Expenditure Tracking Survey revealed that 87 percent of school funds were “leaking”—i.e., disappearing—between central government and schools, either into other programs or the pockets of corrupt district officials. In response, the government started to publicize the amount of monthly transfers to each district in the newspaper and over the radio, and required primary schools to post notices on all inflows of funds. A year after starting the program, leakage had fallen to 10 percent as district officials and school administrators found themselves under greater scrutiny by the public and the media (Reinikka and Svensson 2001). A similar campaign was waged by the government of Buenos Aires, Argentina, in response to pharmaceutical price escalations that were thought to be a result of corruption in procurement. In this case, the fact that the government was collecting information was by itself sufficient to cause prices to fall— presumably because corrupt officials assumed the data collection would be followed by some sort of crackdown (Di Tella and Savedoff 2002). Information-based approaches do not have to be government driven. A free press and civil society can also serve similar functions, as Samuel Paul’s report cards on public services in Bangalore show (Paul 1998). Here, a NGO collected and disseminated information on the performance of public utilities and health providers in urban Bangalore. Some improvements in service delivery were reported to follow, though these were more prominent in services such as water and power where private demand is high. The media also tends to focus on such services. As a result, while outbreaks receive plenty of attention, routine service delivery in public health—the day-to-day functions of surveillance, reporting, data analysis—receives no attention at all. In India, democracy and a free press help ensure outbreak control but not routine disease control, analogous to Sen’s (2000) analysis that they have been effective in preventing famines, but remarkably ineffective in preventing chronic malnutrition (Das Gupta, Khaleghian, and Sarwal 2003). Thus, relying on informational strategies or the media to hold providers accountable for “invisible” services is not, by itself, a complete solution.

The fourth approach is to provide channels for users to voice their concerns and preferences regarding the service. Client surveys are one such approach. In these, client feedback to the provider is used to influence service delivery. Another approach is the use of patient advocates or other independent bodies to which service users have access and which have formal influence with providers. Like the other approaches summarized above, voice channels are most effective for private, measurable services such as water supply, irrigation, education and primary curative care. For the EPHFs, they are unlikely to work well because people have little direct interest in the service—except when it breaks down, when the only accountability that remains is _ex post_ and therefore too late—and because measurement is complicated by the nature of the services and their lack of visibility.

These four approaches are interactive and mutually reinforcing. Information can’t improve service delivery unless accompanied by some recourse method, whether it be control, choice or voice; and no amount of control, choice or voice is useful unless service users have reliable, accurate and easily interpreted information about the service they are supposed to monitor. These linkages are frequently ignored. In India, the government publishes a service 20