auxiliary Nurse Midwife 140 134 134 123 na Assistant Nurses 175 174 174 176 99 Other Technicians 368 438 420 510 552 Indigenous Physicians 31 30 30 38 na Indigenous Compounders/Menpas 26 36 42 43 54 Malaria Workers 47 48 48 48 48 Village Health Workers (VHW) 1,201 1,200 1,087 1,200 1,200 Source: Annual Health Bulletin 2009, MOH.
However, MoH still faces acute shortage of manpower in all staff categories, and acutely so, the shortage of doctors, nurses and technicians. The Government plans to open up a medical college. This is expected to resolve the shortage of doctors in the country. Figure 4: Population per doctor and nurse 1997-2008
7000
6000
5000
4000 3000
2000
1000
0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Population per doctor Population per nurse
Note: Base on the PHCB 2005 and assuming a 1.3 % annual population growth throughout the period. A larger population growth in the past would tend to make the curves steeper. Source: Health Sector Review 2007, Annual Health Bulletin 2007-09.
The child and maternal mortality rates are the important indicators of the population’s access to healthcare services, and can show if a country has a sufficient and equitable distribution of basic goods and services. As shown in Table 7, mothers from the poorest group have lesser tendency of seeking prenatal care. This suggests the prenatal care coverage should be targeted specifically to the mothers in the lower income groups. The causes of maternal mortality are home deliveries, economic problems, lack of funds with the MoH, inadequate antenatal clinics, low literacy and knowledge, cultural and religious beliefs and poor anaemia control. The underlying causes of maternal mortality are maternal anaemia, limited access to Emergency Maternal Obstetric Centres and inadequate capacity and unattractive facilities for the institutional deliveries. The immediate causes are childbirth complications and non-institutional home deliveries.
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Table 7: Wealth quintile and prenatal care Wealth quintile Prenatal care No prenatal care Q1 (Poorest) 81.49 18.51 Q2 87.15 12.85 Q3 85.84 14.16 Q4 92.52 7.48 Q5 (Richest) 93.58 6.42 87.57 12.43 Source: Bhutan Living Standards Survey, 2007.
Pregnancy complications topped the list for hospital admission between 2006 and 2007. However, the chances of safe delivery and child survival have improved drastically comparing to the situation in 2000. The single-most key contributing factor for such an outcome was an inadequate provision of antenatal care services. The antenatal care coverage (2000-07) for at least once a year was 88%, delivery care coverage by skilled attendants at birth was 56% and delivery care coverage at the institutions was 55%. The Maternal Mortality Rate in 2007 was reported to be 255.14 Table 8 shows the progressive increase in all aspects of maternal and childcare aspects between 2004 and 2008.
Table 8: Maternal and childcare indicators (2004-08) Type of care 2004 2005 2006 2007 2008
Maternal health care attendance(a) 58,804 54,142 48,859 49,004 53,352 Antenatal 58,804 54,142 48,859 49,004 53,352 Deliveries attended 7,284 6,957 7,675 7,422 8,621 Home 2,125 1,629 1,317 1,064 927 Hospital/Basic Health Units 5,159 5,328 6,358 6,358 7,694 Child health care attendance 150,416 161,004 171,135 172,955 187,342 First visit 15,231 15,090 14,589 13,285 14,575 Re-visit 135,185 145,914 156,546 159,670 172,767 Malnourished children (b) 14,312 15,095 16,788 55,529 17,342 All malnourished 13,915 15,095 16,788 55,050 17,342 Third degree 397 n.a 428 479 n.a Source: Annual Health Bulletin, 2009, MoH.
Antenatal Care Service programmes were used as a platform for programmes to tackle other problems like nutrition, reproductive health, HIV/AIDS, STD and Acute Respiratory Infection. Reproductive healthcare was an important component of primary healthcare in the country. The family planning policy emphasised providing every individual or couple with access to family planning information, services and counselling. Over the past five years, the use of various contraceptive methods has increased by an overall 50% as shown in the Table 9. The Crude Birth Rate (CBR) dropped from 38 in 1990 to 19 in 2007 with small variations between urban and rural CBR. The General Fertility Rate was higher in urban areas (84 per
14 http://www.unicef.org/infobycountry/bhutan_statistics.html.
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1,000) than in rural areas (72 per 1,000). Total Fertility Rate (TFR) was 2.5. The rural TFR was 2.7 and urban TFR was 2.1, indicating the women in rural areas gave more births compared to women in urban areas. Higher TFR in rural areas was partly attributed to lack of knowledge on the significance of family planning in rural areas and higher women illiteracy rates. Crude Death Rate was seven deaths per 1,000 population with eight per 1,000 in rural areas and five per 1,000 people in urban centres. CBR was high among infants with infant mortality rate of 41 per 1,000 children. Table 9: Types and usage of contraceptive methods (2004-08) Type of Services 2004 2005 2006 2007 2008 Tubectomy 1,364 1,364 1,844 2,808 2,733 Vasectomy 4,919 4,919 7,202 8,927 9,433 Intra uterine device (IUD) Pills (OCP) 2,111 1,305 1,598 2,610 1,970
Condoms 18,807 20,210 32,074 34,688 40,274 Injection DMPA 1,000,679 1,163,234 1,517,705 1,607,790 1,462,467 Other methods 40,745 41,005 57,985 67,965 71,738 Total 1,068,625 1,232,037 1,618,408 1,724,788 1,588,615 Source: Annual Health Bulletin, 2009, MoH.
There is no consistent data on child mortality rate in the country. According to the 2006’s National Health Bulletin, 2006, both under-5 mortality (U5MR) and Infant Mortality Rate (IMR) have improved between 1984 and 2006. U5MR dropped to 61.5 deaths per 1,000 live births in 2007 from 96.9 in 1994. The Infant Mortality Rate (IMR) has dropped from 70.7/1,000 (almost 71 deaths per 1,000 live births) in 1994 to 60.5/1,000 in 2000 and further to 40.1/1,000 in 2009 (the same figure is reported for 2009 in the 2010 Annual Health Bulletin).15 In 1990, about 40% of the population had access to clean drinking water; this increased to 78% in 2005. Likewise, in 2005, about 86% of the population had access to basic sanitation like pits, latrines etc.16 The challenges of providing safe drinking water and sanitation so far were: (1) acute shortage of specialised manpower to maintain water facilities, lack of coordination among stakeholders and technical and financial sustainability. About one-third of the existing water supply schemes are in need of urgent repairs. Table 10 shows the constant increase in the rural water supply schemes. By 2008, EPI coverage has risen to 90% and access to latrines to 90%.
Table 10: Rural water supply and immunization schemes (trend, 2003-08)
Indicators/Year 1985 2001 2002 2003 2004 2005 2006 2007 2008 Rural water supply scheme (nos.) 150 1,944 3,383 3,383 3,852 3,852 3,852 3,852 4,112 Rural population access to piped water (%) 14 65 78 78 78 84 78 78 90 Rural population access to latrine (%) 65 80 88 88 80 89 89 89 90 Universal child immunization coverage (%) - 90 90 90 84 87 90 90 90 Source: Ministry of Health, 2009.
15National Population and Housing Census of Bhutan, 2005. Figures published by Unicef tend to be higher (less positive). For instance, Unicef sets the IMR to 54/1,000 (2008) and the U5MR to 81/1,000 (2008) (www.unicef.org/infobycountry/bhutan-statistics.html). 16Planning Commission, now Gross National Happiness Commission, July 2007, Bhutan MDG needs Assessment and the costing, 2006-15, pp.50.
