In many developing countries, governments have invested substantial resources
in the provision of basic services such as healthcare and education. However,
these investments frequently yield minimal improvements in student learning
and health outcomes. One reason can be found in a growing body of research
that suggests investment in the structural dimensions of service quality beyond a
certain threshold is unlikely to improve service delivery outcomes. Indeed, the
quantity and quality of structural determinants 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. In essence, providers must exert adequate levels of effort by
coming to work regularly and complying with technical and professional standards
to provide high-quality education and healthcare services