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120 Fighting the Diseases of Poverty
help to explain why voting had little effect on corruption (Azfar,
Kahkonen and Meagher, 2001). Other factors clearly have a stronger
influence on voter choices.
These results lead to the tentative conclusion that voice can take
many forms and none by itself will necessarily lead to the effective
control of corruption. However, the expression of voice via the press
or direct community involvement appear to be more powerful tools
than voting in influencing public performance. Public service
delivery does not affect voting patterns or candidate selection sufficiently.
Voting may be too blunt of an indicator, one that captures
a range of interests of constituents. Health will only predominate if
it is the pressing issue of the moment. Otherwise other concerns
drive voter preferences. Some of this may be due to entrenched corruption
where localities regardless of their oversight simply do not
have enough clout to influence public sector behavior. Where hiring
and promotion remain centralized, local voice will have less effect
in any case. Popularity of candidates, other factors that appeal to
voters and insufficient evidence on things like corruption no doubt
play a role, but it is difficult to be definitive given the paltry
evidence and the complexity of the issue.
Community oversight can work but it doesn’t always. In Boliiva
corruption is lower where local oversight groups are active “suggesting
that bottom-up accountability can be effective in keeping
corruption in check” (Gatti, Gray-Molina and Klugman, 2004). In
contrast, Uganda’s Health Management Committees expropriated
drugs and supplies providing virtually no oversight or support to
local service delivery (McPake et al., 1999), and in Nigeria village
development committees and PHC Management Committees had
little impact on health care performance largely due to their lack of
authority (World Bank, forthcoming).
Efforts by a local NGO in Kenya attempted to empower communities
to monitor teacher attendance using both reports to the
school hierarchy on performance and community awarded prizes to
the best performing teacher. Neither served to improve attendance,
despite the active participation of communities. In contrast, an NGO