BRIEFING NOTE 7

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A new decade to measure

Summary

This document looks at thecurrent state of monitoring inthe water supply and sanitationsector at global, national andlocal levels. It identifiesinconsistencies, gaps anddisconnections in how sectormonitoring is tackled. Itconcludes that there is a needfor a coherent approach toreinforce advocacy and makethe case for increased nationalresource allocation to the sub-sectors (rural, urban, watersupply, sanitation). Evidenceis needed to demonstrate thesector’s contribution togovernment povertyalleviation strategies.

2004

Water Supply and SanitationSector Monitoring

Headline issues

Water and sanitation sector impacts on the Millennium Development GoalsThe second International Drinking Water and Sanitation Decade ‘Water for Life’i

(2005-2015) will support achievement of the Millennium Development Goals(MDGs). The water and sanitation sector impacts across the MDGs but this stillneeds to be made known. Improved national level resource allocation, sustainedglobal advocacy and monitoring of the sector’s progress is key.

Inconsistent monitoring risks disconnectionCurrently different sector data collection activities run in parallel. These rarelyconverge to assist planning and decision making. They hide important variationswithin a country and between communities. This may not have a dramatic impactupon the global headlines but can lead to disastrous local decisions about where toput limited resources.

Connecting disconnected targetsOver two thirds of developing countries fail to set sector targets beyond the globalfigures. This risks national monitoring being a reporting, rather than a decisioninforming exercise. National monitoring tends to be patchy and complicatedfailing to make connections between the different monitoring levels, instrumentsand formats.

Data fails to make poverty linkAt sub-national level invalid, biased or unrepresentative data leads to repeatedfailure to target the vulnerable and extend services to the poor.

National objectives, local realitiesSector reform and decentralisation is not necessarily leading to sub-sector anddistrict level decision-making, or coordinated inter-agency partnership andcollaboration. How national plans equate with local realities and reportingtransparency is a problem for district level managers.

Research into monitoring makes poverty linkResearch shows that focusing on consumers and users makes progress and impactmonitoring relevant, better understood and more easily linked to poverty andsustainability indicators.

Reconciling unresolved issuesMonitoring data should be provided horizontally and vertically throughout thesector, sub-sectors and relevant other sectors. Currently the process of monitoring,although a requirement of programmes and projects, fails to accelerate decisionsabout sector investment and resource allocation where it matters.

TheEvidence

Achieving the MDGs -water and sanitationreally count

Poverty: Waterborne diseases costthe Indian economy 73 millionworking days a year.

Education: In Madagascar, 3.5million schooldays are lost each yeardue to ill-health related to badsanitation.

Child health: A study in Salvador,Brazil showed that children inhouseholds with no toilet had twicethe incidence of diarrhoea than thosewith sanitary toilets.

Gender: 11% more girls attendschool where there are working andwell-maintained sanitation facilitiesfor girls, offering proper privacy.

HIV/AIDS: Water, sanitation andhygiene can mitigate against illness.Households with a 10% increase inwater use for cleaning purposes enjoya decrease in cases of diarrhoea by1.3%.

Environmental sustainability: Localpeople in Faisalabad, Pakistan reporta huge improvement in quality of lifesince the installation of communitysewers, with children playing outsidesafely.

For more information about‘Achieving the MDGs - water andsanitation really count’ visithttp://www.lboro.ac.uk/well/resources/Publications/WELLPublications.htm

1 For example, rural water supply and sanitation, urban water supply and sanitation, water for production andwater resource management

Water and Sanitation Sector MissesInvestment Opportunity

The Millennium Development Goals (MDGs) include the target to halve by 2015the proportion of people without sustainable access to safe drinking water andbasic sanitation. This is the basis for international calls for increased investmentin the sector. More than this, the evidence shows that the provision of water andsanitation services impacts on the achievement of other MDGs (poverty,education, child health, gender, HIV/AIDS and environmental sustainability),however this fact is not being effectively used to make the sector’s case.

The time is right to make the case for levering more resources to the sector. Partof the evidence lies in how sector success is monitored, the gaps identified andthe MDG links presented at national level. It then depends on how effectively thisinformation is used to prioritise resources to sub-sectors1 at local government andcommunity level.

