Are you being served?

This article explores the determinants of public satisfaction (or dissatisfaction) with health and education services in Africa. Among prospective explanations, we consider the users’ poverty, their general perceptions of service accessibility, and their specific experiences with service providers. We find that user-friendliness of services is essential, especially to poorer clients. But daily encounters including with substandard teaching and the costs of clinic fees tend to depress public approval, not only of services, but also of democracy. Finally, corruption has unexpectedly mixed effects: perceptions that officials are corrupt decreases citizen satisfaction; but the act of paying a bribe increases it. Are You Being Served? Popular Satisfaction with Health and Education Services in Africa Are you being served? This inquiry always greets the well-heeled customers in the fictional department store in the classic British television comedy series. But it is rarely asked of the ordinary men and women who consume basic public services in Africa. Few systematic details are known about mass opinion regarding public services in Africa’s burgeoning cities or vast rural hinterlands. We have the impression that, in an era of state retrenchment, such services are usually scarce and substandard and are rarely infused with an ethic of customer service. But more analysis is required about the strengths and weaknesses of the public delivery systems for health and education services in Africa, especially as seen through the eyes of users. Do Africans think they are being served? The 2004 World Development Report frames the debate. Its authors seek to “put poor people at the center of service provision: by enabling them to monitor and discipline service providers, by amplifying their voice in policy making, and by strengthening incentives for providers to serve the poor” (World Bank 2004, p.1). We already possess an extensive record of poor people’s demands for socioeconomic development, albeit mainly in the form of narrative testimonies (Narayan 2000, Narayan et al. 2001, Institute for Policy Alternatives 2005). We also have macrolevel evidence from India that responsive governance – the public sector analogue of customer service – depends on the free flow of information in the context of electoral competition (Besley and Burgess 2002, Keefer and Khemani 2003 and 2004). Yet research from the same perspective in Latin America suggests that democratic elections and public spending alone are insufficient to guarantee high quality social services or equitable service delivery (Nelson, 2005, Kauffman and Nelson 2005, World Bank 2004, 36). This paper builds on these foundations by exploring the determinants of public satisfaction (or dissatisfaction) with health and education services in Africa. I select these basic services because of their intimate links to economic growth and human welfare. And, I shift the lens of analysis to the micro level in order to systematically analyze service satisfaction from a user’s perspective. Among prospective explanations, we consider the users’ poverty status, their general perceptions of service accessibility, and their specific experiences with service providers. Research Questions The following research questions guide the study: • How important are basic social services among the development priorities of ordinary Africans? • How satisfied are Africans with government performance in the health and education sectors? • For users, which aspects of service delivery matter more: quantity or quality? • If quality matters, which aspects of users’ experiences with service providers are decisive? • Does official corruption always undermine popular satisfaction with services? • Is there an onward linkage from satisfaction with service delivery to satisfaction with democracy? The paper proceeds in three parts: contextual, descriptive, and analytic.