Part I (Chapters 1 – 3) asks the question: Why does service delivery fall short of potential in the MENA region? In answering the question, the report provides a review of the region’s impressive achievements over the last five years of expanding access to basic education and health services and improving core human development outcomes, while highlighting the remaining challenge of poor service quality and citizens’ dissatisfaction. The conclusion is that a cycle of poor performance has emerged in much of the region as a result of state institutions lacking both internal and external accountability mechanisms. Chapter 3 demonstrates that cycles are alterable. It provides examples of virtuous cycles in the region that have developed at the local level (even in context of a poor performance at the national level) when local stakeholders are driven by individual will or social obligations to take initiatives.
Part II (Chapters 4 – 5) chapter 4 explains how historical experience has led citizens to value health and education, fostered their dependence on the state, and has limited state responsiveness. Chapter 5 provides a detailed picture of the political, administrative, and social institutions that affect service delivery.
Part III (Chapters 6 -7) offers an analysis of performance at the point of service delivery. It explores the efforts of teachers and health professionals in relation to their access to resources and the influence of institutions. Chapter 6 focuses on the national level, with chapter 7 identifying the extent of subnational variation in service delivery performance. The study of subnational variations underscores that local successes exist and that much about service delivery challenges and possible solutions can be learned in local contexts.
Part IV (Chapters 8 – 9) completes the cycle of performance with an analysis of how institutions and performance affect citizens’ perceptions of the state and the nature of citizen action vis-à-vis the state. Chapter 8 shows how performance influences citizens’ trust in the state, with chapter 9 tracing that trust in turn shapes the nature of citizens’ engagement at both the local and national levels.
Part V (Chapters 10 – 12) emphasizes the need to build on evidence of local successes and on positive trends that buck the cycle of generally poor performance, as bases for encouragement and action for citizens, civil servants, policy makers, and donors. Chapter 10 discusses the opportunities that crises offer to national and local leaders to reform institutions and accountability mechanisms, and boost citizen trust. Chapter 11 focuses on the role donors can play in supporting reforms, in the absence of major disruptions, by promoting the right incentives. Chapter 12 offer yet another scenario for incremental institutional reforms driven by reform coalitions in society and government.