'5 billion working days a year being lost in developing countries due tohygiene related illnesses'

It is important that statements and figures on water supply and sanitationare reported for global advocacy and political reasons. However, countingtaps and toilets as the main way of showing success can confuse ends withmeans. It pays too little regard to whether or not facilities are used or if thelocal incidence of diarrhoeal disease begins to fall. The difficult challenge forsector monitoring is to integrate statistical accounting with health andeducation sector and MDG priorities. This requires a better understanding ofthe interrelationship between service delivery (which includes latrineconstruction and counting) and its impact on poverty. Alongside statisticalheadlines there must be evidence-based, and situation relevant povertyreduction indicators.

Ashoke Chaterjee, independentcommunicator specialising inwater and sanitation, com-ments, "We are not againsthaving goals and targets, but ifpeople start chasing figuresagain, without thinking aboutthe process that they're usingto get there, then we're on foranother disaster." WSSCC

Inconsistent MonitoringRisks Disconnection

In many countries at least three sector data collection activities run in parallel,

nationally consolidated data taken from regular line ministry (state, province,district) reports,

census and household survey information analysed to satisfy global reportingrequirements, and in the case of the census provide national reporting, and

community based qualitative data often facilitated by local government andtheir NGO partners.

These activities rarely converge to assist planning and decision making aboutsector and sub-sector resource allocation. They also risk hiding importantvariations within a country, for example gender disparities within and betweencommunities, and local interpretations of poverty. Although this information maynot have a dramatic impact upon the global headlines, at a local level it can leadto disastrous decisions about where to put limited resources. For example, takethe distance-based definition of access to water. If this was deemed to be 'within200 metres' this might be unrealistic and meaningless in reality, and so make theachievement of goals impossible. Why? Because for sparsely populated areasreducing the distance to reliable and safe water from 1 kilometre to within 300 or500 metres for more people rather than a few, may be a great improvement,whilst in a highly populated slum, it may not.

Similar problems are found in relation to global definitions of poverty. The WorldBank's poverty indictor, 'living on the purchasing power of less than US$1 perday' is conceptually flawed. It fails to reflect that costs differ with location andcannot solely be expressed in monetary terms (Satterthwaite 2003). What povertyis, and who the poor are, is a local reality. Using the criteria may have validbenefits to advocacy campaigns but it will need to be used with caution at thedifferent decision making tiers within government.

Local measures of poverty

In Flores, Indonesia,communities that built newwater supplies and latrines withdonor funds were pooraccording to the nationalpoverty standard. However,with locally set criteria, therange of poverty varied fromvillages with 90% poor, 10%middle income and 0% rich to0% poor, 64% middle incomeand 36% rich. Nevertheless,all got the same financialsupport to ensure access.

The challenge is to aggregatemultiple sets of village andcommunity level data so that adistrict can sensibly allocateresources.

Other key global levelinstruments include:Poverty Reduction Strategy Paper(PRSP)A country specific medium-term‘roadmap’ for achieving longer termMDG targets through policy reforms,budget restructuring ‘nationallyowned’ targets and internationalsupport.

Common Country Assessment (CCA)A shared instrument of the UN toanalyse the national developmentsituation and identify keydevelopment issues, including PRSPand MDG activity.

National Human DevelopmentReport (NHDR)An in-depth analysis of options forfostering human development and asource of detailed disaggregated dataon MDG targets.

Global level monitoring highly problematic

'Monitoring the population with access to improved drinking water andfacilities for improved sanitation has posed major problems. A review ofwater and sanitation coverage data from the 1980s and the first part of the1990s showed that the definition of safe, or improved, water supply andsanitation facilities sometimes differed not only from one country to another,but also for a given country over time. Indeed, some of the data fromindividual countries often showed rapid and implausible changes in level ofcoverage from one assessment to the next. This indicated that some of thedata were also unreliable, irrespective of the definition used.'

Global Water Supply and Sanitation Assessment 2000 Report.

Consumer-based informationHousehold survey results present amore accurate picture of the actualuse of sources and facilities thanprovider estimates. Copingmechanisms and the efforts ofindividual’s and communities toimprove their situation are betterexposed. Valuable qualitativeinformation about the perceptions andpreferences for service options can beobtained from the user’s perspective.

"If the campaign is focused only onthe building of latrines," says Dr.Surjya Kanta Mishra, Minister in theGovernment of West Bengal and aformer doctor and local governmentleader who helped launch the well-known Medinipur sanitation project"there will always be people who arenot reached, people who continue todefecate in the open and whocontinue to pollute the water sourcesand spread disease. High levels oflatrine coverage, therefore, are simplynot good enough." – WSSCC

A definition of sanitationcoverage needs to movetowards a focus on no opendefecation.

