The last mile on the route to quality service delivery

A growing body of research suggests that the quantity and quality of structural inputs of education and healthcare services such as infrastructure, classroom and medical supplies, and even teacher and medical training are largely irrelevant if teachers and healthcare providers do not exert the requisite effort to translate these inputs into effective teaching and medical service. To exert adquate effort, providers must feel they are accountable for the quality of service they provide. Yet a sense of accountability among providers does not necessarily occur naturally, often requiring mechanisms to monitor and incentivize provider effort. The literature on improving provider accountability has under-emphasized the role of monitoring practices by school principals and chief medical officers. This study begins to fill this gap by investigating the role of within-facility accountability mechanisms in the education and health sectors of Jordan. To do this, an analysis of existing and original data from these sectors was conducted in which the association of within-facility monitoring and provider effort was quantified. The results indicate that within-facility monitoring is underutilized in both sectors and is a consistent predictor of higher provider effort.