Monitoring Service Delivery in the Financial Crisis

1. Monitoring Service Delivery in the Financial Crisis Markus Goldstein (Interpreted by Jishnu Das) The findings, interpretations and conclusions expressed in this presentation are entirely those of Markus Goldstein. They do not necessarily represent the views of Jishnu Das and/or his family.

2. Predictions • Lots of predictions that financial crisis will hit HD outcomes • This is almost certainly correct for health (Baird, Friedman and Schady, 2007)

3. Predictions • And probably true for education in low-income countries Source: Ferriera and Schady (2008)

4. Sources of the hit: Households • Lots of micro-evidence that shocks to households (especially when they are correlated) lead to declines

5. Sources of the hit: Public Spending • Some evidence that public spending declines with macro-shocks (Peru) • Source: Paxson and Schady (2005)

6. Sources of the hit: Public Spending • But this can be compensated for by donor spending (Indonesia)

7. Two Unknown Unknowns • Will drops in public spending affect outcomes? If so, how? • Do we have monitoring tools to capture household responses with sufficient speed to engender policy responses?

8. Remainder of presentation • How new M&E tools are changing the way we think of the relationship between public spending & outcomes • How these can be used for policy responses to the crisis • A Proposal for monitoring in the crisis

9. Spending ≠ outcomes: In X-sections

10. & time-series Source: WDR 2004

11. Why?Evidence from new studies

12. New Evidence: Results from PETSWhat you get is not what was sanctioned

13. Across Countries Percent of school grants that actually reach schools

14. Indonesia 2000: Sources of school funding by grant receipt and public/private status Substitution between grants and local government funding Primary schools Junior Secondary schools In public schools, local government spending adjusted in response to grant No adjustment in private schools

15. New Evidence from QSDS: Public expenditures crowd-out private expenditures

16. Substitution between grants and household spending Zambia 2001: Effect of a 100 Kwacha increase in expected and unexpected school grants on household expenditures on education Household spending falls by about 45 for each additional 100 Kwacha spent on anticipated grants Evidence experimentally replicated in India, with identical substitution coefficients Source: Jishnu Das, Stefan Dercon, James Habyarimana, Pramilla Krishnan (2004)

17. New Evidence: Absenteeism Surveys

18. Absence rates among teachers and health workers Note: Surveys were all fielded in 2002 or 2003. Sources: Chaudhury et al (2006) except for PNG, World Bank (2004) and Zambia, Das et al (2005).

19. PNG 2002: Depletion of the effective supply of teachers Results from QSDS:Effective supply of teachers Source: PESD 2002.

20. As a consequence: Evidence from Quality Studies

21. Spending ≠ outcomes • In health unqualified private sector doctors in Delhi provide better care than qualified public sector doctors • In education the cost per percentage correct in tests is 3 times higher in public compared to private schools in Pakistan

22. So… • There is plenty of room for improvements • BUT • There are good reasons to believe that we don’t know enough • Can’t find any studies of the effects of spending cuts that are causal (usually strongly correlated with economy wide problems)

23. Proposal based on lessons learnt • Sentinel Surveillance Sites for Service Delivery (S4D)

24. IDEA • High Frequency Surveys in limited sites (villages/neighborhoods) • Collect information using a variety of different tools • Household Surveys • Facility surveys (education health) • Outcomes (for instance, learning)

25. Precursors • ICRISAT • More recently • Financial Diaries in Bangladesh, India and South Africa (Bi-weekly for one year) • Morbidity and Health Seeking behavior in Delhi, India (Weekly and Monthly for 2 years) • LEAPS in Pakistan (Annually for 4 years) • All these surveys are yielding valuable (and new) information on household and provider behavior—particularly in relation to shocks

26. The S4D Outline • Work with limited sampling sites in a number of countries at higher frequency than usual • Collect periodic information from • Households (Main outcomes, labor, wages) • Facilities (Absenteeism, PETS, Quality) • Higher administrative units to track budgets (Funds availability and flows) • Fixed Reporting Formats + Public Data

27. Summary • Financial Crisis will potentially lead to worse HD outcomes • But • This is also an opportunity • To address inefficiencies in the delivery of services • To set up a M framework that can provide real-time information for real-time policy • Deepen our understanding of HD processes

28. Additional slides for discussion

29. And the same for health…

30. …and vastly different changes in spending can be associated with similar changes in outcomes.

31. Figure 1: Official vs. Effective Expenditures by Regional Health Delegations • CHAD: On average, RHDs received only 26,7% of their official non-wage budgetary expenditures from the MoH

32. Percent of time present, and percent of time teaching Beyond absenteeism: Effective supply of teaching Sources: Lane and Millot (2002); Abhadzi, Millot and Prouty (2006).

33. Health: What they know, what they do Percentage of Essential Tasks Completed 40% of essential questions asked Private MBBS Public MBBS Private, No MBBS Source: Das and Hammer (2008)

34. Education: Its not the money Source: Pakistan, The LEAPS Report