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World Development Report 2004 Making Services Work for Poor People Qualidade do Gasto Publico no Brasil June 26-27, 2003 Ritva Reinikka Development Research Group, The World Bank Messages Services are failing poor people. But they can work. How? By empowering poor people to

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World development report 2004 making services work for poor people l.jpg

World Development Report 2004Making Services Work for Poor People

Qualidade do Gasto Publico no Brasil

June 26-27, 2003

Ritva Reinikka

Development Research Group, The World Bank


Messages l.jpg
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


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Universal Primary Education

MDGs—Global Aggregates

Eradicate Poverty & Hunger


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MDGs—Global Aggregates

Promote Gender Equality

Reduce Child Mortality

Ratio of girls to boys in primary and secondary school (%)


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Poorest

quintile

Richest

quintile

Outcomes are worse for poor peopleCumulative deaths per 1000 births

Source: Analysis of Demographic and Health Survey data


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Richest

quintile

Poorest

quintile

Outcomes are worse for poor peoplePercent aged 15 to 19 completing each grade or higher

Source: Analysis of Demographic and Health Survey data





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Similar changes in public spending can be associated with vastly different changes in outcomes



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How are services failing poor people? with similar changes in outcomes.

  • Public spending usually benefits the rich, not the poor


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Percent to with similar changes in outcomes.

richest quintile

Percent to

poorest quintile

Expenditure incidence

Health

Education

Source: Compiled from various sources


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How are services failing poor people? with similar changes in outcomes.

  • Public spending usually benefits the rich, not the poor

  • Money fails to reach frontline service providers

    • In Uganda, only 13% of non-wage recurrent spending on primary education reached primary schools


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How are services failing poor people? with similar changes in outcomes.

  • Public spending benefits the rich more than the poor

  • Money fails to reach frontline service providers

  • Service quality is low for poor people


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Examples of low service quality with similar changes in outcomes.

  • Bangladesh: Absenteeism rates for doctors in primary health care centers: 74%.

  • Indonesia: Absenteeism in primary schools: 18%; in primary health clinics: 42%.

  • Zimbabwe: 13% of respondents gave as a reason for not delivering babies in public facilities that “nurses hit mothers during delivery”.

  • Guinea: 70% of government drugs disappeared.


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But services can work with similar changes in outcomes.

  • Infant mortality and malnutrition reduced in Ceará, Brazil

  • Citywide services in Johannesburg, South Africa reformed

  • Cash transfers to households in Mexico increased enrollment, lowered illness cases

  • Citizen report cards in Bangalore, India

  • More money reached primary schools in Uganda


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A framework of with similar changes in outcomes.relationships of accountability


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A framework of with similar changes in outcomes.relationships of accountability


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A framework of with similar changes in outcomes.relationships of accountability


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Mexico’s PRONASOL, 1989-94 with similar changes in outcomes.

  • Large social assistance program (1.2% of GDP)

  • Water, sanitation, electricity and education construction to poor communities

  • Limited poverty impact

    • Reduced poverty by 3%

    • If better targeted, could have reduced it by 64%


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A framework with similar changes in outcomes.


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Policymaker-Provider: with similar changes in outcomes.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




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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



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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


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EDUCO promoted parental involvement… …which boosted student performance (% increase in test scores per visit)


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EDUCO Effect: School days missed due to teacher absence student performance (% increase in test scores per visit)

Avg # of days

missed: 1.34


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What student performance (% increase in test scores per visit)not to do

  • Leave it to the private sector

  • Simply increase public spending

  • Apply technocratic solutions


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What is to be done? student performance (% increase in test scores per visit)

  • Expand information

  • Tailor service delivery arrangements to service characteristics and country circumstances


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Eight sizes fit all? student performance (% increase in test scores per visit)


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Eight sizes fit all? student performance (% increase in test scores per visit)


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Eight sizes fit all? student performance (% increase in test scores per visit)


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Eight sizes fit all? student performance (% increase in test scores per visit)


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Eight sizes fit all? student performance (% increase in test scores per visit)


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Eight sizes fit all? student performance (% increase in test scores per visit)


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