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Bhutan has achieved almost close to 100% immunisation coverage for children. It has declared universal childhood immunisation in 1991. However, there was some variation among dzongkhags. The Government had initiated multi-year plan of action for EPI, including the improvement of vaccine quality and health workers’ capacity. However, the Government still faces resource constraints to sustain 100% EPI coverage. The outcomes of primary healthcare service coverage are distinctly manifested in the overall increase in the quality of life. Despite this, the health sector is still confronted with many challenges. In terms of physical access, Bhutan Living Standard Survey (BLSS) 2007 showed an estimate of 88% of the population living within two hours distance from the health service delivery point. Only 40% of the population lived within a distance of half an hour walk in comparison to 92% of the urban residents (see Table 11).
Table 11: Geographical accessibility in terms of time taken to reach health facility Time needed to reach nearest health facility < ½ < 1 < 2 < 3 < 6 No Date source hr hr hrs hrs hrs access Av time (minutes) Walking distance NHS 2000 All 57% 67% 78% 89% 96% 4% n.a. RIARD 2007 All n.a. 63% 78% 88% n.a. 12% n.a. Distance using usual means of transportation BLSS 2003 All 63% 91% BLSS 2007 All 56% 73% 88% n.a. n.a. n.a. Poor: 109;Non-poor: 56 Urban 92% 99 % 100% n.a 0% All: 19 Rural 40% 61% 82% n.a. n.a. n.a. All: 84;Poor: 111; Non- poor: 76 Sources: Bhutan Living Standards Survey 2003 & 2007; National Health Survey 2000; RIARD 2007.
Long distance to healthcare centres served as deterrents for the people to access healthcare services. According to the 2005’s NHPC, 12.4 % of the population reported that they do not attend health centres because they are located too far from those centres. Lack of time and transport facilities were two important factors that determined the community’s usage of healthcare services. In urban areas, waiting time is one of the reasons for dissatisfaction with the healthcare service. The physical accessibility aside, there was a significant difference [between regions] in terms of using the healthcare services. Residents in rural areas sought healthcare service less often when ill than urban residents (rural 88% and urban 97%, BLSS 2007). Therefore, the need to reach healthcare services to the un-reached population still remains a task, and has got to put efforts to attain universal basic healthcare services. As per BLSS, 2007, the institutional deliveries remained low, possibly due to low level of acceptability of services. The low number of female workers in the local health facilities and unfriendly delivery rooms are some of the reasons for less institutional deliveries. There were just seven Emergency Obstetric Cares Units in 2007. The people’s perception (household-based) on the provision of healthcare services like on the competence of staff, availability of medicines and quality of facilities is given in the Table 12. 88% of the people (RIARD, 2007) have reported they had access to healthcare services and 60% of them reported the accessibility of health centres within a distance of one-hour walk. The majority of the people surveyed have rate ‘good’ in areas such as competency of staff, availability and affordability of medicines, and quality of medicines. However, only 41% of them rated ‘good’ for time taken to wait to access health care services.
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Table 12. Distribution of Household by the assessment of quality of BHU/hospital services Good Satisfactory Bad Doesn't know Total Competence of medical staff Urban 76% 21% 2% 2% 100% Rural 84% 13% 1% 2% 100% Total 82% 15% 1% 2% 100% Availability of medicines Urban 74% 23% 2% 1% 100% Rural 80% 18% 1% 1% 100% Total 78% 19% 1% 1% 100% Affordability of medicines Urban 64% 27% 3% 6% 100% Rural 60% 25% 4% 10% 100% Total 61% 26% 4% 9% 100% Quality of facilities Urban 73% 26% 0% 1% 100% Rural 81% 16% 1% 2% 100% Total 79% 19% 1% 2% 100% Waiting times Urban 31% 44% 24% 2% 100% Rural 57% 34% 6% 3% 100% Total 49% 37% 11% 2% 100% Source: National Statistical Bureau based on Bhutan Living Standard Survey 2007 data.
The prevalence of under-5 ARI, diarrhoea, dysentery, worm infestations, skin diseases and eyes-ears disorder are still high. There is still a need to enhance integrated management of childhood morbidities. The morbidities are common among the children and can be prevented through an integrated approach to ‘nutrition, proper hygiene practices, immunisation, improvement in sanitation and access to clean water, etc’. The increased resources must be allocated to nutrition, immunisation, water and sanitation and health awareness and education programmes.
4.3 Agriculture and environmental services More than 69% of the country’s population still depends on subsistence agriculture. There is a huge shortage of food. This is caused by poor soil fertility, pests and diseases, threat from wildlife and lack of proper post-harvest management practices, as well as the impacts of climate change. More than half of the rural households were reported to experience seasonal food shortage. The provision of agricultural development services has been recognised as crucial to improve the national food security. The Government made effort to improve a minimum of 70% food grain self-sufficiency through delivery of improved seeds, technology and other extension services. The Renewable Natural Resource (RNR) sector is important. It contributes to GDP (one-fifth) and is the major source of employment activity. The RNR sector has critical role to play in environmental management and conservation. The rural economy depends on the utilisation of different natural resources through a mixed land-use pattern for subsistence production. The main objectives for the RNR sector are: to attain national food security; to conserve and manage natural resources; to enhance rural income; and to generate employment
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09 opportunities. One of the RNR strategies constituted delivery of extension services. The top demand from the rural people had always been related to RNR services. Table 13 gives the details of various agriculture service centres provided by the Government between 1997 and 2008. The major thrust had been on improving the people’s access to RNR services. The number of RNR Centres has, therefore, increased from 35 in 1997 to 114 in 2008. They are mostly located in the gewog centres for easy access. However, according to RIARD (2007), 35% of the respondents reported RNR services as accessible within one hour distance, which means that many farmers still have to walk minimum of two hours to access RNR extension services. Irrigation development has been an important area of the agriculture sector programme. Despite loss of paddy land to urbanisation, rice production has increased over the years. In 2005, more than 67,000 MT of rice was produced. The agriculture sector focused on building new irrigation channels and on rehabilitating and renovating the existing ones with the support from the communities. In the 9th FYP, more than 133 km of irrigation channels were built and about 133 km of the old ones repaired.
Table 13: Various Agriculture Services from 1997 to 2008 Agriculture and Environment 2000 2001 2002 2003 2004 2005 2006 2007 2008
Agriculture Extension Centres 159 159 79 79 69 51 51 49 50 Agriculture Seed Protection Farms 11 11 11 11 11 11 11 11 11 Plant Protection Centres 3 3 3 3 3 1 1 1 1 Farm Mechanization Centres 3 3 3 3 3 3 3 3 3 Farm Mechanization Trainings Centres 1 1 1 1 1 1 1 1 1 National Mushroom Centres 1 1 1 1 1 1 1 1 1 National Post Harvest Centre 1 1 1 1 RNR centres 35 35 74 74 85 90 95 110 114 RNR Research Centres 4 4 4 4 4 4 4 4 4 RNR Research sub-Centres 6 6 6 6 6 6 6 6 6 Soil & Plant Analytical Laboratory 1 1 1 1 1 1 1 1 1 National Resources Training Institutes 1 1 1 1 1 Source: National Statistical Bureau, 2009.
