Providing vital public services is typically seen as the responsibility of the state. However, in practice a number of formal and informal providers are likely to be delivering water, sanitation, education and health in most developing country settings. Non-state providers (NSP) take many forms, ranging from large-scale for-profit firms, to individual entrepreneurs, to non-profit community groups. In conflict-affected contexts, some basic services may also be delivered by non-state armed groups with territorial control over a particular area. In other contexts, NGOs or faith based organisations may be the provider of choice for some or all parts of the population. Research shows that poor people use private providers to a surprising extent, given the associated costs, and sometimes choose them over free public services.
There is considerable debate about the role and impact of private and non-state health and education providers in developing countries. Some experts argue NSPs are pro-poor where they provide access to services in areas not reached by state provision. Others are concerned with the equity, quality, affordability and sustainability implications of non-state provision. Promoting better state engagement with non-state providers is often proposed as a route towards reducing any such negative impacts, but in practice state-NSP relationships are often characterised by mistrust.
MacLean, L. M. (2011). The Paradox of State Retrenchment in Sub-Saharan Africa: The Micro-Level Experience of Public Social Service Provision. World Development, 39(7), 1155-1165.
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.
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Batley, R. (2006). Engaged or Divorced? Cross-service Findings on Government Relations with Non-state Service-providers. Public Administration and Development, 26(3), 241-252.
This article synthesises case studies of non-state provision of education, healthcare and sanitation services in South Africa, Malawi, Nigeria, Pakistan, Bangladesh and India. It finds that, while policy is now generally in support of NSP, practice is more often unsupportive and relationships are surrounded by mistrust. Nevertheless, enhanced operational engagement between governments and NSPs – in the form of strong, independent regulatory bodies and joint ventures – could promote better services for poor communities.
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Tadros, M. (2011). Faith-Based Organizations and Service Delivery: Some Gender Conundrums (Gender and development program paper number 11). Geneva: UNRISD.
Women face particular dilemmas when the extension of services and assistance is conditional on their conforming to the FBOs’ interpretation of religiously appropriate gender roles and behaviour. Without generalizing for all service-providing FBOs, in some instances, services are used overtly or more subtly as a means of seeking to inculcate religious values and ideologies. Often, controlling women’s behaviour becomes a symbol of conformity to religious ideology. While women are the targets of many such processes, they are not simply repositories of doctrines and ideologies and often engage in acts of subversion as well as covert and overt forms of contestations.
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Oxfam International, (2009). Blind optimism: Challenging the myths about private health care in poor countries (Oxfam Briefing Paper 125). Oxford: Oxfam International.
The realisation of the right to health in poor countries depends upon a massive increase in health services to achieve universal and equitable access. A growing number of international donors are promoting an expansion of private-sector health-care delivery to fulfil this goal. This paper contends that while the private sector can play a role in health care, prioritising this approach is extremely unlikely to deliver health for poor people. Governments and rich country donors must strengthen state capacities to regulate and focus on the rapid expansion of free publicly provided health care, a proven way to save millions of lives worldwide.
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Day Ashley, L., Mcloughlin, C., Aslam, M., Engel, J., Wales, J., Rawal, S., … Rose, P. (2014). The role and impact of private schools in developing countries: a rigorous review of the evidence (EPPI report 2206). London: Department for International Development.
This rigorous review asked: Can private schools improve education for children in developing countries? The findings include: There is strong evidence that teaching is better in private schools than in state schools, in terms of higher levels of teacher presence and teaching activity as well as teaching approaches that are more likely to lead to improved learning outcomes. There is moderate evidence that girls are less likely than boys to be enrolled in private schools. The evidence is ambiguous about whether private schools geographically reach the poor. Although private schools are continuing to focus on urban areas, they are also becoming increasingly prevalent in rural areas; but research cautions against assuming this means they are reaching the poor.
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