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world development report 2004

world development report 2004. Making Services Work for Poor People. Messages. Services are failing poor people. But they can work. How? By empowering poor people to Monitor and discipline service providers Raise their voice in policymaking

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world development report 2004

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  1. world development report 2004 Making Services Work for Poor People

  2. Messages • Services are failing poor people. • But they can work. How? • By empowering poor people to • Monitor and discipline service providers • Raise their voice in policymaking • By strengthening incentives for service providers to serve the poor

  3. Outcomes are worse for poor peopleDeaths per 1000 births Source: Analysis of Demographic and Health Survey data

  4. Growth is not enough Sources: World Bank 2003a, Devarajan 2002. Notes: Average annual growth rates of GDP per capita assumed are: EAP 5.4; ECA 3.6; LAC 1.8; MENA 1.4; SA 3.8; AFR 1.2. Elasticity assumed between growth and poverty is –1.5; primary completion is 0.62; under-5 mortality is –0.48.

  5. Making Services Work for Poor People But increasing public spending is also not enough * Percent deviation from rate predicted by GDP per capita Source: Spending and GDP from World Development Indicators database. Under-5 mortality from Unicef 2002

  6. Vastly different changes in spending can be associated with similar changes in outcomes. Sources: Spending data for 1990s from World Development Indicators database. Child mortality data from Unicef 2002. Other data from World Bank staff

  7. How are services failing poor people? • Public spending usually benefits the rich, not the poor

  8. Expenditure incidence Health Education Source: Filmer 2003b

  9. How are services failing poor people? • Public spending benefits the rich more than the poor • Money/goods/people are not at the frontline of service provision • Public expenditure tracking results on what reaches or is at the facility level

  10. Nonwage funds not reaching schools: Evidence from PETS (%)

  11. Access to primary school and health clinics in rural areas Source: Analysis of Demographic and Health Survey data. Note: GNI per capita is in 2001 US$. Medical facility encompasses health centers, dispensaries, hospitals, and pharmacies.

  12. How are services failing poor people? • Public spending benefits the rich more than the poor • Money/goods fail to reach frontline service providers • Service quality is low for poor people

  13. Percent of staff absent in primary schools and health facilities

  14. But services can work • Motivating health workers reduced infant mortality in Ceará, Brazil • Contracted services in Johannesburg, South Africa improved transport and water delivery • Cash transfers to families in Mexico increased enrollment, lowered illness • Citizen report cards improved services in Bangalore, India • Publicizing what schools were supposed to get resulted in more money reaching primary schools in Uganda • Delegating project choice and management to villagers improved infrastructure in Indonesia

  15. A framework of relationships of accountability Poor people Providers

  16. Short and long routes of accountability

  17. The relationship of accountabilityhas five features

  18. A framework of relationships of accountability Policymakers Poor people Providers

  19. Client-provider Strengthen accountability by: • Choice • Participation: clients as monitors

  20. Making Services Work for Poor People FSSAP Bangladesh • Criteria: • Attendance in school • Passing grade • Unmarried • Girls to receive scholarship deposited to account set up in her name • School to receive support based on # of girls

  21. Client-provider:EDUCO Program in El Salvador • Parents’ associations (ACEs) • Hire and fire teachers • Visit schools on regular basis • Contract with Ministry of Education to deliver primary education

  22. EDUCO promoted parental involvement… …which boosts student performance Source: Adapted from Jimenez and Sawada 1999

  23. The Bamako Initiative • Community managed services • Partnership between state and community organizations • Financial contributions from users locally retained, owned and managed • Government contract and subsidy

  24. Making Services Work for Poor People Client-Provider:Bamako Initiative Evolution of antenatal care coverage Mali 1987-2000 Evolution of national immunization coverage

  25. Making Services Work for Poor People Client-Provider:Bamako Initiative Under five mortality decrease ….among the poor in Mali

  26. No blanket policy on user fees

  27. A framework of relationships of accountability Policymakers Poor people Providers

  28. Citizen-policymaker • Political economy of public services

  29. Why don’t services work for poor people? Ah, there he is again! How time flies! It’s time for the general election already! By R. K. Laxman

  30. PRONASOL expenditures according to party in municipal government Source: Estevez, Magaloni and Diaz-Cayeros 2002

  31. Citizen-policymaker • Political economy of public services • Formal channels • Importance of non-formal channels • Role of information • Citizen report card (initiatives in Vietnam, Indonesia, Philippines) • Publicizing textbook distribution in Philippines—and engaging communities as monitors

  32. Schools in Uganda received more of what they were due Source: Reinikka and Svensson (2001), Reinikka and Svensson (2003a)

  33. A framework of relationships of accountability Policymakers Poor people Providers

  34. Policymaker-provider • “Hard to monitor” versus “Easy to monitor” • Information for monitoring

  35. Policymaker-provider:Contracting NGOs in Cambodia • Contracting out (CO): NGO can hire and fire, transfer staff, set wages, procure drugs, etc. • Contracting in (CI): NGO manages district, cannot hire and fire (but can transfer staff), $0.25 per capita budget supplement • Control/Comparison (CC): Services run by government 12 districts randomly assigned to CC, CI or CO

  36. Utilization of facilities by poor People sick in last month Source: Bhushan, Keller and Schwartz 2002

  37. Making Services Work for Poor People Ceara : increased effectiveness of government services Source: www.developmentgoals.org

  38. A framework of relationships of accountability Policymakers Poor people Providers

  39. What not to do • Leave it to the private sector • Simply increase public spending • Apply technocratic solutions

  40. What not to do… technocratic solutions… Of course we have progressed a great deal, first they were coming by bullock-cart, then by jeep and now this!

  41. What is to be done? • Expand information • Generation and dissemination • Impact evaluation • Tailor service delivery arrangements to service characteristics and country circumstances

  42. Eight sizes fit all?

  43. Eight sizes fit all?

  44. Eight sizes fit all?

  45. Eight sizes fit all?

  46. Eight sizes fit all?

  47. Eight sizes fit all?

  48. What are we up against when attempting to improve aid efficiency?

  49. WDR messages to donors • Harmonize policies and procedures around recipient’s systems • Where possible, integrate aid in recipient’s budget • Finance impact evaluation of service delivery innovations • $300 million a year in Bank projects allocated for evaluation

  50. world development report 2004 Making Services Work for Poor People http://econ.worldbank.org/wdr/wdr2004

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