What has been the impact for sub-Saharan Africans of declining state involvement in public service provision? This paper examines public service experiences in Africa following neoliberal economic reform. It argues that the erosion of the quality of state services has led to a two-tiered system. The rural poor are forced to rely on public schools and clinics, while better-off urban citizens use private services providers. This has important implications for the sustainability of publicly provided social services in sub-Saharan Africa and elsewhere.
Past concerns by policymakers about levels of access to public services have resulted in inadequate attention to service quality. Perceptions of service quality (or lack thereof) are critical in individual decisions on whether to choose public or private social services. Africans’ experiences with social services are more complicated than a black and white portrayal of the excluded poor and included wealthy. The rural poor are in fact more likely to have some experience of state social services than the more urban well-off citizens.
State retrenchment in Africa has stimulated the growth of a two-tiered system where those who can pay frequently opt-out of what the state has to offer. This interpretation is counter-intuitive and stands in contrast with much of the earlier literature on the impacts of structural adjustment in Africa.
Micro-level experiences of public social service provision show an erosion of quality in publicly provided social services. Analysis of 2005 Afrobarometer survey findings shows that:
- A majority of Africans surveyed (54 percent) would actually prefer to pay school fees in order to raise the quality of education. Most revealingly, they preferred to pay fees in order to raise the quality of education whether or not they had any experience with public schools.
- The data also highlight that by 2005, the quality of education and health was becoming the more obvious problem throughout most of sub-Saharan Africa. Africans complained about quality issues such as overcrowding, poor facilities, absentee teachers and poor teaching more frequently than about school fees.
- Africans with experience of public clinics complained more about the quality of healthcare than the cost. They complained more about long waiting times (60 percent), lack of supplies (55 percent), lack of attention and respect given to patients (45 percent), and absentee doctors (44 percent), than about public clinics being too expensive (42 percent).
Donors and governments therefore need to invest more in the quality as well as the quantity of pubic services. Additional implications are that:
- The creation of a two-tiered system could threaten the sustainability of the public social welfare system. While the rural poor currently have access to public social services, this could decline should service quality continue to drop and discourage future use.
- Further, increased use of the private sector could undermine public political support for a social welfare system.
- The two-tiered experiences of state retrenchment also appear to be leading to a two-tiered citizenship. Africans with some experience of public schools and clinics are more likely to register, vote, contact their political leaders and attend community meetings.
