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world development report 2004

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Title: world development report 2004


1
world development report 2004
Making Services Work for Poor People
Flagship Course on Governance
Anticorruption Washington DC, December 2, 2003
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
Why focus on human development outcomes?
Millennium Development Goals global aggregates
Eradicate poverty and hunger
Universal primary education
Source www.developmentgoals.org
4
Millennium Development Goals global aggregates
Promote gender equality
Reduce child mortality
Source www.developmentgoals.org
5
Outcomes are worse for poor peopleInfant and
child deaths per 1000 live births
Source Analysis of Demographic and Health Survey
data
6
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
Percent living on 1/day Percent living on 1/day Primary completion rate (percent) Primary completion rate (percent) Under-5 mortality rate Under-5 mortality rate
Target 2015 growth alone Target 2015 growth alone Target 2015 growth alone
East Asia 14 4 100 100 19 26
Europe and Central Asia 1 1 100 100 15 26
Latin America 8 8 100 95 17 30
Middle East and North Africa 1 1 100 96 25 41
South Asia 22 15 100 99 43 69
Africa 24 35 100 56 59 151
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.
8
Increasing public spending is 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
9
Increasing public spending is not enough
Percent deviation from rate predicted by GDP
per capita Source Spending and GDP from World
Development Indicators database. School
completion from Bruns, Mingat and Rakatomalala
2003
10
Similar changes in public spending can be
associated with vastly different changes in
outcomes
Sources Spending data from World Development
Indicators database. School completion from
Bruns, Mingat and Rakatomalala 2003
11
and 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
12
How are services failing poor people?
  • Public spending usually benefits the rich, not
    the poor

13
Expenditure incidence
Health
Education
Source Filmer 2003b
14
How are services failing poor people?
  • Public spending benefits the rich more than the
    poor
  • Money fails to reach frontline service providers
  • In Uganda, only 13 percent 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
  • India Absenteeism rates for teachers in
    government primary schools 50 percent
  • Bangladesh Absenteeism rates for doctors in
    primary health care centers 74 percent
  • Zimbabwe nurses hit mothers during delivery
  • Guinea 70 percent government drugs disappeared
  • India Delhi Chennai get 4 to 6 hours of water
    per day, Hyderabad gets 1.5 hours every other day

17
But services can work
  • Infant mortality and malnutrition reduced in
    Ceará, Brazil
  • Citywide services in Johannesburg, South Africa
    reformed
  • Municipal services improved in Bangalore, India
  • Rural electricity cooperatives increased access
    to power in Bangladesh
  • More money reached primary schools in Uganda

18
What contributes to an effective classroom or
health clinic?
  • For a service transaction to be successful, we
    need a frontline provider who
  • is capable
  • has access to adequate resources inputs
  • is motivated to pursue goals that can be
    monitored

19
So, spend more money to hire and train more
teachers?
  • But governments spend a lot on teachers salaries
  • 16 out of 18 sub-Saharan African countries spent
    more than the recommended 66 of recurrent
    education spending on teacher salaries, some more
    than 90
  • Its obvious this crowds out other inputs, yet
    governments keep spending on salary budgets
  • So problem is not these proximate determinants,
    but with institutional context that generates and
    sustains these decisions

20
One way of looking at the problem of a motivated
provider
  • Reducing teacher absenteeism from, say, 12 to 7
    is a matter of money and technical solutions such
    as training its a managerial problem
  • Reducing absenteeism 70 to 7 is not a matter of
    money and technical solutions, its an
    institutional problem

21
What, then, is the right question to ask?
  • What institutional conditions support the
    emergence of good frontline providers and
    services that work for poor people?
  • The answer Services work for poor people when
    they involve institutional relationships in which
    key players in service delivery are accountable
    to each other

22
Accountability seems key to service delivery
  • If accountability is strong or can be
    strengthened, services may be improved by
    spending more on
  • building more schools and clinics
  • training more teachers and health workers
  • designing better curricula drug procurement
    schemes
  • building bigger infrastructure networks
  • But if accountability remains weak, addressing
    the proximate determinants of success will not
    work

23
A framework of relationships of accountability
Poor people
Providers
24
A framework of relationships of accountability
Policymakers
Poor people
Providers
25
The relationship of accountabilityhas five
features
26
A framework of relationships of accountability
Policymakers
Voice
Poor people
Providers
27
Mexicos PRONASOL, 1989-94
  • Large social assistance program (1.2 percent of
    GDP)
  • Water, sanitation, electricity and education
    construction to poor communities
  • Limited poverty impact
  • Reduced poverty by 3 percent
  • Even an untargeted, uniform per capita transfer
    would have reduced poverty by 13 percent

