Service delivery to reduce inequality

Vivi AlatasLead Economist, World Bank

Who failed Putri?

All actors have failed Putri.

Government

Service providersThe community

providers failed Putri

Vital services are often unavailable or too far away.

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5

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30

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10

20

30

40

50

60 Distance to N

earest Puskesmas if not in V

illage (km)

Perc

ent w

ith P

uske

smas

% village with puskesmas Ave. distance to puskesmas, if not in village

Source: Podes 2011 Infrastructure Survey

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5

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35

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urban rural Java Kalimantan Maluku &Papua

Distance to N

earest SMP if not in V

illage (km)

Perc

enta

ge o

f Vill

ages

with

SM

P

% villages with SMP Average distance to SMP if not in Village

Existing facilities are often inadequate.

87.4

50.0

71.1

0

10

20

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60

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90

100

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ogya

kart

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mur

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anta

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atan

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Nat

iona

l Ave

rage

Puskesmas Service Readiness Index (amenities, equipment, diagnostics, medicine, SOPs)

Source: Risfaskes (2012)

Existing facilities are often inadequate.

Source: Podes 2011 Infrastructure Survey

77% 68% 45%national rural Maluku/papua

SHARE OF JUNIOR HIGH SCHOOLS WITH LABORATORIES

The quality of workers is also problematic.

0 2 4 6 8 10 12 14 16

Sumatra

Java

Bali and Nusa Tenggara

Kalimantan

Sulawesi

Papua and Maluku

Teacher absence rates (%)

Source: SMERU (2014)

Improvements should tackle both access and quality.

0.92

0.13

1.16

0

0.2

0.4

0.6

0.8

1

1.2

1.4

Closing quality gap (all students tobasic skills)

Closing access gap (full secondaryschool participation)

Closing both gaps

Increase in long-run growth rates based on education interventions

THE STATE failed Putri

Governments need to ensure that services are done right.

RIGHTLEVEL OF RESOURCES

AMOUNT OF SPENDING

TIME OF DELIVERY

MODE OF DELIVERY

There is not enough spending on service delivery.

2012 spending breakdown

Education : 20% of the budget

Health : 5% of the budget

Social assistance : 3% of the budget

Spending is often allocated to the wrong places.

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

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20

40

60

80

100

120

Direct Transfers All Education Health Energy Subsidies

Effectiveness Index Spending as % GDP

Source: Susenas 2012, APBN 2102 (realized), World Bank calculations

EffectivenessIndex

% of GDP

The allocation of spending is not pro-poor enough.

0%

1%

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5%

6%

7%

0%

20%

40%

60%

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100%

120%

140%

Argentina Bolivia Brazil Mexico Peru Uruguay Armenia Sri Lanka Indonesia

Share of GD

PIn

cide

nce

as a

sha

re o

f Mar

ket I

ncom

e

Poorest decile Richest decile Share of GDP (right axis)

Source: For Latin America see: Lustig and Pessino 2014; Paz, et al. 2014; Higgins and Pereira 2014; Scott 2014; Jaramillo 2014; Bucheli, et al. 2014; Lustig, et al. 2014. For Armenia and Sri Lanka, results are preliminary by Younger, et al. (2014) and Arunatilake, et al. (2014).

RELATIVE BENEFITS OF HEALTH SPENDING

However, recent development in spending are encouraging.

SIGNIFICANT CUTS IN FUEL SUBSIDIES

EXPANSION IN DIRECT TRANSFER

SPENDING

Accountability mechanisms must be improved and enforced.

Central government

LOCAL GOVERNMENTS

Service providers

incentivizes

to finance, monitor & evaluate

Central Government can incentivize pro-poor spending.

In order to encourage pro-poor spending by local governments, central government can link transfers to:

• Needs (poverty, inequality, service quality)

• Performance (improvement in needs indicators in the previous year)

The Village Law initiative also enables pro-poor spending.

1,151m727m20162015

Average allocation of “Village Fund” per village:

• Community-driven decision-making for allocation of “Village Funds”

• Participation by poor and marginalized groups is needed to ensure their needs are also met

Data on spending and service delivery must be tracked.

5,500 medical doctors, 34,000 nurses, and 10,000 midwives graduate each year,

but where they take up jobs is not tracked.

Data also needs to be collected from citizens and beneficiaries.

Citizen monitoring apps have been developed, but are still under-utilized.

New technology should be utilized for improved data collection.

Satellite data to monitor infrastructure

Crowdsourcing mechanisms

Real-time reporting

Better data allows the identification of positive deviance.

Better data collection allows central government to track high performing areas and check:

• What is the local government doing differently?

• What are the service providers doing differently?

• What are the beneficiaries doing differently?

Information dissemination must also be improved.

Several new initiatives are not yet well understood by local governments, providers, and beneficiaries:

• BPJS (health and employment insurance)

• Kartu Indonesia Pintar (schooling subsidies)

• Village Law (community-driven budget allocations at village government level)

PUTRI’s FAMILY AND community failed Putri

There is not enough willingness to use services.

0

20

40

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80

100

Skilled Ante-natal Care Skilled Post-natal Care Skilled Birth Delivery

No Education Some Primary Primary

Some secondary Secondary More than Secondary

Use of Skilled Maternal Health Services by Maternal Education

Immunization completion

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20

40

60

80

100

None Full (Hep B) Full (no Hep B)

Urban Rural Poorest Richest

Communities do not demand better provision.

Central government

LOCAL

GOVERNMENTS

Service providers

incentivizes

to monitor & evaluate

community pressures

Behavioral change is needed.

In 2016, Indonesia is allocating419 trillion IDR for education

WILL NOT WORK IF TEACHERS DON’T TEACH

Dana Desa plans to transfer1.5 billion IDR for each village’sdevelopment plans

WILL NOT WORK IF THE COMMUNITY DOES NOT PARTICIPATE

Universal coverage of BPJS and JKNis planned to be achieved by 2019

WILL NOT WORK IF HOUSEHOLDS DON’T UTILIZE IT

People can be nudged to use services.

Raw lentils increased immunization in India by

20 percentage points

People can be nudged to pressure providers.

The adopt-a-hydrant model can be used so individuals take ownership of services:

Adopt-a-Puskesmas

Adopt-a-School

Adopt-a-Village Meeting

It takes everyone to help Putri

Government

Service providersThe community