Putting the public back into public services

Governance, Health, Innovation

As we launch Held to Account, Oxfam’s new briefing paper on public service accountability, guest blogger from India Dr Abhay Shukla – activist, physician and public health specialist – calls for donors and CSOs to support moves to put responsiveness and accountability at the heart of public services.

Today, societies across the world face a challenge: how to bring public services in line with the needs and aspirations of ordinary people? Held to Account, Oxfam’s new briefing paper, is an attempt to respond to this question.

In the second half of the twentieth century, developing countries significantly expanded their public services, as part of post-independence promises of a ‘welfare state.’ However, the achievements of many have been mixed. Public systems for health care, education, food security, water and social security have often ended up being controlled by unaccountable bureaucracies. They are increasingly distanced from the people they were created to serve and are often dominated by national elites and vested interests. Many are riddled with corruption and endemic misuse of
resources.

State services have been starved of funds, partly privatised, or even entirely replaced by private providers, leading to a veritable crisis in the public sector.

It is in this setting that the neoliberal agenda of weakening public systems in the name of ‘austerity’ and ‘reforms’ has been promoted. State services have been starved of funds, partly privatised, or even entirely replaced by private providers, leading to a veritable crisis in the public sector.

So, what next?

Needless to say, developing these kinds of people-focused services is likely to be a complex and prolonged struggle. It requires a new kind of work ethic and public spirit among officials and service providers, accompanied by significantly higher levels of consciousness and action by organised groups of people regaining their public entitlements.So, what next? The way forward needs to avoid both unaccountable public bureaucracies and privatisation which leads to unresponsive systems ‘of the elites, for the elites, by the elites.’ It must be based on a process
of people collectively reclaiming their public systems, forging new relationships between society and the state.

Good intentions are an important starting point, but these must be translated into workable accountability processes and mechanisms, which gain wider social support, as well as traction within the systems they intend to change. We also urgently need to learn the practical lessons from successful examples of people-centred accountable public services.  

Held to Account cover and link to download the paper

As both a physician and social activist, I find the area of public service accountability particularly fascinating. How can a large, complex and technically-driven institution like a public health service be substantially reoriented in a positive direction, under the influence of ordinary people who are largely less educated, poor and traditionally powerless?

This challenges our traditional notions of hierarchies of knowledge, and experiences shows how barely literate people can ‘teach’ a thing or two to officials who have far more formal training. The key role of accountability processes in context of health systems reminds us that however technical the content of their services may be, these systems are above all social systems.

As a social activist, one views the experience of community accountability as a key approach to democratising the public health system. This is one front of struggle and change among many, if we want to move towards a democracy where people’s involvement and power is not just limited to pressing a button once in five years. In this context, ‘reclaiming the public health system’ is emerging as a way forward for democratisation in the health sector. 

I continue to be inspired by myriad grassroots activists who are persistently pushing such rights-based democratisation processes.

Since my involvement with a people’s organisation in tribal villages of Dahanu area of Maharashtra in Western India two decades back, I continue to be inspired by myriad grassroots activists who are persistently pushing such rights-based democratisation processes. Their determination and persistence provides hope, despite the many obstacles that today stand in the way of genuine community accountability and participatory governance.

It is hoped that Held to Account will be widely read and discussed among diverse stakeholders, including policy makers, especially in developing countries; activists of civil-society organizations and social movements; frontline public providers and field-level public officials; staff of international donor agencies; and concerned citizens looking for ways to make public systems
responsive to people’s needs. This report contains considerable value for all of these groups, and perhaps poses the beginnings of an answer to one of the central questions facing us today: how to bring the public to the centre of public systems.

Main image: Primary Healthcare Centre, Maharashtra State, India. Credit: Cecile Unternaehrer/Oxfam

Read more

Download Held to Account: Putting democratic governance at the heart of development finance

Author: Abhay Shukla
Archive blog. Originally posted on Oxfam Policy & Practice.