The Last Mile to Quality Service Delivery in Jordan

Abstract

proximity to the actual service delivery exchange, within-facility accountability may be able to overcome some of the limitations of top-down and bottom-up mechanisms, substantially contributing to improved provider accountability. This book contributes to addressing this underemphasis, specifically focusing on the linkages between within-facility accountability and provider effort in the health and education sectors in Jordan. In the case of healthcare, a study was developed to generate novel insights from an original survey instrument. It is worth noting that this is the first nationally representative study in Jordan to measure within-facility accountability and provider effort in primary health care facilities, and the first study in the Middle East and North Africa region to investigate these linkages. The study relies on a nationally representative sample of 122 primary healthcare facilities where data are collected through patient exit interviews, and surveys administered to chief medical officers, doctors, and nurses who work at the centers, and where available, a representative of the community health committee. In the case of education, an empirical analysis of a nationally representative sample of 156 schools was conducted, relying on existing data collected through principal, teacher, and student surveys; third-party classroom observations and school inventories; and math and reading student assessments. This empirical analysis was complemented by a comparative case study of six Jordanian schools using statistical matching and a process-tracing procedure. Jordan provides an excellent case to study the role of Accountability in improving the Quality of education and Healthcare service Delivery In the past two decades, Jordan has achieved close to universal primary school enrollment (97 percent) and completion (93 percent), as well as high enrollment (88 percent) and completion (90 percent) rates at the secondary level, on par with Organisation for Economic CoOperation and Development (OECD) countries. Yet, international student assessments refocus the country's attention on what actually matters: student learning. Despite high levels of educational attainment, 15-year-old Jordanians' average mathematics, language, and science Program for International Student Assessment (PISA) scores rank among the lowest of PISA-participating countries. Similarly, in education systems that participate in the Trends in International Mathematics and Science (TIMSS) Study, eighth-grade students' average achievement in both mathematics and science ranks at nearly the bottom. Indicators as such are somewhat unexpected given Jordan's internationally comparable expenditure levels in the education sector. Public education expenditure as a share of total government expenditure stood at roughly 10.3 percent in 2012, slightly above the OECD average for that same year (9.8 percent), and on par with, for example, strong PISA performers such as Austria, Germany, and Poland. Furthermore, public education expenditure as a share of GD...