With 98% of Bhutan’s poor people living in the rural sphere, Bhutan Development Corporation Limited is an important credit provider. Micro-financing or rural credit schemes are in a nascent stage. The other essential rural agriculture services consist of provision of inputs like seeds, fertilizers and tools; access to micro-credit; and access to markets. The production and distribution of improved variety of seeds was a critical determinant of the agricultural production so far. Druk Seed Corporation has been distributing the seeds, though; it was not able to fully meet the demands for seeds by small farm holders due to high transportation costs to rural areas. The production and distribution of seeds to farmers has remained more or less centralised with no involvement of local producer groups or associations in this venture. Improving rural access was recognised as crucial to delivering agriculture input services and access to and from markets. Farm roads and power tillers tracks topped the list in local development priorities, but building roads had been always difficult given the rugged
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09 terrain and scattered settlements. However, in the 9th FYP, approximately 800 km of farm roads and 173 km of power tiller tracks have been built. The other sector of importance for the rural population is livestock farming. The list of various livestock facilities and services (1998-2008) is given as Annex 2. A rich biodiversity and forest cover and their conservation constituted an overriding national priority. Maintaining healthy ecology was considered crucial because without it, Bhutan could have become vulnerable to soil erosion, landslides, forest fires, soil depletion which would have strong negative impacts on the overall development. The goal of ensuring environmental sustainability was pertinent to poverty eradication activities and goals. The country still retains about 72% of its total land under forest cover, 29% under protected area and 9% as biological corridors. Danida supported the National Environment Commission (NEC) in strengthening legislation, institutionalising environmental assessment process and information dissemination, and to create enabling policy and legal framework for participatory and sustained management and use of natural resources. The social forestry and community forest management programmes placed the people at the centre of development and conservation. The GYT Act 2002 empowered the GYTs to manage the community forest, identify parks and frame rules and programmes to prevent local environmental issues. A new forest development and management schemes helped forests regenerate quickly, bringing direct benefit to the people in terms of availability of fodder, firewood, leaf litter, timber, mushroom and cordyceps. The enforcement of stringent forest rules and regulations, however, also has affected the people’s access to forest resources. The wildlife threat to the crops has negative impacts on the farm livelihood. At present, 31% of the population live in urban areas. With rampant urbanisation, major towns have started facing some environmental issues like waste disposal, deterioration of air quality through pollution and proliferation of squatter settlements. The current urban development constitutes programmes to improve the standard of living in urban areas with a strong emphasis on the creation of infrastructure, a healthy environment and effective service delivery mechanisms (urban utilities such as water, drainage system, waste disposal, sewerage). The need to improve the livability of the urban environment has long been recognised. Danida has been the important partner with the Government in developing urban sector like construction of sewerage facilities in Thimphu and Phuentsholing. However, the quality of urban infrastructure and services are poor in several new townships, in terms of access to water, improper waste disposal, sanitation facilities and provision of other utilities. Bhutan Development Finance Corporation is the only financial institution providing credit to the rural people with its 23 branches across the country. Its field staff travel on motorcycles to disburse credits, collect payment and savings, but the cost of operation has been extremely high. BDFCL schemes has been plagued by other factors like high costs of administration, low recovery rates, poor market linkages and entrepreneurship, low literacy, and low recycling of funds. Rural credit service, though widely available has not been so successful because of the nature of operations specific to conditions imposed that are not always conducive to the poor villagers and small farm holders. The majority of farmers lack collateral or lack a reliable and diverse source of income to repay. The fear of inability to repay loans deters them from availing the credit facilities.
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4.4 Governance The access to a proper justice system was considered as an inalienable rights of every citizen, and thus, since 1980’s, the Judiciary has been establishing itself as an independent branch of the Government, enhancing equal and easy access to justice by improving infrastructure and institutional capacity. Many of the district courts share buildings with the dzongkhag administrations, and face the problem of overcrowding and lack of privacy for litigants. Most of the court buildings are in dilapidated conditions and require repairs. Since 1992, Denmark has supported the Judiciary in improving physical and technical infrastructure, organizational development, training and education of judges and bench clerks and legal awareness campaigns. By 2008, five new district court buildings have been built with the support of Danida. The other donors supporting Judiciary were SDC, UNDP and UNICEF. The Government’s focus on capacity, institutional and operational strengthening of the Judiciary and the donor’s support programmes resulted in many dzongkhag courts having separate court buildings. Judicial and legal services to the general public have improved. ICT is now used to enhance efficiency in delivering judicial services. LAN is used in almost all the district courts. Despite progress in the judicial sector, the infrastructure problems still exist in many district and dungkhag courts. Many of these courts are not appropriately housed and do not have adequate facilities for effective judicial processes. The effectiveness of judicial service provision was assed using data from GNH survey conducted by the CBS in 2008. The court services, according to this perception survey were divided into two categories: Whether the courts were providing quick justice; and whether justice provided was fair or impartial. The survey of 950 respondents revealed that only 31.2% of the respondents rated provision of quick justice by courts as excellent, 41.3% rated it as good and 12.3% rated it poor. In terms of fair judgment, 34.7% rated it excellent, 42% rated it good and 6% rated it poor. The timeliness of court adjudications has improved on average between 2000 and 2006 (shown in Figure 5). However, substantial numbers of court cases have taken more than 108 days. The reason was a shortage of judges, which calls for the need to train more judges (Human Resource). The increase in number of appeal cases increased in 2006 to 173 from 123 in 2004, showing people’s dissatisfaction with the services of local courts17. The general perception on courts’ performance in dzongkhags like Thimphu, Dagana, Wangduephodrang, Trashigang and Samdrupjongkhar was poor according to the same survey. The general perception on the leadership qualities of local leaders: Gups, mangmis and tshogpas were higher than that on leadership qualities of dzongdags. This may have to do with the local people having to deal more with the GYT leaders than the dzongkhag officials. The people consider leaders as good based on ‘past performance experience’, ‘maintaining harmonious relations with the people’ and those who ‘understand community’s problems’. Ability to read and write is not so important a criterion, and this presents an interesting policy issue.
17 P. Rabten, GNH Survey Findings.
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Figure 5: Duration of number of courts cases (2000-06)
Duration and number of courts cases between 2000-2006
7000
6158 6000 6064 5721 5471 5641 5000 4975 4827
4388 4000 3753 3708 3550 More than 108 days Less than 108 days 3162 3000 2695 No. of court cases adjucated cases court of No. 2000 1896
1000
0 2000 2001 2002 2003 2004 2005 2006 Year
Source: www.judiciary.gov.bt, html/case/statistics.php
4.5 Communication Another important service area where considerable improvements have been achieved includes telecommunications and postal service sectors. The Information and Communication (ICT) sector is beginning to play a key role in socio-economic growth, transfer of knowledge, improvement of efficiency and transparency, improvement of local service delivery and empowerment of the poor. At present, all the 20 dzongkhags and 199 gewogs (out of 205) are connected with telecommunication networks including mobile networks. The Wide Area Network (WAN) intranet and Local Area Networks (LAN) are established in all the 20 dzongkhags. E-service is expected to improve the speed of service delivery to the people. This has been already happening as the dzongkhags and other service agencies have their own websites from which the public can download forms, or make several online applications. There has been drastic improvement in the provision of service by the telecommunication sector as is evident from the increase in the number of telephone exchanges, number of telephone connections and number of internet connections. Annex 3 shows that the number of telephone exchange has increased from 26 in 2000 to 82 in 2008; and internet connections from 446 in 2000 to 5,422 in 2008. The table showing the number of ICT facilities (2000-08) is attached as Annex 3. Over the years, the postal service facilities and wireless stations have decreased, and this signifies the positive impact of ICT on the communication sector.
