Service delivery for human development in Asia

Although there has been significant economic growth in Asia, the delivery of basic services has not kept pace with that growth. This paper examines the trends, challenges and opportunities associated with the provision of health and education services in Asia.

Several factors are exerting pressure on health and education systems in the region. These include expanding urbanisation and inequalities arising from increasing migration. The growth of non-state providers of health and education services has accentuated the need for regulation by the state. The hazard of HIV-AIDS, SARS, pandemic flu and other emerging diseases highlight the need for urgent and coordinated national responses.

Service delivery problems revolve around issues of access, quality, and affordability and sustainability. Current responses include measures to improve existing state provision, to decentralise service delivery, to experiment with new approaches involving non-state actors, and to engage users.

These have varying degrees of success, depending on the particular social and political context. In some cases, lack of commitment to the decentralisation of service provision has exacerbated inequalities in access to services. Resistance from professional associations or public sector unions can undermine reform efforts. Various forms of social exclusion relating to, for example, gender, caste, religious or ethnic minorities, are slowing progress to universal coverage.

It is clear that political commitment is required to address the strategic improvement of existing services, taking account of the plurality of providers, and the need to regulate non-state providers, tackle social exclusion, empower citizens (especially the poorest), and construct common interests among users. Governments can draw lessons from successful policy innovations, and explore the opportunities for transferring these to other contexts and for scaling up. There is a need to recognise, engage, support and regulate a plurality of providers. The involvement of stakeholders in the early stages of standard-setting can support the process of regulation. Branding and franchising may help raise standards. Poorer citizens can be empowered to make collective demands and stake claims in order to sustain quality improvements.

Development assistance has an important part to play in improving service delivery through financial and technical support. It can:

• focus attention on the problems faced by socially excluded groups by highlighting various measures to address exclusion
• support long-term monitoring, stimulate experimentation, scale-up pilot programmes, and help to share information about successful experiences
• International agencies can offer support for crossborder issues such as migration, or the spread of diseases such as HIV and AIDS.

[This paper was prepared for the Asia 2015 Conference, held in London, 6 and 7 March 2006]