Shanta Devarajan argues:
Teachers in Tanzania are absent 23 percent of the time; doctors in Senegal spend an average of 39 minutes a day seeing patients; in Chad, 99 percent of non-wage public spending in health disappears before reaching the clinics.
These and other service delivery failures have been widely documented since the 2004 World Development Report, Making Services Work for Poor People.
But why do these failures persist? Because they represent a political equilibrium where politicians and service providers (teachers, doctors, bureaucrats) benefit from the status quo and will therefore resist attempts at improving services. For instance, teachers are often the campaign managers for local politicians. They work to get the politician elected, in return for which they get a job from which they can be absent. Powerful medical unions ensure that their members can work in the private sector and neglect their salaried government jobs. The losers are the poor, whose children don't learn to read and write, or get sick and die because the public clinic is empty.
[…] How can we disrupt this equilibrium to improve services for poor people? One possibility is to provide them with information. We saw that community monitoring (poor people obtaining the information directly) had an effect on teacher performance. But more broadly, poor people do vote. If, with information, they vote along service delivery lines--rather than for politicians from their own ethnic or religious group, or who promise them private goods such as a job building roads--then it would be more difficult for politicians to ignore service delivery failures.
[…] Information may not be the only solution. The underlying problem is that politicians are behaving "clientelistically"--more interested in handing out private goods to their "clients" rather than public goods that benefit society, especially the poor--and getting away with it (they get elected). And if most politicians behave this way, it's in every politician's interest to follow suit. How can we move from clientelism being the norm to one where it is the exception?
This reasoning also perfectly fits the state of service delivery in Nepal. Eventually, there is continued supremacy of extractive political and economic institutions over inclusive ones.