world development report 2004

1
world development report 2004
Making Services Work for Poor People
2
Messages

• Services are failing poor people.
• But governments, citizens, and donors can make
  them 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
MDGsGlobal aggregates
Eradicate poverty and hunger
Universal primary education
Source www.developmentgoals.org
4
MDGsGlobal aggregates
Promote gender equality
Reduce child mortality
Source www.developmentgoals.org
5
Outcomes are worse for poor peoplePercent aged
15 to 19 completing each grade or higher
Source Analysis of Demographic and Health Survey
data
6
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.
7
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
8
Expenditure incidence
Health
Education
Source Filmer 2003b
9
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

10
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

11
Examples of low service quality

• Bangladesh Absenteeism rates for doctors in
  primary health care centers 74 percent
• Zimbabwe 13 percent of respondents gave as a
  reason for not delivering babies in public
  facilities that nurses hit mothers during
  delivery
• Guinea 70 percent of government drugs disappeared

12
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
• Public information campaign to reduce leakage of
  education funds in Uganda

13
A framework of relationships of accountability
Policymakers
Poor people
Providers
14
A framework of relationships of accountability
Policymakers
Poor people
Providers
15
Citizen-policymaker

• Pro-Poor vs. clientelist politics
• Universal vs. narrowly targeted services
• Capture
• Role of informed voting, social polarization,
  credible politicians in making services work for
  poor people
• Role of information

16
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
• If better targeted, could have reduced it by 64
  percent

17
PRONASOL expenditures according to party in
municipal government
Source Estevez, Magaloni and Diaz-Cayeros 2002
18
Increase in primary school enrollments in Uganda
Source Murphy, Bertoncino, and Wang 2002.
19
Schools in Uganda received more of what they were
due
Source Reinikka and Svensson (2001), Reinikka
and Svensson (2003a)
20
A framework of relationships of accountability
Policymakers
Providers
Poor people
21
Policymaker-provider

• Delegation, finance, performance, monitoring, and
  enforcement
• Hard to monitor versus Easy to monitor
• Information for monitoring
• New type of micro surveys

22
Policymaker-providerContracting 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

23
Utilization of facilities by poor People sick in
last month
Source Bhushan, Keller and Schwartz 2002
24
A framework of relationships of accountability
Policymakers
Poor people
Providers
25
Client-provider

• Strengthen accountability by
• Information
• Choice
• Participation clients as monitors

26
Client-providerEDUCO 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

27
EDUCO promoted parental involvement
which boosts student performance
Source Adapted from Jimenez and Sawada 1999
28
Eight sizes fit all?
Difficult to monitor Easy to monitor




29
Eight sizes fit all?
Difficult to monitor Easy to monitor
Heterogeneous clients
Heterogeneous clients
Homogeneous clients
Homogeneous clients
30
Eight sizes fit all?
Difficult to monitor Easy to monitor
Heterogeneous clients Clientelist politics
Heterogeneous clients Pro-poor politics
Homogeneous clients Clientelist politics
Homogeneous clients Pro-poor politics
31
Eight sizes fit all?
Difficult to monitor Easy to monitor
Heterogeneous clients Clientelist politics
Heterogeneous clients Pro-poor politics
Homogeneous clients Clientelist politics
Homogeneous clients Pro-poor politics Government provision or contracting
32
Eight sizes fit all?
Difficult to monitor Easy to monitor
Heterogeneous clients Clientelist politics
Heterogeneous clients Pro-poor politics
Homogeneous clients Clientelist politics
Homogeneous clients Pro-poor politics Central-government provision Government provision or contracting
33
Eight sizes fit all?
Difficult to monitor Easy to monitor
Heterogeneous clients Clientelist politics Demand-side subsidies, co-payments by households
Heterogeneous clients Pro-poor politics Local-government provision Local-government with contracting
Homogeneous clients Clientelist politics
Homogeneous clients Pro-poor politics Central-government provision Government provision or contracting
34
world development report 2004
Making Services Work for Poor People
http//econ.worldbank.org/wdr/wdr2004