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 hungerUniversal primary education Source:

MDGs—Global aggregates Source: Promote gender equalityReduce child mortality

Outcomes are worse for poor people Percent aged 15 to 19 completing each grade or higher Source: Analysis of Demographic and Health Survey data

Growth is not enough Percent living on $1/day Primary completion rate (percent)Under-5 mortality rate Target2015 growth alone Target2015 growth alone Target2015 growth alone East Asia Europe and Central Asia Latin America Middle East and North Africa South Asia Africa Sources: World Bank 2003a, Devarajan 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 Other data from World Bank staff

Expenditure incidence HealthEducation Source: Filmer 2003b

Use of an improved drinking water source Percent of households who use an improved drinking water source Source: Analysis of Demographic and Health Survey data

Nonwage funds not reaching schools: Evidence from PETS (percent) CountryMean Ghana Peru Papua NG Tanzania Uganda 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) CountryEducationHealth Honduras 2000 Papua NG Uganda Sources: World Bank 2001 &2004; Reinikka 2001

Extent of absence: Global results Absence rates (percent) in: Primary schools Primary Health Centers Bangladesh1635 Ecuador14-- India2540 Indonesia1940 Papua New Guinea1519 Peru1123 Uganda2737 Zambia17--

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 peopleProviders Policymakers A framework of relationships of accountability

Short and long routes of accountability

The relationship of accountability has five features

Poor people Policymakers A framework of relationships of accountability Providers

Mexico’s PRONASOL, 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 peopleProviders 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 peopleProviders National policymakers Local policymakers

Degrees of decentralization

Eight sizes fit all?

Making Services Work for Poor People world development report 2004