Public Service Delivery: Does Accountability & Local Institutions Matter

India is hailed as the world’s largest democracy but there is something curious in the fact that public service delivery continues to be poor, despite country’s strong democratic tradition. This paradox is inescapable. The case in point unarguably is, India’s highest percentage of under-six underweight and anaemic children in the world. Much of the public policy discourse holds ‘weak accountability’ as one of the reasons for service delivery outcomes remaining poor in India. A key driving question of this book is how accountability as an idea and a process, significant in the everyday encounters of key actors at the frontline of public health service delivery, as against its high rhetoric in policy and development discourse. The book analyses how users, especially the poor, interact and interface with accountability mechanisms esp. the informal ones, when the formal mechanisms of accountability fail or exclude them. Two national public health programmes – National Rural Health Mission (NRHM) and integrated Child Development Services (ICDS) are the book’s context, using a comparative case study design. Findings reveal that malnutrition is not only about a well-functioning anganwadi or lack of frontline accountability or even economic prosperity, as perceived, but inherently linked to local institutions that shape information barriers, hierarchy, elite capture and gender bias.