world development report 2004

Making Services Work for Poor People

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

MDGs—Global aggregates

Eradicate poverty and hunger Universal primary education

Source: www.developmentgoals.org

MDGs—Global aggregates

Source: www.developmentgoals.org

Promote gender equality Reduce child mortality

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

Source: Analysis of Demographic and Health Survey data

Growth is not enoughPercent living on

$1/dayPrimary completion

rate (percent) Under-5 mortality rateTarget 2015 growth

aloneTarget 2015 growth

aloneTarget 2015 growth

aloneEast 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.

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

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

Expenditure incidence

Health Education

Source: Filmer 2003b

Nonwage funds not reaching schools: Evidence from PETS (percent)

Country Mean Ghana 2000 49 Peru 2001 30 Papua NG 2001 28 Tanzania 1998 57 Uganda 1995 78 Zambia 2001 (discretion/rule) 76/10

Source: Ye and Canagarajah (2002) for Ghana; World Bank (2004) for PNG; Instituto Apoyo and World Bank (2002) for Peru; Price Waterhouse Coopers (1998) for Tanzania; Reinikka and Svensson 2002 for Uganda; Das et al. (2002) for Zambia.

Ghost workers on payroll (percent)

Country Education Health

Honduras 2000

Papua NG

5

15

8.3

-

Uganda 1993 20 -

Sources: World Bank 2001 &2004; Reinikka 2001

Extent of absence: Global results

Absence rates(percent) in:

Primaryschools

PrimaryHealthCenters

Bangladesh 16 35

Ecuador 14 --

India 25 40

Indonesia 19 40

Papua New Guinea 15 19

Peru 11 23

Uganda 27 37

Zambia 17 --

But services can work• Contracting-in and contracting-out of health

services in Cambodia

• 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

Poor people Providers

Policymakers

A framework of relationships of accountability

Short and long routes of accountability

The relationship of accountabilityhas five features

Poor people

Policymakers

A framework of relationships of accountability

Providers

Mexico’s 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

PRONASOL expenditures according to party in municipal government

Source: Estevez, Magaloni and Diaz-Cayeros 2002

A framework of relationships of accountability

Providers

Policymakers

Poor people

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

Utilization of facilities by poor People sick in last month

Source: Bhushan, Keller and Schwartz 2002

A framework of relationships of accountability

Poor people Providers

Policymakers

Schools in Uganda received more of what they were due

Source: Reinikka and Svensson (2001), Reinikka and Svensson (2003a)

Accountability and decentralized service delivery

Poor people Providers

National policymakers

Local policymakers

Degrees of decentralization

Eight sizes fit all?

Eight sizes fit all?

Eight sizes fit all?

Eight sizes fit all?

Eight sizes fit all?

Eight sizes fit all?

Making Services Work for Poor People

http://econ.worldbank.org/wdr/wdr2004

world development report 2004