Global level monitoring instrumentsThe main instrument for monitoring global achievements in the water supply andsanitation sector is the UNICEF/WHO Joint Monitoring Programme (JMP). Thisprovides the official indicators for monitoring MDG targets for water andsanitation and informs policy-makers on the status of the sector through theGlobal Water and Sanitation Assessment Report. The 2000 report presents theway forward to combine efforts to show good progress towards the sector's aims.

Contributing to the global assessment is an onerous task involving national teamsrepresenting the different sector agencies for data collection and assessment of theurban and rural water and sanitation sector. The coverage figures returned by eachcountry, with endorsement by their government, are based, as far as judgedappropriate, on credible estimates.

The 2000 assessment used a different methodology from those used previously,in an attempt to address some of the difficulties and disparities witnessedpreviously. Attention shifted from reliance on provider-based estimates towards anew dimension: the view of the consumer. The data sources used include nationalcensus data, the Demographic Health Survey (DHS) and UNICEF's MultipleCluster Surveys (MICS).

LimitationsAlthough national governments endorse global figures it is often the case, asin Mozambique that key sector stakeholders are unaware of the presence ofthe data and its potential.

The data from these different monitoring instruments can be difficult tocompare, particularly as not all countries have all of them in place.

Governments and international agencies can assume that a particulartechnology-type may be better for health than another. For example a venti-lated pit latrine (VIP) being better than a traditional pit latrine. Therefore,national standards and norms are based on this. This does not recognise thatwhat counts for people as an improvement in water supply and sanitationdepends on what level of provision they have already. Therefore these incre-mental improvements are not reported in relation to coverage.

The shift towards consumer-based information is widely preferred, but untilthis method of data gathering becomes normal national practice, globalcalculations will continue to be based on non-standardised information.

Indications show that watersupply and sanitation resourceallocation is anything butconsistent

A recent indicative review ofpractices in resource allocation inthe water supply and sanitationsector concluded that:

Criteria are either not used ina systematic way or, if they are,there is poor documentation ofhow they are applied

There is no evidence of eitherinternationally standardised or'best practice' defined criteriafor resource allocation, and

Each country appears to haveits own unique set of catego-ries and definitions that areunique to that country.

Incremental improvement

It is important to acknowledge the value of incremental improvement offacilities at a household level. For example, household A can afford atraditional pit latrine with a grass wall and no vent pipe while its neighbour,household B, has a VIP latrine. Only household B meets national coveragecriteria and therefore is counted in the statistics, although household A'ssituation may have improved significantly.

UgandaIn recent years, there has been asubstantial increase in resourcesaimed at improving water andsanitation services in Uganda, as adirect response to the government'scommitment to poverty reduction.Additional measures of servicequality are reduced time and distanceto collect water, regularity andquantity of supply, and equity ofresource distribution, all of equalimportance in determining whetherpolicies, objectives and targets aremet.

The Government of Ugandarecognises that better performancemonitoring would also reveal 'valuefor money'. The ultimate aim is toprovide clear evidence that water andsanitation contributes to povertyreduction. However, improvementsin national managerial performancemust filter down the sub-sector leveland vice-versa. This does not takeaccount of the internationalcommunity's demand for globalreporting and poses an enormouschallenge not least because of thecomplexity of existing data andreporting practices.

Currently, economic policy,operational planning, objectivesetting and budgeting for povertyreduction is grounded in a 3 yearlyupdated, multi-sectoral PovertyEradication Action Plan (PEAP),which acts as a Poverty ReductionStrategy Paper (PRSP).

Now undergoing reform, the sector ismanaged through a sector wideapproach (SWAp) and feeds itsstrategic priorities into the country'smedium term expenditure framework(MTEF). All public expenditure isbased on an analysis of the linksbetween inputs, outputs andoutcomes. Consistent sectoralexpenditure levels have to beensured, within given constraints.The intention is to both sustain themacro economy while maximisingefficient public expenditure againstthe PEAP goals.

