delivery, by sector

TABLE 2.2 What has worked and what could work better in public service delivery, by sector

SECTOR WHAT HAS WORKED

Health • Expanded health facilities and equipment • Increased staffing of health facilities • Increased budget allocations • Reduced disparities in service delivery access and levels in some areas

Agriculture • More frontline staff • Investments in agriculture infrastructure

Early childhood education • Improved enrollment rates • Reduced disparities in enrollment • Increased spending • More trained teachers • More ECDE centers

Water • Increased investments and coverage in rural water • Increased urban population served

Urban services • Increased level of investments, later supported by conditional grants

Source: World Bank. Note: ECDE = early childhood development and education. WHAT COULD BE WORKING BETTER

• Staff absenteeism, motivation, and deployment of existing human resources • Balance between investment in infrastructure and equipping and operating existing services • Balance in provision of preventive and curative care • Quality of care • Availability of consistent and standard service delivery performance information over time • Disruption and decline in frontline agricultural extension services • Overall decline in staffing, which remain inadequate and poorly motivated • Absence of information on agriculture service delivery • Reduction in disparities not equitable • More teachers needed to reduce teacher-to-student ratio • Availability of management information on quality of ECDE services

• Urban water investments inadequate for population growth • Functionality of rural water supply schemes • Absence of management information in rural water service delivery • Availability of funding for urban services and investments • Absence of management information on urban services

cases, may have deteriorated (particularly in the immediate post-2013 period). But devolution has not led to a collapse in service delivery, which was a concern before the first national and county elections were held after the adoption of the new 2010 constitution. In the post-2013 period immediately following the establishment of county governments, there were undoubtedly challenges and some confusion and disruption; yet most counties have been able to take on their service delivery functions in a short space of time.

Counties have generally expanded and invested in services that were devolved to them. Access to, and use of, county services has increased in health and other sectors that had previously been neglected, such as rural water and ECDE. County governments have increased expenditure on investments, equipment and supplies, and staff in the service delivery sectors for which they are responsible. This has not been universal; staffing in agriculture and consequently extension services have suffered. Investments in piped water have not kept pace with population growth in urban and rural areas.

The quality and efficiency in service delivery represent more significant challenges, although there have been some positive trends. Human resources are inadequate, and issues of absenteeism and staff motivation, especially in health, represent major constraints to service delivery quality and efficiency. The quality of services being delivered is limited by a lack of adherence to guidelines and norms, such as the educational curriculum and clinical standards. Challenges in the maintenance and sustainability of investments undermine both their quality