# **_Accountability_**

In the final analysis, the effectiveness of service delivery depends on the extent to which those who deliver it are held accountable for their performance. In this section we consider two kinds of accountability: hierarchical accountability, which is based on bureaucratic controls within government<sup>3</sup> ; and social accountability, which involves communities in management and monitoring of programs (Das Gupta and Khaleghian forthcoming).

_Hierarchical accountability._ This involves monitoring the performance of public servants, rewarding them for good performance and punishing them when performance is bad. This is easier for some services than others. For services where output is easy to measure—the number of bricks laid or amount of taxes collected—this type of accountability is relatively straightforward. Tax collection reforms in Brazil, Mexico and Ghana bear out this point. In all three countries tax collectors were given a pecuniary incentive linked to their productivity in collecting taxes, as a result of which collection rates improved dramatically. In other countries, pay reforms were used rather than monitoring, the intention here being to reduce corruption by “raising the stakes” due to the higher wages which corrupt officials would forfeit if caught. The Becker-Stigler theory postulates that these two approaches are interactive, with higher pay and higher monitoring intensity both contributing to better performance and reduced corruption (Becker and Stigler 1974). Studies of corruption and government performance in several contexts confirm the validity of this hypothesis (Mookherjee 2001).

When measurement is difficult, however, it becomes considerably harder for supervisors to monitor and incentivize staff performance—and correspondingly easier for staff to manipulate the system in their favor—leading in turn to principal-agent problems and accountability failures. This applies to several of the EPHFs. Surveillance, for example, becomes less visible the more effectively it is carried out. Without strong internal controls and process measures, the first sign of a failing surveillance system is frequently a major outbreak—too late for corrective action. The same is true of health promotion. Since the impact of these activities is difficult and expensive to measure, evaluations—when they are carried, which they frequently aren’t—are seldom linked back to the staff involved in preparing the program in the first place. As a result these staff operate in an accountability vacuum and have little incentive to “get it right”. Monitoring can also be difficult for other reasons. In the case of health inspection, problems can arise when inspectors are expected to survey a large area and there are few supervisors above them. In this context, inspectors know that the likelihood of a supervisory check—i.e., the intensity of monitoring— is low, and they therefore have little incentive to perform efficiently or honestly, since the likelihood of being caught or punished is also low.

These points have important implications for the use of bonus payments and other ways of rewarding good performance. If measurement is weak or imprecise, whether because the service in question is hard to monitor or because monitoring is done poorly, it becomes difficult

> 3 See the citation from Schick (1998) above.

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