The last mile to quality service

In many developing countries, governments have invested substantial resources in the provision of basic services such as healthcare and education. However, these investments frequently yield minimal improvements in student learning and health outcomes. One reason can be found in a growing body of research that suggests investment in the structural dimensions of service quality beyond a certain threshold is unlikely to improve service delivery outcomes. Indeed, the quantity and quality of structural determinants of education and healthcare services such as infrastructure, classroom and medical supplies, and even teacher and medical training are largely irrelevant if teachers and healthcare providers do not exert the requisite effort to translate these inputs into effective teaching and medical service. This book contributes to addressing this under emphasis, specifically focusing on the linkages between within-facility accountability and provider effort in the health and education sectors in Jordan. In the case of healthcare, a study was developed to generate novel insights from an original survey instrument. It is worth noting that this is the first nationally representative study in Jordan to measure within-facility accountability and provider effort in primary health care facilities, and the first study in the Middle Eastand NorthAfrica region to investigate these linkages. The study relies on a nationally representative sample of 122 primary healthcare facilities where data are collected through patient exit interviews, and surveys administered to chief medical officers, doctors, and nurses who work at the centers, and where available, a representative of the community health committee. In the case of education, an empirical analysis of a nationally representative sample of 156 schools was conducted, relying on existing data collected through principal, teacher, and student surveys; third-party classroom observations and school inventories; and math and reading student assessments. This empirical analysis was complemented by a comparative casestudy of six Jordanian schools using statistical matching and a process-tracingprocedure.