World Development Report 2004 Making Services Work for Poor People

1. 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

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. Universal Primary Education MDGs—Global Aggregates Eradicate Poverty & Hunger

4. MDGs—Global Aggregates Promote Gender Equality Reduce Child Mortality Ratio of girls to boys in primary and secondary school (%)

5. Poorest quintile Richest quintile Outcomes are worse for poor peopleCumulative deaths per 1000 births Source: Analysis of Demographic and Health Survey data

6. 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

7. Growth is not enough

8. Increasing public spending is not enough

9. Increasing public spending is not enough

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

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

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

13. Percent to richest quintile Percent to poorest quintile Expenditure incidence Health Education Source: Compiled from various sources

14. How are services failing poor people? • 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

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

16. Examples of low service quality • 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.

17. But services can work • 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

18. A framework of relationships of accountability

19. A framework of relationships of accountability

20. A framework of relationships of accountability

21. Mexico’s PRONASOL, 1989-94 • 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%

23. A framework

24. 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

25. Utilization of Facilities by Poor People Sick in last month, %

26. A framework

27. 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

28. Decentralization

29. 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

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

31. EDUCO Effect: School days missed due to teacher absence Avg # of days missed: 1.34

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

33. What is to be done? • Expand information • Tailor service delivery arrangements to service characteristics and country circumstances

34. Eight sizes fit all?

35. Eight sizes fit all?

36. Eight sizes fit all?

37. Eight sizes fit all?

38. Eight sizes fit all?

39. Eight sizes fit all?