Learning from Local Success. Stories in Service Delivery in the. Middle East and North Africa. Hana Brixi, Ellen Lust, and Michael Woolcock

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1 Trust, Voice, and Incentives Learning from Local Success Stories in Service Delivery in the Middle East and North Africa Hana Brixi, Ellen Lust, and Michael Woolcock WORLD BANK GROUP

2 Contents Foreword Acknowledgments About the Autbors and the Contributors Abbreviations xv xvii xix xxiii Overview 1 Citizens' expectations 2 Local successes: Autonomy, accountability, and participation 2 The cycle of poor Performance 4 Bases for improvement 11 Reference 14 Data sources 14 Introduction 15 Organization of this report 16 Note 18 References 18 PART I Expectations, Reality, and Inspiration in Education and Health Services Delivery A Demand for Better Services but Not Formal Accountability 21 The right to education and health services in the MENA region 21 Citizens' satisfaction and demands on government 23 Citizens' trust and engagement 29 Notes 32 References 32 Data sources 33

3 Vi CONTENTS 2. The State of Education and Health Services Delivery: The Quality Challenge amid Impressive Advances 35 Outcomes 35 Access 40 The quality challenge 47 Citizens' satisfaction 54 Reflections in the wider historical and institutional contexts 61 Notes 62 References 63 Data sources Local Successes: Satisfaction, Accountability, and Quality at the Local Level 67 Gase study 1: Education services in Jenin, West Bank 68 Case study 2: Education services in Yarqa, Jordan 76 Case study 3: Health care services in Jordan 88 Case study 4: Health care services in Morocco 93 Case studies to share ideas and inspire change 98 Notes 98 References 101 Data source 101 PART II The Historical and Institutional Drivers of Performance Historical and Cultural Roots of Citizens' Attitüde s and State Performance 107 Education and health as elite privilege 108 From privilege to State Building 110 Independence and the new social compact: Services, a right for all 111 Institution Building in newly independent states 112 Economic crises, neoliberal policies, and the failure to reconstruct the social compact 113 High expectations, weak institutions, and low Performance 115 Notes 118 References 119 Data sources Institutions Influencing the Cycle of Performance 123 Political institutions 125 Administrative institutions 135 Social institutions 144 Potential for reform? 154 Notes 157 References 158 Data sources 163 PART III Service Delivery Performance Service Delivery: Gaps in Providers' Efforts and Abilities and in Inputs 167 Providers' efforts 168 Providers' abilities 172 Availability of key inputs 175

4 CONTENTS V i i Interpreting service delivery Performance 177 Notes 179 References 179 Data sources Subnational Variation in Service Delivery Performance 181 Subnational Variation in health services delivery in the Republic of Yemen 182 Subnational Variation in health services delivery in Morocco 187 Education and health services in Egypt 195 Education services in the Republic of Yemen 197 Education services in Morocco 199 Education services in Saudi Arabia, Oman, Qatar, the United Arab Emirates, Bahrain, and Tunisia 203 Concluding observations 207 Annex A 209 Annex B 210 Notes 210 Reference 211 Data sources 211 PART IV Citizens'Trust arid Engagement Citizens' Response to Poor Performance and Unresponsive Institutions? Lower Trust 215 Blaming the State for poor services 216 Ladung trust in institutions and actors 217 Conclusion 224 Annex Predicted probabilities tables on trusting the national government 225 Notes 230 References 231 Data sources Effects of Lower Citizen Trust on Citizen Engagement: Circumventing the State, Relying on Wasta, and Pursuing Conflict 233 Directly engaging the State and public services delivery institutions 234 Circumventing the State 239 Clashing with the State 241 The use of social media 242 Conclusion 243 Annex Predicted probabilities tables 244 Notes 246 References 248 Data sources 249 PART V New Openings Transitions, Conflicts, and Refugees: Both an Opportunity for and a Strain on the Cycle of Performance 253 Transitions 254 Conflict 262

5 v i i i CONTENTS Refugees 266 Conclusion 269 Notes 269 References 270 Data sources Donor Support 275 An overview of the World Bank's education and health activities in the MENA region 276 Factors shaping Variation in operational effectiveness 279 The challenge of project Implementation in the MENA region 283 Lessons and opportunities going for ward 288 Conclusion: Are there even more "lessons" to be learned? 289 Notes 291 References 292 Data sources Incremental Changes in the Social Contract and Local Empowerment 295 Lessons from experience 296 Strengthening accountability and incentives through incremental changes 297 Empowering communities and local leaders to find best-fit solutions 304 Delivering quick wins 310 Moving for ward 311 Notes 311 References 312

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