This piece is co-authored by Jonathan Diab, Bessma Momani and Anna Klimbovskaia
With recurring outbreak of conflict or violence in the Middle East and North Africa (MENA) region, focusing on implementing essential services may seem like a secondary concern. Conversely, the low-quality services may be the root of the problem. Poor state performance is exacerbating tensions in society, deepening mistrust and discouraging citizens from engaging with the state. At the IMF and World Bank Spring meetings, the World Bank put forward a fascinating study on why improving public service delivery is key to building a foundation for stability and prosperity.
The World Bank study noted that public services in healthcare and education are often deemed to be unsatisfactory to MENA citizens. Yet simply modernizing schools and hospital facilities are no longer sufficient. Delivering quality services requires a motivated workforce of public servants. Across the region of MENA, 20 to 80 per cent of doctors are absent from healthcare facilities during working hours. Even sadder, 30 per cent of all students in MENA countries attend schools in which principals reported that teacher absenteeism is a serious issue.
Teachers are not following a curriculum, and doctors are not following protocols for care or merely not showing up to work in public facilities. With public sector teachers and doctors not showing up to work, they instead offer some services privately for a fee and creating conflicts of interest. For example, in Egypt, 89 per cent of private physicians also work in public facilities where they are absent or extend little effort during official hours while giving their best performance for their private practice.
Public institutions that deliver essential social services are not responsive to citizens' needs, leaving citizens to abandon the system and seek alternative means. The poor, lacking the means to pay informal fees and the financial capability to opt out of the public service system, are the ones suffering the most from ineffective service delivery.
Disgruntled citizens are obviously a political issue as well. With levels of public dissatisfaction increasing in MENA, there is also a corresponding decrease in trust of national governments. For example, the probability of trusting national government declines by 12 per cent when citizens are dissatisfied with education. The cycle of poor performance continues with the lack of trust, citizens feel cheated by their government, disengage and rely on informal fees for service delivery.
The World Bank study, however, offered an opportunity to share some success stories. MENA government officials, health care professionals, and education principals, alongside with World Bank analysts, came together at the Spring Meetings to learn from local success stories in service delivery and come up with strategies to build trust, voice and incentive for civil participation.
One such interesting success story was offered by Sami Hourani, founder of Leaders for Tomorrow, who explained that if we want to incentivize civil participation, citizens need to see tangible results. Hourani describes the courage of MENA citizens who stay in the region and continue to put pressure on their government officials for change.
At the local level, visionary leadership can inspire the required changes by showcasing local solutions. The Spring Meetings welcomed, Abla Habayeb, a school principal in the West Bank who has built a culture of motivated community members, parents, and teachers to offer quality education to local girls. The success of the school is notable due to the community's shared responsibility for implementing the service. Despite the political turmoil of the West Bank, the students surpass national education tests.
There is no one size fits all model for creating standardized mechanisms to monitor and motivate public servants, service providers, and citizens. MENA must look to visionary leadership, learn from local successes to strengthen inclusive institutions and break this vicious cycle. By revealing more local successes of performance in service delivery, there can be change in citizen's perception of the state, influence citizen action and build trust in the state.
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