28
PRONASOL expenditures according to party in
municipal government
Source Estevez, Magaloni and Diaz-Cayeros 2002
29
A framework of relationships of accountability
Policymakers
Compact
Providers
Poor people
30
Policymaker-providerContracting NGOs in Cambodia
  • Contracted out NGO managed could hire, fire,
    transfer staff, set wages, procure drugs
  • Contracted in NGO managed and could transfer
    but not hire and fire staff
  • Control group Services run by government
  • 12 districts randomly assigned to each category

31
Contracting for Outcomes health services in
Cambodia
Use of facilities by poor people ill in previous
month
Source Bhushan, Keller and Schwartz 2002
32
A framework of relationships of accountability
Policymakers
Poor people
Providers
Client power
33
Keeping girls in secondary school in Bangladesh
choice
  • Girls to receive scholarship deposited to bank
    account set up in their name if
  • Attend school regularly
  • Maintain passing grade
  • Stay unmarried
  • Schools receive grants based on number of girls
    enrolled

34
EDUCO program in El Salvador participation
  • Parents associations contract with Education
    Ministry to deliver primary education
  • Associations have authority to
  • visit schools on regular basis
  • hire and fire teachers

35
EDUCO promoted parental involvement
which boosts student performance
Source Adapted from Jimenez and Sawada 1999
36
Accountability and decentralized service delivery
37
Degrees of decentralization
38
What not to do
  • Leave it to the private sector
  • Simply increase public spending
  • Apply technocratic solutions

39
What is to be done?
  • Expand information
  • Tailor service delivery arrangements to service
    characteristics and country circumstances

40
Eight sizes fit all?
41
Eight sizes fit all?
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
Politics matters for service delivery
  • Lack of information among voters about politician
    performance
  • Social, cultural, ideological polarization that
    leads to identity-based voting
  • Lack of credibility of political promises
  • Politics dominated by clientelism, political
    patrons providing private goods to clients

48
Some puzzles on politics
  • Why do politicians who depend on political
    support of poor people not deliver basic services
    to them?
  • Why are voters not able to provide stronger
    incentives for politicians service providers to
    deliver better service outcomes?
  • What is the impact of political market failures
    on basic service outcomes for poor people?

49
Some how-to research questions on voice politics
  • How can information mechanisms be
    institutionalized that allow voters to provide
    stronger incentives for better performance?
  • How to design high-impact sectoral interventions
    that politicians might find easier to commit to
    and take credit for?
  • How to unpack notions of political credibility to
    understand its process of change?

50
How donors provide aid matters
51
Donors and service delivery
Policymakers
Project implementation units
Global funds
Poor people
Providers
Community driven development
52
What donors can do to scale up
  • Harmonize procedures
  • Integrate aid in recipients budget system so
    that accountability is not undercut
  • Finance impact evaluations of service innovations
    (300 million/year -World Bank)
  • Create conditions for knowledge-driven
    development, particularly in clientelist settings

53
Implications for World Bank adjustment lending
  • PRSCs in Benin, Ethiopia, Rwanda, Madagascar
    focusing on service delivery
  • India Andhra Pradesh, Karnataka, Orissa rising
    social sector expenditures but impact?
  • PRSCs supporting service delivery experiments
    with evaluation Ethiopia, Nepal
  • Readiness for reform 8 sizes fit all?
  • Staffing implications who leads PRSCs?

54
Implications for policy dialogue
  • Service delivery as entry point in difficult
    political settings
  • Middle East and North Africa Governance Report
  • Symptoms v. causes of corruption
  • Ghost doctors in Bangladesh

55
Latin America
  • Use WDR framework to understand success and
    failures
  • Cochabamba v. Cartagena
  • Mainstream impact evaluation
  • Cross-fertilizing experiences of evaluation and
    scaling up
  • Evaluation now a major emphasis in country
    strategies

56
Plans in South Asia
  • Background rapid growth in India Pakistan but
    poor service delivery MDG implications
  • Fixing service delivery institutions learning
    from success failure
  • Power sector tariffs
  • Contracting out education in Madhya Pradesh
  • Providing knowledge services in high-capacity
    settings
  • WDR director will be new Chief Economist for the
    South Asia region

57
Services work for poor people when accountability
is strong
http//econ.worldbank.org/wdr/wdr2004
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