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Making Services Work for Poor People

Making Services Work for Poor People

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Making Services Work for Poor People

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  1. Making Services Work for Poor People Shanta Devarajan World Bank

  2. Universal Primary Education Services are failing poor people:MDGs—Global Aggregates Eradicate Poverty & Hunger

  3. Services are failing poor people:MDGs—Global Aggregates Promote Gender Equality Reduce Child Mortality Ratio of girls to boys in primary and secondary school (%)

  4. Poverty Headcount Primary Education Enrollment % Infant Mortality per 1000 Target 2015 Growth alone Target 2015 Growth alone Target 2015 Growth alone EAST ASIA 14 3 100 100 14 33 ECA 1 1 100 100 9 22 LAC 8 7 100 100 14 30 MENA 21 1 100 92 20 46 SA 22 18 100 87 29 70 AFRICA 24 40 100 64 33 87 Growth is not enough Source: Global Economic Prospects 2001, p.42 base case; Devarajan (2002)

  5. Why are services failing? • Governments spend on the wrong goods and people

  6. Benefit Incidence of Public Spending

  7. Why are services failing? • Governments spend on the wrong goods and people • Resources fail to reach the service provider (Uganda tracking study) • Weak incentives for effective service delivery

  8. Examples of ineffective service delivery • India: Teachers arriving drunk regularly, high levels of absenteeism. • Zimbabwe: 13% of respondents gave as a reason for not delivering babies in public facilities that “nurses hit mothers during delivery”. • Guinea: In 1984, 70% of government drugs disappeared. • Costa Rica: absenteeism rate is 30% in public health facilities.

  9. Why are services failing? • Governments spend on the wrong goods and people • Resources fail to reach the service provider (Uganda tracking study) • Weak incentives for effective service delivery • Demand-side constraints

  10. Making services work for poor people Donors

  11. Relationships

  12. 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

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

  14. Relationships

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

  16. %Effect of 1 more class visit by ACE on math and language score

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

  18. Relationships

  19. 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

  20. Relationships Donors