The MTEF is the interface betweenPEAP goals, operational workingplans and resource management. Thecurrent goal for water is 100% or

Although called the 'water and sanitation sector', sanitation data often does notfeature in sector policy documents. For example, data collected through annualsanitation surveys may be retained by the health ministry and may not appear inthe water and sanitation sections of the country's budgetary framework. Similarly,data on school sanitation may not be readily available outside the domain of theeducation sector. Monitoring and evaluation activities carried out by planning andquality assurance departments may not link to those undertaken by the financeministry for value for money purposes. Data collected at district level may neverbe processed into management information to inform national understanding ofinfrastructure functionality or coverage.

Connecting DisconnectedTargets

Data used for reporting against global targets often fails to connect to nationalplanning decisions about sub-sector resource allocation or the prioritisation andfocus of bilateral and multilateral cooperation. Of the numerous monitoringframeworks and opportunities that exist, most are disconnected to one anotherand so run on separate tracks and timeframes. National monitoring is more aboutreporting than a decision informing exercise.

Conforming to country based Poverty Reduction Strategy Papers (PRSP) andlocalised goals require sub-sector based thematic and multiple indicators andthese may have little resemblance to global reporting requirements. Given thissituation the onus is on global agencies and stakeholders to convincegovernments of the existence of global monitoring instruments and their practicalapplication.

Where a national government has set its own monitoring criterion that does not'fit' in to global reporting formats it must be assumed the information, includingimpact and success, is not reported.

The lack of clarity in national target setting and reporting contributes to patchyand complicated national monitoring systems. Dependable information could bethe lever for prioritising investment decisions and equitable sub-sector resourceallocation, yet it is too often not available at the right time, in the right place. Theexperience of the water supply and sanitation sector in Uganda (left) illustratessome of these issues.

Over two thirds of developing countries failing to set targets

'Goals and targets mobilise national and international partners into actionand help forge new alliances. They also provide a means for benchmarkingand assessing progress towards human development. Policy reforms,institutional change and resource allocations often result from discussionscentred on time-bound targets. Yet less than one third of developing coun-tries routinely set specific and quantifiable national targets for reducingpoverty and enhancing human development'.

maximum feasible access to safewater by 2015. There is no goal forsanitation. Although monitoringindicators exist they do so in theabsence of verifiable baselineinformation and responsibility foractual monitoring is unclear. Equally,definitions (e.g. 'access') areambiguous. The targets leading toPEAP goals are output-based and tofurther complicate matters somepolicy documents have conflictingtargets.

A medium term budgetary framework(MTBF) links in to the MTEF butonly provides analysis of sectorperformance by physical outputs.Although a range of 'resultsorientated management (ROM)outputs and sector outcome indicatorsare listed, many of them areinconsistent with the performanceindicators used in the past andelsewhere. Expected outcomes arenot supported by how these are to bemeasured. Financial performance isprovided but is not linked to itsoutputs. It is therefore difficult toderive value for money or costeffectiveness of activities over thereporting period. Given this situationand the fact that the sector does notcarry out community-basedevaluation of water and sanitation theonly valid criterion for resourceallocation is quantity of outputs.

In a sector fast steering towardsconsumer-orientated serviceprovision and commercial viability, aradical rationalisation of keyperformance indicators, data sourcesand institutional responsibilities isrequired. This the sector is looking todo through performance measurementinitiatives.

Data Fails to MakePoverty Link

A major concern at sub-national level is data validity and how biased orunrepresentative data leads to repeated failure to engage with the vulnerable andextend services to the poor. In Tanzania, 11% of households in Lindi and 74% inKilimanjaro (both regions comparable to provinces) used protected water sourcesaccording to surveys. The Ministry of Water and Livestock quote 34% and 48%.This shows that once such figures are aggregated, the national picture becomesvery distorted.

The concept of access is also open to abuse. If piped water supplies areintermittent or pressure problems lead to repeated failure to reach the outerperimeters of a village or town, if water sources are dry or pumps broken, thiscannot count as access, despite the fact that the national statistics suggestotherwise. Similarly in households with latrines, non-use by men and adolescentboys and children is widespread. If only the excreta of a third of the population,namely adult women and adolescent girls, ends up in a safe place, then effectiveaccess to sanitation cannot be claimed.

To turn this situation around requires truly demand based service provision, whichmany countries are far from attaining. Many professionals believe that the viciouscircle of poor service delivery will continue until monitoring involves first andforemost the view and reality of the consumer or user and outcome basedperformance measurement.

