Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized INFORMATION AND SERVICE DELIVERY: CASE STUDIES FROM KENYA AND ETHIOPIA Editors: Sahr Kpundeh, Gilbert Khadiagala, and Shyamal Chowdhury December 2008 • AFTPR, AFRICA REGION, WORLD BANK © December 2008 The International Bank for Reconstruction and Development The World Bank 1818 H Street, NW Washington, DC 20433 Telephone: 202-473-1000 Internet: www.worldbankorg E-mail: feedback@worldbankorg All rights reserved. The findings, interpretations, and conclusions expressed in this volume do not necessarily reflect the views of the Executive Directors of the World Bank or the governments that they represent. The World Bank does not guarantee the accu­ racy of the data included in this work The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judg­ ment on the part of the World Bank concerning the legal status of any territory nor the endorsement or acceptance ofsuch boundaries. ii CONTENTS Acknowledgments iv Acronyms v Executive Summary 1 1. Introduction to Information Access, Governance, and Service Delivery in Ethiopia and Kenya 7 2. Information and Efficiency in the Supply of Drugs to Public Health Facilities in Kenya 17 3. Access to Information and Service Delivery in the Global Fund to Fight AIDS, Tuberculosis, and Malaria 31 4. Transparency and Service Quality in Financing Higher Education in Kenya 43 5. Access to Information, Transparency, and Service Delivery: Educational Satellite Television in Ethiopia 55 6. Information Flows and the Quality ofWater Services in Nairobi 65 7. Access to Information, Transparency, and Service Delivery: Addis Ababa Water and Sewerage Authority 8. Transparency and Public-Private Partnerships: Street Lighting in Nairobi 85 9. Information Flows and Service Delivery: Case of the Addis Ababa Acts and Documents Registration Office 93 10. Conclusions: Lessons from the Kenyan and Ethiopian Experiences 103 Appendix 1. About the Contributors 113 iii ACKNOWLEDGMENTS The findings in this monograph are based on research conducted in 2005-06 by Ethiopian and Kenyan researchers. This work was supported by the World Bank-Netherlands Partnership Program (BNPP). At the time, Jane Kiringai and James Njeru were based at the Institute for Policy Analysis and Research (rPAR) in Nairobi. Mulat Demeke and his colleagues in Addis Ababa were then affiliated with the University of Addis Ababa. Following the completion of field research, in June 2007 the authors presented their findings to a select group of Kenyan and Ethiopian stakeholders in Addis Ababa. During this workshop, experts from the two countries in each of the sectors debated the findings and made suggestions that the chapter authors incorporated in subsequent revisions. We would like to acknowledge that helpful comments and advice were received from numer­ ous workshop participants. The chapter authors and editors have made attempts to update the data on some of the cases. However, there have been changes in some sectors and the broader institutional environment of information access and service delivety that the present study has not adequately captured. Similarly, an earlier version of the findings published as part of the World Bank's PREM Note series in July 2008 did not include some of the more recent changes. Despite the limits ofaddressing all the significant changes in each sector and country, we hope that this study illuminates the significant progress and shortfalls in improving information for service delivery and poverty reduction in Ethiopia and Kenya. iv ACRONYMS AAWSA Addis Ababa Sewage and Water Authority AAADRO Addis Ababa Acts and Documents Registration Office AAL Adopt-A-Light ADRO Acts and Documents Registration Office AMREF African Medical Research Foundation BNPP World Bank-Netherlands Partnership Program CAS Country Assessment Strategy CBO Community-based organization CCM Country Coordinating Mechanism CDC Centers for Disease Control (US) CIDA Canadian International Development Agency CIFA Community Initiative Facilitation and Assistance (Kenyan regional NGO) CRDA Christian Relief and Development Association (Ethiopian NGO) CSO Civil society organization DARO Documents Authentication and Registration Office DFID Department for International Development (UK) DHS Demographic Health Surveys EMA Educational Mass-Media Agency (Ethiopia) v FAR Financial administration regulation FBO Faith-based organization FDRE Federal Democratic Republic ofEthiopia FM Financial management FMOH Federal Ministry of Health (Ethiopia) GF Global Fund to Fight AIDS, Tuberculosis and Malaria HELB Higher Education Loans Board HIV/AIDS Human immunodeficiency virus/acquired immune deficiency syndrome ICPA Institute of Certified Public