5. Challenges on improved public service delivery
The provision of quality and equitable services is challenged by the geo-physical nature of the country and scattered settlements. The inaccessibility of certain communities to the main centres of development hampers delivery of basic goods and services, escalates their costs and creates disparities. Frequent landslides and road blockages, and the need to maintain the roads and other communication infrastructure take away substantial amount of funds, thereby resulting in fewer resources for local service delivery.
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5.1 Mandates and responsibilities There seems to be a further need to improve an accountability mechanism and efficient transparency system in service delivery. The community involvement - especially the poorer ones - in the assessment of quality and efficiency of public service delivery has not improved as purported. The local communities do not have adequate mechanisms to monitor and to conduct ‘social auditing’ or to participate in expenditure tracking, though social auditing is crucial in assessing the social or community benefits of the public services. The poor people tend to remain satisfied with what is provided to them. The roles of community-based organizations, now recognised as civil society organizations, in analysing and engaging in policy dialogue are limited. Policy makers are compelled to remain poorly responsive to the pledges of the community members due to a long channel of reporting. Policy makers at the central level could hardly reach the unreached and poor because of the higher cost involved. It was for this reason that Good Governance Plus, 2005: In Pursuit of Gross National Happiness notes that the ‘route of accountability is often too long and policy makers can rarely be reached by clients, especially poor clients with information, complaints and feedback’. The report further notes that the policy makers cannot necessarily lead to improved public service delivery even if the clients reach them because of the long route of accountability between the policy makers and service providers. Even if the services were to be provided, timeliness of delivery is an issue. The Government has identified ICT as an effective tool to curb this long route of accountability and a useful tool to improve access to information and services to remote regions, but most of the gewogs still lack IT capacity, both in terms of resources and technical skills. The gewog ICT centres are still in a nascent stage. One of the objectives of decentralisation is to enhance the policy dialogue between the central level and DYTs and GYTs, but the link between various ministries, sector agencies, and local governments is ambiguous. For example, the Ministry of Home and Cultural Affairs is still seen as the main agent for receiving the development related complaints or feedbacks (from the local people) and as the lead agency to coordinate decentralised service delivery. The minutes of the DYTs and GYTs meetings are therefore usually submitted to this ministry, which are hardly analysed leading to ill-response or inaction as this ministry is not fully responsible for entire sets of public services18. It is mainly responsible for culture promotion, security, census and immigration and disaster management. Dasho Karma Ura points out the need to enhance inter-agency coordination, and for relevant phases of deliberations at the DYTs and GYTs to be passed through the concerned ministries to the central government for effective decisions. DYT and GYT minutes contain deliberations on issues covering all aspects of service delivery and have implications for relevant agencies and ministries. The GYT minutes are normally written in Dzongkha, whereas English is popular in many of the central ministries. This creates certain communication gaps or impedes exchange of information between the central and local governments. Ura further notes: ‘At the moment, there is no institutionalisation of feedback and no unit to process information gathering from the local government levels’. The information flow, according to Ura, is one-way and like ’emptying it into a vacuum,’ which affects the service delivery. The communication linkages in most cases are weak and lack dissemination of information on the plans, schemes, outcomes, costs and benefits.
18 Dasho Karma Ura, Archers and Deities.
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The GYT Act 2002 empowers local governments to hold gewog field staff accountable for the service they provide, but there is no clear way of doing it. These officials are more accountable to the district administrator (dzongdag) and the root sectors rather than being accountable to the gups or other GYT members. There are no proper sanctions or rewards. There is no system of reporting the monitoring aspects to improve the outcomes of various sector service provisions. Gups who are mainly responsible for decision making and implementing service delivery activities may have some conflict of interests. The local leaders are not highly educated and trained to make effective decisions and implement the programmes. Moreover, the GYTs are constrained by shortage of staff, including technical personnel. The DYTs comprise of gups, mangmis as indirectly elected members and dzongkhag sector staff as the observers. The DYT members are mostly men, thus limiting the role of women in decision-making on development and service delivery. Either dzongdag or other sector heads advises the DYTs on all matters of policy, rules and procedures. There is an active dialogue between the sector staff and the DYT members on issues such as progress reports, planning schedules and policy queries, but there is not so much information flow back to the GYTs.
5.2 Capacity of local government The important dimension of local service delivery is whether every local government and community has equal capacities to absorb the resources efficiently and effectively, or get equal access to goods and services. Despite increased efforts to channel goods, services and investments to rural areas, some communities – constrained by low knowledge, expertise, technological capacities, shortage of skilled manpower and isolation - have not benefited equally. Having access to services does not alone indicate use of services.19 In addition, some sectors have not been able to deliver the same level of services as others. The Poverty Analysis Report (2004) mentions that the services by the industry and agriculture sectors have been chronically affected by low levels of labour productivity. Certain communities also lack behind in terms of socio-economic indicators, either because they are isolated or face shortage of personnel to deliver services. The administrative capacity is crucial for a successful decentralization and for properly implementing development programme and service delivery activities. After 2002, the administrative set-up saw the increase in the number of staff in district administrations (50- 70 at dzongkhag head quarter with 20-40 extension staff excluding teachers and health workers). But, the technical staff continue to have a dual line of reporting both to the dzongdag and the centre thus creating confusion. There is no devolved authority over cadre size at dzongkhags. It is still done centrally. The dzongkhag has only the authority to appoint general service cadre of grade below 13 and elementary service posts. The gups and the GYT members are far less educated, have lesser remunerations than the gewog sector staff, which makes it difficult to put a check-and-balance against them. The dzongkhag administration needs more qualified staff than support staff but the situation in most dzongkhags is otherwise. This is a reflection of the lack of a comprehensive and coordinated human resource development policy in tune with the decentralisation policy. In support of devolution, the Royal Civil Service Commission (RCSC) has deployed Human Resource Officers (HRO) at dzongkhags. In 2004, the first batch of district HROs were appointed. This initiative was seen as a forerunner of further human resource development initiatives at the local level but so far there has not been any visible impacts, since these
