‘Structural changes needed to improve quality of health, education in Jordan’

AMMAN – Switching to a performance-based pay system has the potential to improve the quality of services in Jordan in two main sectors: education and health, according to a recent World Bank report. 

Titled "The Last Mile to Quality Service Delivery in Jordan", the report also showed that altering the current incentives and pay systems to ones based on performance rather than years of service in addition to increasing monitoring to strengthen accountability can drastically develop the quality of services. 

The report is considered the first "nationally representative study in Jordan that measures within-facility accountability and providers' efforts in primary healthcare facilities, and the first study in the MENA region to investigate these linkages", according to the World Bank. 

"This study provides strong empirical evidence about the link between accountability and the quality of health and education service delivery in Jordan. It emphasises the importance of performance-based system to address service delivery challenges in quality — a central reform agenda for Jordan moving forward," said Tamer Rabie, World Bank lead health specialist and task team leader.

He made his remarks during an event held on Monday to highlight the findings of the report, which showed that efforts of service providers at Jordan's schools and primary healthcare centres are still "seemingly low".

The report also noted that Jordan has achieved enrolment rates close to the world average at the primary school level, and approximately 88 per cent at the secondary level. 

“However, Jordanian children are not performing as well as their peers globally in math, language and science,” the report showed. 

In the education sector, when a student cannot answer a question, only 24 per cent of public school teachers in grades 2 and 3 encourage the student to try again, explain the question, or correct the student without scolding, the report said.

In the health sector, the Kingdom has also achieved remarkable progress over the past two decades, recording huge strides in maternal and child health and significant improvement in the management and treatment of communicable diseases. 

“However, the country is grappling with non-communicable diseases, which are responsible for three out of four deaths annually,” Rabie said.  

The study showed that only one in five doctors take “vital signs”, and patients’ visits last only 10 minutes on average. 

From a financial perspective, Jordan’s public spending on health and education is higher than many countries, according to the report.  

“In fact, Jordan spends nearly as much as countries like Germany, Austria, and Poland on education relative to total government expenditure, and almost double that of the MENA regional average on health relative to GDP,” the World Bank highlighted. 

Yet, the contrast between Jordan’s spending on health and education, and its lower than expected health and education outcomes is not a matter of means, but rather the quality of service delivery, including how doctors and teachers provide services, the study said, relying on a nationally representative sample of 122 primary healthcare facilities and 156 schools. 

The report argued that increasing the monitoring of heads of healthcare centres as well as school principals may yield tangible improvements in the level of effort exerted in the workplace. 

In conjunction, the report suggested it is pertinent to introduce strong incentive mechanisms to reap the highest possible gains from monitoring. 

These measures are at the centre of a performance-based accountability system that uses clearly determined indicators to reward service providers, the study reported. 

During Monday’s event, Minister of Planning and International Cooperation Imad Fakhoury, Minister of Health Mahmoud Sheyyab and Education Ministry Secretary General Mohammad Okour underlined the significance of the study and their commitment to addressing challenges that stand in the way of providing quality services. 

Fakhoury noted that the report, conducted upon a request from the government, underscored the need to draw up an accountability system for service providers in order to reform the education and health sectors. 

“We, along with the education and health ministries, will include the recommendations of the report in our action plans and the 2016-2019 executive development programme,” he said, noting that the public sector employs around 230,000 people, of whom 130,000 serve in the health and education sectors.