"Political Context, Organizational Mission and the Quality of Social Services: Insights from Lebanon”
Melani Cammett, Executive Committee; Steering Committee; Faculty Associate; Harvard Academy Senior Scholar. Professor of Government, Department of Government, Harvard University.
Peggy Levitt, Associate. Chair; Professor of Sociology, Department of Sociology, Wellesley College.
Jocelyn Viterna, Faculty Associate. Associate Professor of Sociology, Department of Sociology, Harvard University.
In many developing countries, non-state actors are important providers of social welfare. In parts of the Middle East, South Asia, sub-Saharan Africa and other regions, religious charities and parties and NGOs have taken on this role, with some preceding independent statehood and others building parallel or alternative welfare infrastructure alongside the modern state. How well do these groups provide welfare goods? Do some exhibit a “welfare advantage,” or a demonstrated superiority in the quality and efficiency of providing social services? In this paper, we explore whether distinct organizational types are associated with different levels of the quality of care. Based on a study in Greater Beirut, Lebanon, where diverse types of providers operate health centers, we propose and test some hypotheses about why certain organizations might deliver better services. The data indicate that secular NGOs, rather than religious, political or public sector providers, exhibit superior measures of health care quality, a seemingly counterintuitive finding in Lebanon where religious and sectarian actors dominate politics and the welfare regime and command the most extensive resources. Our preliminary explanation for this finding emphasizes the ways in which the socio-political context shapes the choices of qualified providers to select into secular organizations in part because of their missions and why citizens might perceive these providers to be better, irrespective of the actual quality of services delivered.