19 Rapid Rural Impact Assessment p. 23.
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09 officers lack experience and are neither supported by a district HRD plan nor have sufficient funds to implement HRD development programmes. This leaves HRD plans highly dependent on donor funding. The DYT and GYT members were given both short and long-term training on routine administration but the fact that they serve in their posts for only a certain number of years has set a requirement for the continued need to train newly elected leaders. Many of them get replaced in the next elections, that too, after making considerable investments in training them. Until now, this kind of training has been externally funded but whether such initiatives can continue with the phasing out of support programmes by various donor agencies is a critical question. The Royal Institute of Management has been providing training courses for the DYT and GYT members, but absence of partnership and involvement of other ministries led to these courses being delivered without actually capturing the essence of sector-based decentralised service reforms. The GYTs are auditable and accountable units of the Government. The gups act as both political and executive heads. They have to serve the double roles of GYT administration and overall governance, putting them under tremendous pressure. There is a need to strengthen executive staff capacity in the GYTs, otherwise, there is immense risk of comprising the decentralisation reform. The recent initiative to post gewog administrative officers (GAO) and accounts officers is a move towards strengthening the executive capacity of the GYTs. However, as long as the variation in the size of gewog administrations exist, larger GYTs are likely to remain constrained by shortage of executive staff as these GYTs have more administrative works comparing to the smaller ones. What came up clearly during the Joint Evaluation Mission’s (2009 December) focus group discussions with the dzongkhag officials of Punakha was the issue of shortage of professional staff. There is a heavy reliance on the dzongkhag administration to undertake all technical support work including scheme estimation, design, tendering, contract management, supervision and monitoring. The dzongkhag administrations too face the severe constraints of technical staff. For example, the engineers who are the most demanded professionals for the construction and maintenance of roads, irrigation channels, water supply schemes, schools and dispensaries are based in the district headquarters while the actual activities take place in the gewogs. They cannot cater to every local demand [for technical assistance] as the district engineering units have one or two engineers, who are further constrained by lack of adequate transport facilities, travel budgets and other incentives to travel to construction sites. Though most of the construction works are outsourced, these engineers cannot participate and monitor the construction quality. The results are poor standard infrastructures for the local people. Besides, the rural areas fail to attract central staff due to lack of incentives and opportunities for higher training. Most of the professionals and civil servants are concentrated in the central ministries. They defy rural postings due to difficulties of livelihoods, lack of incentives, less training opportunities, etc. The local governments have no authority to hire or fire the local officials like community teachers, health assistants, foresters, RNR staff, etc. They are placed by the central government and their remuneration is determined centrally. The local governments’ capacity to deliver services effectively is constrained by the lack of an institutional framework for coordination among different sectors. RNR tries to deliver agriculture sector service in a package comprising of forestry, livestock and agriculture services, but when it comes to actual delivery, it happens independently. The GYT members
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09 spearhead the local service delivery plans and programmes, but they lack knowledge on resource analysis, prioritisation of services and activities and financial management for effective service delivery planning (RIARD, 2007). Even if the facilities like BHUs and schools are set up, there are many cases of these facilities being understaffed, especially in rural areas. This represents the case of creating the service centres with inadequate number of skilled service providers. Decentralisation is not just a matter of devolving power and responsibilities to the GYTs, but to seek to define the specific roles and responsibilities and provide appropriate staff to the local sector offices to make an optimal use of limited resources. The local agencies should have adequate and appropriate staffing strength to fulfil local goals and objectives while the central government fulfils the national objectives. Decentralisation reforms have given considerable degree of discretionary powers to the local administrations in relation to the budget implementation, procurement, expenditure, etc which has contributed to the general efficiency in the service delivery. The issue here is whether there are enough people at the GYTs (personnel) to operate these funds. The community schools are under the management of the community, though staffed by the centrally placed staff. One of the challenges facing community schools is that the local people fail to see the immediate benefits of education for their children, and therefore, get little incentives to cooperate and support the school management. When the community schools management refers such cases to the DYTs and district education sector, they take least interest in the matter because the community schools do not fall within its purview. This leads to the poor service quality, in the form of ill-maintained school infrastructures. What is the policy pattern of production and provision of local services? There seem to be some ambiguities in functions among the providers. For example: Goenshari gewog – one of the most inaccessible gewogs has most of its lands under Jigme Dorji National Park. This park is managed by the Park Office located at Damji under Gasa dzongkhag. The villagers travel all the way to Punakha dzongkhag headquarter to get the permits only to be sent back to the park office. This creates lot of confusion and problems for the people. There are too many complications to avail services including filling up forms which sometime is not so conducive to illiterate people, and those who provide services are helpless as they are bound by practices and rules.
5.3 Participatory planning The community members are involved in the process of designing and implementing plans with technical backstopping from the civil servants. However, the participation of the members of different groups is complex, as the knowledgeable and influential, and with some exposure to government, and therefore vocal members tend to dominate the planning discussions and decisions.20 This indicates a need to improve planning process to prevent elite capture; otherwise it defeats the purpose of grass-roots participatory planning and development. Lack of literacy, numeracy and access to information are major inhibitors of the mass participation. Another pertinent area in the planning process is transparency. The planning is done in the public meeting, but people are mostly not aware of budget allocations for activities to be implemented or deferred.21 The planning process carried out is a one-off event and
20 Rapid Rural Assessment (p. 48). 21 Rapid Impact Assessment for the Rural Development, pp.56.
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09 commences at village level. Once the plans are made, a system for farmers to check the plans does not exist as monitoring is done by the GYT, not chiwogs, though the latter is the smallest unit headed by tshogpas who have direct contact with the local people22. The extent of decentralised planning is limited by the sector-wise budgeting system and, although communities are empowered to identify and select activities for priority funding, the overall design of the plan activity lies with the respective sectors. There is a tendency for the plan to become an offshoot of the budget rather than the plan shaping the budget allocation. This is in contrast to planning for activities under the DSP or Local Government Development Programme supported block grants mechanism where the gewog has full discretion to decide on any activity, scheme or sector in line with the local priorities and needs. The level of participation and submission of requests by different communities also depend on the dynamics between various groups and level of cooperation and conflict among them in executing development or service delivery programmes. Some communities often cannot come to terms on the location of the common development or service centres. The local capacity, context and nature of settlements matters much in this case. The arbitrators, who are usually civil servants of the dzongkhag administrations, make the decisions on their behalf, whose decisions often lead to wrong locations of service centres. In some other cases, the nature of settlements determines the access to the service centre. In Goenshari gewog, the Gewog Service Centre (RNR, Gup’s Office, School and BHU) are all located together away by a distance of more than two hours from every village in the gewog. This means the people’s accessibility to the gewog service centre has not improved much. The rural people when discussing development activities are largely concerned with the inputs but think little about the outcomes. One typical example: the communities of Goenshari gewog, have fought through for road budgets and built two farm roads without actually building bridges, and so far, these roads have not been able to improve development and service outcomes for local residents. The consultations with the local people by the local staff or district staff normally are patterned in such a way that in the end, they come up with a long wish-list or list of unrealistic demands or ‘over-planning’. The consultations do not emphasises much on where the limited expenditure should be focused-based on the balance between the needs of citizens and what the Government can realistically afford, but in most of the consultations, the district administrations or local staff end up saying they would submit it to GNHC or other ministries for further scrutiny thereby creating unrealistic expectations in the minds of the local people. The plans are made by the local people, and these plans are normally ambitious, and lack consistency between the plans and adequacy of the resource envelope and priorities, resulting in non-implementation. So far, there has been no one-stop services, though the present Government has announced its plan to set up these facilities. This somehow results in poor inter-agency coordination. For example, in order to claim pensions, the pensioners have to travel all the way to district headquarters, which otherwise could have been effectively done from the nearest post office or banks. The process of service delivery in many cases is procedurally long.