The sustainability vacuum

The purpose of international initiatives, such as the MDGs, is to reducepoverty by tackling its many dimensions concurrently. Monitoring in the waterand sanitation sector should not happen in a vacuum. It should also contrib-ute to developing and implementing policies for poverty reduction andtargeting resources . However if the emphasis remains on counting physicalinfrastructure over qualitative data, sustainability issues that impact uponlivelihoods, will be overlooked. The challenge is to show that provision ofwater supply and sanitation infrastructure alone is not sufficient to ensuresustained service provision.

National Objectives,Local Realities

Sector reform and decentralisation should lead to sub-sector and district leveldecision-making and coordinated inter-agency partnership and collaboration, butoften this is not the case. National plans may include sub-sector resourceallocation but these tend to be compartmentalised and national objectives do notalways reflect local targets. How national plans are equated with local realitiesand levels of reporting transparency is a problem for district level managers. Theyhave no guarantee that this will be the best way of delivering local services, or iftelling the truth about coverage will help or hinder future resource allocation tothe district. This makes sensible monitoring very difficult, as the risks associatedwith accuracy are untold.

Unpicking these issues in the midst of a district's immediate need to keep theirwater supply and sanitation projects on track is a huge expectation. Motivationand incentive is also a key issue. If a district believes that a rosy picture ofcoverage will send the message that all is well, resources may be reallocated to adistrict with greater need. Alternatively, if a poor picture is portrayed, themanager may risk being personally sidelined in favour of someone who couldbetter turn the district around. Monitoring and reporting is highly sensitive anddeeply political and the rules are often unspoken. Interestingly, a lack of capacityis often blamed here but at what point is the whole system questioned?

The case for changes in global reporting, and moreover national utilisation isstrengthened by recent research into non-traditional monitoring of water supplyand sanitation. The research shows that by starting with consumers and users,progress and impact measurement is relevant, better understood and is moreeasily linked to poverty and sustainability indicators.

Three new monitoring approaches are gaining interest:

Monitoring of Vision 21This social survey approach developed by the London School of Hygiene andTropical Medicine goes beyond construction of facilities to functioning, useand hygiene behaviour. It makes it possible to validate national statistics andfills essential information gaps about actual impact on people's lives.

Monitoring for equitable water supplyThis approach developed by WaterAid, looks at a field survey method tomeasure access to water supply with equity. It links water supply monitoringto PRSPs and provides new findings about the strengths and weaknesses ofstatistical work.

The quantification of qualitative, participatory dataThe Water and Sanitation Program (WSP), World Bank and IRC-Delft arepioneering an approach that quantifies the results of Participatory Learningand Action (PLA) findings and uses this information to aggregate and com-pare data between different locations and across time.

Each new approach has feasibility, strengths and limitations. The main differenceslie in how data is collected. Finding a systematic way to pass this data up theinstitutional line, to influence national and international decision-making, is thenext challenge.

Research into MonitoringMakes Poverty Link

Making a start at the nationallevel

A good starting point is to considerthe national objectives to whichwater and sanitation sectorprogrammes contribute. Resourceallocation will be more effective,and the outcomes most easilymeasurable, the more it supportsthe achievement of these objec-tives and targets. This means:

Focusing on service delivery,rather than on physicalinfrastructure; this requires agreater understanding andassessment of:- Peoples' access to different

levels of service- Institutional issues such as

sector reform- Operational factors such as

system performance- Capacity development

needsAssessing key aspects ofhygiene behaviour changecentral to the realisation ofhealth benefits associated withimproved water supply andsanitation, and establishingbetter practices for reportingthese.Increasing attention on servingthe poor as access to waterand sanitation are key indica-tors for poverty reduction.Relevant socio economicindicators need to be incorpo-rated into global and nationalreporting.

In preparation for these changesthere is also a need to:

Conduct an audit of available datato provide an opportunity to bringtogether data from these differentsources. Review how these can beused to best advantage in order toaddress key national monitoringneeds and reduce duplication ofeffort.

Harmonise indicators and datafrom different sources by asking,- what indicators are used in

these different data sources?- how are the indicators de-

fined?- what data is used to calculate

the indicators?This information provides thestarting point from which theprocess of discussion and negotia-tion for using the same indicatorsand definitions can take place.