Accountants ICT Information and communication technology IMS Information management system IPAR Institute for Policy Analysis and Research (Nairobi) ITU International Telecommunication Union KEI Knowledge Exchange Institute KEMSA Kenya Medical Supplies Agency KEPSA Kenya Private Sector Alliance KfW Kreditanstalt fur Wiederaufbau (corporation under public law domiciled in Frankfurt am Main) KIPPRA Kenya Institute for Public Policy Research and Analysis KNCCI Kenya National Chamber of Commerce and Industry KNCHR Kenya National Commission on Human Rights Ksh. Kenya shilling LC Local council Le Leone m3 cubic meter M&E Monitoring and evaluation MDA Ministries, departments, and agencies MDTF Multi-Donor Trust Fund MoFED Ministry of Finance and Economic Development (Ethiopia) NCC Nairobi City Council vi Acronyms vii NHA National Health Account NHAPCO National HIV/AIDS Prevention and Control Office (Ethiopia) NCWSC Nairobi City Water and Sewage Company PASDEP Plan for Accelerated and Sustainable Development to End Pov­ erty (Ethiopia) PDO Project development objective PDP Plasma display panel PETS Public Expenditure Tracking Survey PFMRU Public Financial Management Reform Unit (Ministry of Finance) PLWHA People Living with HIV/AIDS PPP Public-private partnership PTA Parent-Teachers Association RHAPCO Regional HIV/AIDS Prevention and Control Offices STI Sexually transmitted infection TI Transparency International TIVET Technical, industrial, vocational, and entrepreneurship training TSC Technical Steering Committee UNAIDS Joint United Nations Program on AIDS UNFPA United Nations Population Fund UNICEF United Nations Children Fund USAID United States Agency for International Development V-Sat Satellite dish receiver WEDC Water Engineering Development Centre WHO World Health Organization viii Information and Service Delivery: Case Studies from Kenya and Ethiopia EXECUTIVE SUMMARY ANAND RAJARAM This monograph probes the role ofinformation in service delivery by focusing on key sectors in Kenya and Ethiopia. Findings from comparative studies done in 2005-06 in the health, education, and water and sanitation sectors plus public and private partnerships (PPPs) illustrate the significance of information access to delivery of quality services. Linking information access to service delivery is instructive to deepen institutional reforms around transparency and governance. This volume contends that three constraints-governance, trust, and technology deficits-impede information flows for service delivery in Ethiopia and Kenya. Although these constraints are formidable, the cases reveal that reforms in the gov­ ernance arena have began to make a difference in the domain of service delivery. The role ofinformation in service delivery is vital in understanding the nature and pace of second-generation public sector reforms. In the first-generation reforms, which began in the 1980s, the focus was on how governments could build institutional capacities to manage the development process. The interest in creating functional government institutions identified a wide menu of capacities that informed the policy reform agenda. These capacities included commitment to policy choices, flexibility in adjusting to change, and enforcement and imple­ mentation of given choices. As key players in the reforms, donors emphasized the centrality of quality institutions in forging new relationships between states and markets, and states and societies. Equally significant, the development of capaci­ ties for sound public policies entailed the corresponding expansion of societal efficacy in the policy domain, including measures to empower non-state actors. 1 The current public sector reforms seek to draw from the successes of previous reforms by bolstering the sturdiness ofinstitutions in the provision and delivery of services. Given the importance ofservice delivery in meeting development objec- I Batley 2004,31-56; Keefer and Khemani 2004, 935-43; Grindlee 2003. 1 2 Infonnation and Service Delivery: Case Studies from Kenya and Ethiopia rives, a core part of the reform centers on how to craft functional service delivery systems. Once they have been established, puhlic institutions ought to have a stake in transparent mechanisms to disseminate information ahout the services that they provide. This is the broad context that drives interest in information as a core puzzle in service delivery. The research that informs this monograph addresses the links between infor­ mation access and service delivery in the health, education, water, and sanita­ tion service sectors in Ethiopia and Kenya. Through the generous funding of the Government of the Netherlands, researchers from these countries studied the contribution