5.4 Service delivery There are no set standards for procedural requirement including time of delivery. There are no quality assurance groups in the ministry or agencies to assess the compliance of service
22 Ibid. pp.56.
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09 providers through internal checks and feedbacks from the public. GG Plus recommended establishing such groups, but many agencies do not have the one. A further challenge is presented in the form of infrastructure and service delivery in environmentally protected areas. Bhutan has a strong commitment to environmental protection especially relating to national parks which have strict controls on the nature and form of infrastructure. At the same time local government needs to be involved in regulation and enforcement of these provisions. There are park management offices, their functions often duplicating the functions and authority of the GYTs in the management of the environment. Improving access to clean and safe drinking water through water supply schemes in rural areas has been given priority since 1974. The major setback is that once the water supply project is completed and handed over to the communities, many of them fail to remain operational because of poor maintenance. The communities lack skills and resources to maintain the schemes. It was found out, as early as in the 1990s that ineffective community management of water supply facilities was a real threat to the programme’s sustainability. One of the complaints that the people raised during the election campaigns in 2008 was on shortage of drinking water. Sustaining water supply services has become a challenge to human development.23 Rural-urban migration is another problem affecting service delivery. The proportion of people living in urban areas has increased from 21% in 2004 to 31% in 200524, putting undue pressure on health and educational facilities in urban areas and leading to under utilisation of those facilities in rural areas set up with higher establishment and operational costs. While the communicable diseases are common, non-communicable life style related diseases are increasing, posing a serious double-burden of diseases. The enormous resources demanded for these double-burden diseases might affect the resource available for the primary health care services.25 The MDG 2005 Report claims that achieving 4th MDG of reducing child mortality will require emergency obstetric care services made available and accessible to every pregnant woman in need. There is lower maternal and newborn care services in rural areas and low literacy of mothers and caregivers add to poor outcomes for children. Services like rural credit schemes, due to its operation conditions have not reached widely. The loan scheme has not been conducive to poor small farm holders as they lack necessary collaterals and do not have diverse sources of income to repay the loans. In principle, credit access is available to all, but many poor farmers do not avail loans fearing their inability to repay them. Credit provider like Bhutan Development Finance Corporation also does not provide loans to everyone due to delay in repayment and non-payment of loans.26 Out of 1,141 respondents in a sample survey, only 167 (15%) responded they availed rural credit, whereas 90% said they have access to the same. To decentralise the delivery of goods and services, local government must be given sufficient fiscal discretion, besides giving them clear roles and responsibilities. However, in-depth interviews with dzongkhag officials and focus group discussion (RIARD, 2007) revealed
23 Kuensel. ‘Bhutan: much vaunted water supply schemes in disrepair’, October, 2008. 24 NSB (2008). Socio-economic and Demographic Indicators 2005. RGoB: Thimphu. 25 Unicef (2008). Bhutan: Country Analysis for Maternal, Neonatal and Child Health. Thimphu. 26 Planning Commission (2007). Rapid Impact Assessment of Rural Development. RGoB: Thimphu.
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‘limited concurrent financial decentralisation with administrative decentralisation’.27 The local government can hardly fund the public services through the local resource mobilisation such as taxation and other sources of revenues. The local government is fully dependent on the central government for development funds. In the 9th FYP, the gups or GYTs were empowered to make some procurement or outsource the activities to private firms. But inadequate knowledge on rules and procedures of procurement or tendering resulted in non-compliance of rules and acceptance of substandard and substitute goods and services thus affecting the quality and timeliness of service delivery. The new formula for budget allocation is not being queries by many of the gups.28 Many gewogs have to strike a balance between the need to preserve the parks and improve their own livelihoods. Some communities suffer because they have to forego opportunities in the name of parks. Therefore, many gups feel the ‘environment’ should have been one criterion to allocate resources. Civil Society Organizations (CSOs) or Community-Based Organizations (CBOs) can play a more strategic role in analysing and presenting data, and in engaging in a policy dialogue to encourage effective reform measures. CSO-led activities can take place inside or outside of formal monitoring systems, in partnership with the state or independently, but the CSOs have limited roles in these areas. The Government has been encouraging the formation and development of local associations and cooperatives, but most of these CSOs, particularly the informal community organizations, do not have stable legal status, access to subsidies and standard procedures of registration. As a result, these CSOs cannot enter into policy dialogue with the Government and make the local governments accountable nor are they able to react realistically to the provision of local service delivery.
6. Recommendations and conclusion This chapter summarises the findings and recommendations to improve the local service delivery. The issue that came about clearly is ‘accessibility to services’ being greatly challenged by the geo-physical nature of the country and dispersed nature of settlements. The development approach adopted so far has made significant progress in improving local service delivery, but more efforts needs to be addressed to enhance access to rural roads, markets and other social infrastructures.
6.1 Access to services Emerging disparity in terms of access to basic social services is a cause of concern, and this issue can be resolved only through specific targeted interventions, and opening up the remotest parts of the country to the mainstream development. At present, provision of basic services are scattered across different sectors, and creation of a single focal agency to coordinate local service delivery activities may be considered as a crucial component of the 10th FYP. Looking at the content of services in each sector and their implementation mechanisms, in some cases, it is better for the central ministry to closely coordinate with the local governments to take advantages of both the capacities towards achieving the same goals of
27 RAP, pp.53. 28 Revealed during the interviews conducted by The Joint Evaluation Mission. Many gups in Punakha, Samtse and Bumthang dzongkhags feel the formula is not all-inclusive.
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09 enhancing public service delivery. Therefore, the central-local coordination and collaboration should be carefully studied. Wherever possible, the cooperation needs to be enhanced through effective exchange of information, manpower-sharing and exchange of technical expertise. This ‘intertwined model of decentralisation’ can, to a certain extent, resolve the problems of human and financial resource crunch. The fact that the majority of the rural population are illiterate and lack adequate expertise to execute development plans and programmes entirely on their own, deserve maximum possible support from the central agencies. Decentralisation reforms should be seen as a measure depriving the central ministries of their power (as perceived by most of the rural community members), but rather as a mechanism of attaining optimum balance and collaborative platform between the central and local governments in order to create enabling conditions for tackling the service delivery challenges through the system as a whole.
6.2 Decentralisation One of the concerns that many district officials had was whether it was appropriate to thrust too much responsibilities on the GYTs without actually considering the absorptive capacities of the local governments to implement the development and service delivery programmes. Decentralised service reforms, though may be viewed positively must also take into account the capacities of the GYTs to handle huge responsibilities assigned to them. The capacities of the GYTs vary across districts; some are at the state where they can fulfil functions and responsibilities devolved to them whereas some GYTs are not. Therefore, it important to carefully review the capacities of GYTs based on past experience, and decisions to assign responsibilities and power of each service delivery activity must be based on the absorptive and implementation capacities of respective GYTs accompanied by reasonable support from the central ministries to the weaker GYTs. The concerns at the central ministries are that the local demands are not in consonance with their implementation capacities. Past experience show many GYTs had to surrender their funds, either due to delay in programme implementation or altogether non-implementation of the programmes. The local leaders justify that they are not able to implement certain programmes owing to lack of technical expertise. While the local people are engaged in planning, design and implementation, the question that arises here is whether the plans are finally approved as per the local decisions, or determined largely by central sectors based on the availability of budgets. There is no universal model of decentralised reforms applicable to all the GYTs in the same manner; and therefore, it is important that the budgeting process is introduced at the stage of local consultations to avoid long-list of priority which mostly end up not being implemented, keep aside the unreasonable expectations generated in the minds of the people. The existing local government support programmes, aimed at decentralised reforms based on the particularities of each GYTs and endogenous processes should be enhanced and extended to all the gewogs. The funds and resources not reaching the under-privileged regions had been regarded in the past as a major problem of decentralised reform. To resolve this problem, GNHC has introduced the new method of disbursing funds based on the resource allocation formula. This system sounds fine from the central perspective, but it has its own problems when viewed from the local point. Many of the local leaders are not happy with the formula-based grant system, as some of the gewogs now receive relatively lesser funds than they used to get in the past.