WELL is a network of resource centres:WEDC at Loughborough University UKIRC at Delft, The NetherlandsAMREF, Nairobi, KenyaIWSD, Harare, ZimbabweLSHTM at University of London, UK

This Briefing Note looks at monitoring inthe water and sanitation sector.

Key referencesSatterthwaite, David (2003). TheMillennium Development Goals andpoverty reduction. in DavidSatterthwaite, ed. The MillenniumDevelopment Goals and local processes:Hitting the target or missing the point?London, IIED, pp. 7-46.

van Wijk, C. (1998). Gender in waterresources management, water supplyand sanitation: roles and realitiesrevisited. IRC Technical Paper no. 33,The Hague, The Netherlands, IRC andWorld Bank.

Full details of all the material used insupport of this briefing note are available atwww.lboro.ac.uk/well

There are seven briefing notes in this series:1. The Poverty Millennium Development

Goal: What water, sanitation andhygiene can do

2. The Education MillenniumDevelopment Goal: What water,sanitation and hygiene can do

3. The Child Health MillenniumDevelopment Goal: What water,sanitation and hygiene can do

4. The Gender Millennium DevelopmentGoal: What water, sanitation andhygiene can do

5. The HIV/AIDS MillenniumDevelopment Goal: What water,sanitation and hygiene can do

6. The Environmental SustainabilityMillennium Development Goal: Whatwater, sanitation and hygiene can do

7. Water Supply and Sanitation SectorMonitoring: A new decade to measure

DFID Resource Centre in Water, Sanitation& Environmental Healthwww.lboro.ac.uk/well

Briefing Note compiled bySue Coates of WEDC

Photographs by: P. Harvey,S. Parry-Jones, D. Saywell, M. Sohail

For further information, contact:Sue Coates or Andrew CottonWater, Engineering and Development Centre(WEDC)Loughborough UniversityLeicestershire LE11 3TU UK

Email: S.Coates@lboro.ac.ukA.P.Cotton@lboro.ac.uk

Phone: 0 (44) 1509 222885Fax: 0 (44) 1509 211079Website: http://www.lboro.ac.uk/well/

TREND, Kumasi, GhanaSEUF, Kerala, IndiaICDDR, B, Dhaka, BangladeshNETWAS, Nairobi, Kenya

This note was funded by the UK Departmentfor International Development (DFID).The views expressed, however, are notnecessarily those of DFID.

Published by WEDC on behalf of WELL

ReconcilingUnresolved Issues

The use of monitoring instruments should enable information to be providedhorizontally and vertically throughout the sector, sub-sectors and relevant othersectors. Yet this universal management tool, although a requirement ofprogrammes and projects, fails to accelerate decisions about sector investmentand resource allocation where it matters. Things may add up but they certainly donot stack up to improved access to water supply and sanitation service provision.At one level there is a desperate need for simplicity, at another, acknowledgementthat everyone has an equally - and surely connected - important agenda. This willalways complicate matters. As the next international decade approaches, at thevery least, three issues must be reconciled.

1. Processes for poverty alleviation are multi-dimensional. In the water andsanitation sector this means more than the construction of taps and toilets. Forexample, sustainable access to water supply (an MDG indicator) may requirea focus on issues such as effective water conservation, leak detection,improved maintenance, rationalised irrigation and crop selection, rather thanonly on the construction of water facilities. Sanitation may require aconcentration on demand creation and hygiene behaviours of different groups(men and boys, and women and girls) alongside latrine construction. Povertyand gender indicators cut across the sector, but the sector also cuts acrossother sectors, primarily health and education, and vice versa. The evidencemust be articulated and used to greater effect.

2. The connection needs to be made between global monitoring instruments andhow national governments allocate resources in the water supply andsanitation sector and sub-sectors. Currently data collected in this way does notseem to fulfil national government or international agency agendas. Decisionsare needed to agree what is their purpose, potential and inter-connection.

3. National resource allocation methods to the sector and sub-sectors requirerationalisation and direction. The use of consumer based qualitative indicatorsand definitions that reflect local realities, will help to allocate resourcessensibly. However, when this data is aggregated up the monitoring hierarchyand vice versa, its essence is lost. This situation risks undermining the sector’scontribution to the MDGs. The fact also remains that whether the informationis coming from above or below, a district needs a straightforward means ofdistilling the key facts, so that resource allocation can truly be targeted at thepoor.

ISBN 1-84380-073-X