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What the World Bank Does at the Country Level

International and Domestic Approaches to Accountability in Public Spending Independent Monitoring Organization Grants Program Public Expenditure Reviews Public Expenditure Tracking and Absenteeism Surveys March 23, 2010. What the World Bank Does at the Country Level.

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What the World Bank Does at the Country Level

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  1. International and Domestic Approaches to Accountability in Public SpendingIndependent Monitoring Organization Grants ProgramPublic Expenditure ReviewsPublic Expenditure Tracking and Absenteeism SurveysMarch 23, 2010

  2. What the World Bank Does at the Country Level • Country Director and Country Manager • Country Economist(s) watches overall economy and public spending, poverty) • SectoralStaff (public administration, social sectors, infrastructure, agriculture, environments, financial sector) • Manage sectoral dialogue and do some analytical work • Projects/lending • Contribute to Public Expenditure Reviews, Poverty Reports, Country Partnership Strategy, other general documents/activities • Advantages • After 2-3 years staff get to know overall country policy issues and sectoral issues extremely well. • Develop relationships with high level civil servants • Often can influence other donors • Disadvantages • Move on after 3-4-5 years • Sectoral staff overwhelmed by project implementation details • Little dialogue beyond national level • Limited means to change policy – Development Policy Lending, Projects, Persuasion • Increasingly staff are decentralized but sectoral staff may be in country only 6 weeks out of the year

  3. Latvia PER 2010 • Latvia’s Situation • GDP fell by 18% in 2009 • Unemployment rose to 20% • Trying to keep currency peg to Euro – internal deflation • Borrowing Euro 7.5 billion from IMF/EC/WB (Total GDP is Euro 17 billion) • Needs to revenue/expenditure measures of Euro 720 million in 2011 and 2012 (LVL 500 million, USD 1 billion) • PER • What can be done in 2011 and 2012? • Lets look at health

  4. Public health expenditure per capitain 2007,US$ PPP

  5. Health care budget in Latvia 2005 - 2010 (million lats)

  6. Reform of Administration(1st task) Ministry of Health MPEC SCHIA HSMTSA PHA Health Payment Centre (settlement of accounts) Health Inspectorate (surveillance and control) Health Economics Centre (Health economics) Number of employees (on 01.01.2009.) 1 319 Number of employees (on 01.01.2010.) 566 Decrease by 57% MPRSA 6 6

  7. Changes of administrative staff capacity(1st task)

  8. Reform of Health Care Institutions Reduction of number of beds • The number of beds planned to close • year 2009 • to close 1000 beds • to re-profile 345 beds • year 2010 • to close 1335 beds • year 2011 • to close and re-profile 3231 beds 17 001beds In the beginning of 2009 • 131 hospitals in 2003 • 88 hospitals in 2008 59 by 01.04.2009. • 287 beds (the13 local hospitals by 01.04.2009) • -273 beds (profile from the 01.07.2009) 41 22 EMC hospitals, incl. 3 university clinics 7 regional hospitals 7 nursing hospitals 13 specialized hospitals - 1320 beds after 01.09.2009. MoH planed 10550 beds in 2017 - 2192 beds by 01.01.2010. Reduction of number of hospitals Numberofbedsafter 01.01.2010. 12 929 8 8

  9. Health care budget expenditures according to thebudget of2009 and 2010 (mill. lats) -70.95 - 14.1% Treatment 2009 2010 432.59 milj. (85.9%) 394.73 milj. (91.2%)

  10. Latvia PER 2010 • Very high level of abstraction • Key overall parameters within which the system will operate – import resource allocation and equity decisions at the top level • What issues are raised locally that we don’t see?

  11. BIGS Indonesia BIGS Indonesia PATTIRO CIPPEC IDPMS India CDD Ghana CIEN Guatemala CADEP Paraguay CBPS India

  12. Bandung Institute for Governance Studies (BIGS) - Indonesia • To discover how well local governments are doing in health and education service delivery, BIGS examined budgets for 3 cities in West Java • By simply examining 2004 - 2007 budget data, BIGS found that local officials (like national officials) are not reaching the spending targets for health and education • Very low spending on anything other than salaries and investments • But some districts innovate and have greater amounts of cash available for services • Any impact?

  13. Centre for Regional and Information Studies (PATTIRO) - Indonesia • Evaluated specific education funding schemes • Central, Provincial, and District • Schools Receive Money from 7 Different Funds (2 Operating Funds and 4 Investment Funds from Various Levels, plus 1 Textbook Fund) • Following money from Source to Ground in 38 schools uncovered problems • Delays in Operating Funds up to 3 Months • Unplanned Cuts in Allocated Funds (For District Operating Funds, Unplanned Cuts in Every School)

  14. Indo-Dutch Project Management Society (IDPMS) - India • Focused on service delivery in primary health centers in 2 districts of Karnataka (CR Nagar, Bellary) • Results • Often no doctor is available for official and unofficial reasons (37% of days PHCs are open) • Replenishment of 6 common drugs can be delayed 6 to 8 months • Pharmaceutical budget of 100,000 rupees/PHC insufficient

  15. Finding Centre for Democratic Development (CDD) - Ghana • Found 47% of teachers were absent at least once during 5 school visits Absenteeism peaks on Fridays (40% of teachers) Weekend long-distance education lectures should be moved (time or location) Salaries should be paid to teachers, near schools, or on Saturdays Education officials should actively encourage formation of PTAs in schools Recommendation Evidence that teachers miss class to collect salaries Absenteeism and active PTA negatively correlated

  16. Finding Recommendation National Center for Economic Research (CIEN) - Guatemala • Investigated 6 spending programs in 30 primary schools in Guatemala City (scholarships, meals, milk, textbooks, supplies, teaching kits) Schools should start after the fiscal year to give time for money to flow, improving chance that resources get to schools on time Ministry of Education announced that school start would move from January to February in 2009 28% of primary school students had books and only 7% had school supplies in the first school month of 2008 Impact

  17. Centre for Budget and Policy Studies (CBPS) - India • Evaluating health and education budgets in 2 districts, CBPS found that spending decisions are do not reflect local needs • Analysis, findings, and video are being used by advocacy NGOs that could not do this work themselves, one of the goals of CBPS. • Video showed some government officials explaining away the problems and other successfully acting to solve them.

  18. What’s Missing? • How to get these two levels of working with budgets today to be more complementary and consistent? • In longer run, how to substitute for World Bank/IMF with local capacity? • Developing your organizations is key but so is developing relationships with government and international organizations

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