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The new formula-based approach includes geographical location, poverty incidence and population size - and this looks all-inclusive. But in reality, even though some gewogs are considered fairly out of remoteness, the scattered settlements within the gewogs makes the needs more and efforts to address these needs costly. For example, by distance, Geonshari gewog in Punakha is not far from the district headquarter, but the villages are scattered (none of the villages are located at a distance of less than two hours walk from the school and gewog development centres). The population size is smaller and highly dispersed than other gewogs, The formula-based grant system put this gewog at disadvantage on top of the higher cost of service delivery due to dispersed settlements. On the contrary, Guma gewog in the same district has highest population on account of district town being located in this gewog, while the settlements are not highly dispersed. Guma gewog receive higher share of budget though the cost of development and service delivery is not as high. Therefore, the application of formula-based resource allocation needs to be carefully assessed, and go beyond to include other peculiar characteristics and challenges of the gewogs, and develop adequate framework for additional support programmes to substantiate unique hurdles faced by some gewogs which are discounted by the formula-based resource allocation system. The planning method is considered to be ‘participatory’ though there is a need to carefully check if it is really participatory in nature reflective of the true needs and priorities of all the villages in a gewog. The tendency as noted in many gewogs so far is that usually a few vocal and powerful individuals prevail on the planning processes affecting the transparency of planning and decision-making at the local level. In view of this problem, it is important to conduct further research on how the local decisions are made and what needs to be done to promote mass participation and transparent decision-making. There is a problem of inconsistency of creating service infrastructures and their utilisation. There are many cases where schools or BHUs are built, but without adequate arrangements for the provision of adequate number of staff for the actual operations. Rather than being too extreme, there is a need to have some objective decisions to balance the facilities with the availability of staff to manage and run these facilities, and there is a need to strike a balance between the availability of capital grant and recurrent budgets. Looking at the three functions of GYTs – administrative, financial and regulatory – GYTs assume the role of the provider of administrative services (executive) as well as the implementer of policies and programmes (governance). The magnitude of the responsibility assigned to the GYTs in relation to their operational capacities is extremely substantial. GYTs for that matter have a gup, mangmi, clerk, gewog administrative officer and accountant which by any standard is not sufficient to assume all three categories of responsibility and functions. There is a need to enhance the staff strength of the GYTs if effective decentralised service is to be met. It is extremely important to ensure a constant and reliable technical and administrative backstopping from the district and central governments. In order to enhance effectiveness of local service delivery, decentralised reform is supposed to post the civil servants closer to the rural residents to effectively reach out to community whenever their service is required. However, as reported by several local civil servants, there are so many challenges that they face such as low number of technical personnel, wider dimension of works, limited budgets, poor means of transport and lack of incentives like limited rural travel allowances and training opportunities. It can be, therefore, significant to look at addressing all these problems, and delegating staff, equipment and other materials as
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09 per the magnitude and nature of functions and responsibilities assigned to the local governments. Decentralised reforms have brought about the transfer of discretionary powers to the GYTs in terms of budget implementation, tendering and procurement, contributing to operational improvement. However, looking at the link between such power delegation and local capacity in these areas, further training of gups and other GYT members must be continually given so that they do not have to rely heavily on district sector staff to clarify policies, rules and procedures. There is a tendency that extreme reliance on the sector staff often leads to deviation in decisions under their influences.
6.3 Civil society Considering the limited capacities of GYTs to handle every aspect of service delivery activities, the new avenues of cooperation must be explored, particularly with the community-based organizations and private sector entities. It has been found that almost every village has some kind of associations, be it association for the pursuit of spiritual activities (chothuen tshogpa), farm cooperatives, or village development groups (drongyul yargay tshogpa), these CBOs can play important role in enhancing the service delivery capacities, as well as in mobilising resources. Certain communities have been observed to be benefiting so much from such CBOs, which so far were involved in community road constructions, sanitation activities, and provision of informal credit facilities to the members. The GYTs must identify such CBOs and explore the ways of collaborating with them. On the other hand, most of the national level civil societies are based in the capital or major towns, though they have higher potential for fund mobilisation and are technically better equipped. These non-government organizations and national-level civil societies need to create link with the more informal CBOs at the local level so that their services are better channelized to the needy and un-reached population. Village tsgogpas are the ones who are closer to the villagers, and they provide for the optimal level local service delivery decision-making point. They work closely with the villagers in identifying local needs while the GYTs have to cater to wider population. In this context, the roles of the tshogpas as the lowest possible level to decide on service needs and delivery system needs to be recognised. At present, the post of tshogpas are normally rotated among the households annually; there is certain level of reservations to take up this post because taking this post means shouldering extra burdens without any remuneration. The roles and functions of tshogpas need to be recognised and ways of compensating them for their services must be explored. Monitoring of service delivery through involvement of tshogpas can be considered the most direct means of ensuring accountability. One of the impediments to the outcomes of decentralised service reforms is the delay in activity implementation that requires technical expertise. The GYTs have limited technical personnel causing delays in constructions activities or other works that involve some professionalism. The release of budget by the Ministry of Finance is now streamlined, and occurs in timely manner. The problem of shortage of professionals leads to delays in the activity, and the fund remains unspent towards the end of the fiscal year. The GYTs are required to surrender their limited funds to the district financial sector, which then goes back to the MoF. This problem must be addressed.
6.4 Accountability A serious confusion in terms of accountability is the existence of two or more parties to whom the local sector staff are accountable. In the decentralised system, the local staff are
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09 supposed to be accountable directly to the community members who actually use their services and can better judge the timeliness and quality of service delivered, and they are supposed to be indirectly accountable to the GYTs. The GYT Act 2002 allow for this system of accountability. However, the present system is directed towards the upward system of accountability, and that too, to two different parties – to the dzongdag, the executive head of the district administration and to the central sector ministries. It is necessary to explore ways of making the GYTs implement the provisions in the GYT Act on their power to demand accountability from the local sector staff and to equip them with appropriate capacity to check the performance of the local sector staff. It is also necessary to reduce the burden on the local sector staff of having to be accountable to dual parties, that is, dzongdag and sector ministries. Provision of free education is a noble objective and decentralising the management and monitoring of community schools to the community members has been considered a good policy initiative. However, over the recent years, non-cooperation and non-participation by the community members to maintain and monitor the community schools has been noted. This is because the local people do not see the immediate benefits from the education sector. Adequate awareness campaigns on the long-term benefit of education services must be made at the local levels, and the GYTs must ensure that they are able to mobilise the community participation in the local school management. It is likely that the channel of reporting from the local to central governments will be shortened once the online National Monitoring and Evaluation System (NMES) becomes fully operational. How the information flowing from the local governments to the central government will be analysed and responded to, through the participation of respective ministries are some of the issues that needs to be reviewed thoroughly. On the other hand, the mechanisms by which the GYTs can pass the information from the central ministries to the local residents should also be explored. The ICT facilities and its use at the gewog levels must be improved, as the present ICT facilities at gewog level does not show much potential for the use of ICT in e-governance and improving local service delivery. Wherever possible, local residents’ access to ICT facilities enabling them to download forms or process online applications should be improved through private sector involvement. These private entrepreneurs operating in the remote places must be given entrepreneurial incentives including subsidies and other support from the Government. It has been observed in the recent years the existence of possible duplication and ambiguity in the functions among different local sectors. It is important that the sectors have their own power and functions clearly delineated so that they can effectively focus on these functions, and also reduce the confusion as well as burden arising from confusion of which sector to approach for particular service provisions. There are many cases where the local residents are not clear on whether they should approach district forestry offices or park officers to get the timber permits.
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References RGoB Centre for Bhutaneese Studies, Gross National Happiness Survey, 2008 Department of Planning, RGoB (2005): Millennium Development Goals-Progress Report, 2005, Thimphu. Gross National Happiness Commission (2009): Tenth Five Year Plan (2008-2013), Volume I, Thimphu. Gross National Happiness Commission (2009): Tenth Five Year Plan (2008-2013), Volume II, Thimphu. Ministry of Agriculture, Department of Livestock, (2008): Livestock Statistic 2008, Thimphu. Ministry of Education (2009): General Statistics, 2009, Thimphu. Ministry of Education (2008): General Statistics, Thimphu. Ministry of Education (2004): General Statistics, Thimphu. Ministry of Health (2007): Bhutan Health Information System: Human Resources Requirements, Thimphu. Ministry of Health (2009): Quarterly Morbidity and Activity Report, Thimphu. Ministry of Health (2009): Annual Health Bulletin, 2009, Thimphu. Ministry of Health (2008): Annual Health Bulletin, 2008, Thimphu. Ministry of Health (1998): Master Plan for Human Resources for Health in Bhutan, Thimphu. Ministry of Health (2005) Annual Health Bulletin, 2005, Thimphu. Ministry of Health (2006): Annual Health Bulletin: A Window to Health Sector Performance, Thimphu. Ministry of Health (2007): Health Sector Service Review, Thimphu. Ministry of Health (2007): Healthcare Financing Strategy, Thimphu. Ministry of Health (2009): Access to Health Service in Bhutan, Thimphu. Ministry of Planning (2002): Ninth Five Year Plan (2002-07), Thimphu. National Environment Commission (2008): Bhutan Environment Outlook, 2008, Thimphu. National Statistical Bureau (2004): Bhutan Living Standard Survey Report, 2003, Thimphu. National Statistical Bureau (2007): Bhutan Living Standard Survey Report, 2007, Thimphu. National Statistical Bureau (2007): Population Projections-Bhutan 2005-2030, Thimphu. National Statistical Bureau (2007): Statistical Yearbook of Bhutan, 2007, Thimphu. National Statistical Bureau (2008): Socio-economic and Demographic Indicators, 2005, Thimphu. National Statistical Bureau (2009): Statistical Yearbook of Bhutan, 2009, Thimphu. Nature Conservation Division (2008): Bhutan National Human-Wildlife Conflicts Management Strategy, Thimphu. Office of the Census Commissioner (2006), Population and Housing Census of Bhutan 2005 Planning Commission (2007): Bhutan Millennium Development Goals-Needs Assessment and Costing Report (2006-2015), Thimphu. Planning Commission (2007): Rapid Impact Assessment of Rural Development, Thimphu. RGoB (2002): Bhutan Medical and Health Council, Thimphu. RGoB (2005): Bhutan National Human Development Report, 2005, Thimphu. RGoB (2006): Ninth Round Table Meeting Report, Thimphu.
Danida and RGoB Ministry of Foreign Affairs, Denmark & RGoB (2003): Education Sector Support Programme-Support to the Ninth Five Year Plan.
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Ministry of Foreign Affairs, Denmark & RGoB (2004): Sector Support Programme: Environment and Urban Sector, 2004-2008. Ministry of Foreign Affairs, Denmark & RGoB (2004): Environment and Urban Sector Programme Support to Bhutan (Component I: Support to NEC). Ministry of Foreign Affairs, Denmark & RGoB (2004): Environment and Urban Sector Programme Support to Bhutan (Component II: Support to Decentralised Natural Resource Management). Ministry of Foreign Affairs, Denmark & RGoB (2004): Environment and Urban Sector Programme Support to Bhutan (Component II: Support to Urban Sector: Policy, Planning, Legislative Framework and Human Resource Development). Ministry of Foreign Affairs, Denmark & RGoB (2008): Good Governance Support Programme (2008- 13). Ministry of Foreign Affairs, Denmark & RGoB (2002): Health Sector Support Programme.
Other Institute for International Cooperation, JICA (2008): Decentralised Service Delivery in East Africa-A Comparative Study of Uganda, Tanzania and Kenya, Japan.
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Annex 1: Prevalence of deprivation (%) across five dimensions, by region Poverty Shelter Sanitation Information Education Dzongkhags Incidence (%) (%) Water (%) (%) (%) East average 22.17 10.17 12.83 26.17 23.33 Trashigang 29.3 24 12 15 27 26 Trashiyangtse 14.3 24 9 12 27 22 Samdrupjongkhar 38.0 28 8 14 27 23 Lhuentse 43.0 14 13 10 26 24 Pemagatshel 26.2 20 10 11 23 15 Mongar 44.4 23 9 15 27 30 West average 13.3 10.7 17.7 15.1 19.7 Chukha 20.3 21 12 17 18 24 Gasa 4.1 15 22 56 15 42 Haa 13.2 7 8 8 12 13 Wangdiphodrang 15.8 13 9 17 19 21 Paro 3.9 9 9 10 12 12 Thimphu 2.4 15 6 3 12 11 Punakha 15.6 13 9 13 18 15 South average 27.0 8.3 25 23.2 318 Sarpang 19.4 22 6 12 20 26 Samtse 46.8 28 8 25 29 37 Dagana 31.1 34 10 42 26 35 Tsirang 13.9 24 9 21 18 29 Central average 13.7 9.0 12.3 22.0 18.0 Trongsa 22.2 15 12 13 24 15 Zhemgang 52.9 16 11 18 29 27 Bumthang 10.9 10 4 6 13 12 National average 20 9 15 21 23 Source: NHPC, 2005
Above national average
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09
Annex 2: Various livestock service centres (1998-2008) 2000 2000 2001 2002 2003 2004 2005 2006 2007 2008
Livestock Veterinary Hospital 21 21 17 17 19 20 20 20 20 Livestock Extension Centres 110 110 110 110 66 54 54 50 50 Regional Veterinary Laboratory 4 4 4 4 4 4 4 4 4 Satellite Veterinary Laboratory 2 2 2 2 3 3 3 3 3 Livestock Farms 11 11 11 11 11 11 11 11 11 Fodder Seed Production Centres 2 2 2 2 2 1 1 1 1 Vaccine Production Centres 1 1 1 1 1 1 1 1 1 National Artificial Insemination Centres & Semen Processing Centre 1 1 1 1 1 1 1 1 1 Cold Water Fishery Centre 1 1 1 1 National Warm Water Fish Culture Centre 1 1 1 1 National Centre for Animal Health 1 1 1 1 Pheasant rearing centres 1 1 1 1 1 Source: NSB, 2009.
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Thematic Paper: Local Service Delivery Joint Evaluation of Danish-Bhutanese Programme 2000-09
Annex 3: Number of ICT facilities (2000-08) Indicators/Year 2000 2001 2002 2003 2005 2006 2007 2008 Number of Telephone exchanges 26 16 16 16 82 86 82 82
Number of Telephone connections 9,314 5,496 17,509 21,071 32,709 31,526 29,857 27,937
Number of Internet connections 446 956 1,262 2,239 5,078 6,685 6,486 5,422
- Dial-up connection 5,027 7,004 6,400 4,014
- Lease line connection 51 63 86 108
Broadband connection 1,300
General Post Offices 2 2 2 2 2
Agency Post Offices 10 10 10 10 9
Community Post Offices 70 70 70 70 56
Number of Post Offices 106 107 109 109 96 90 90 90
Branch Post Offices 25 25 27 27
Number of WT stations 37 30 21 76 87 19 - -
B-Mobile Subscribers 37,842 82,078 149,439 231,304
Tashi cell Subscribers 57,948 Source: National Statistical Bureau, 2009 and Ministry of Communication.
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