Improving Service Delivery for the Poor in OIC Member States

Transcription

1 Improving Service Delivery for the Poor in OIC Member States Dr. Meltem A. Aran Development Analytics September 10, 2015

2 Outline Conceptual framework An overview of OIC countries showing Access to basic services Service delivery models, financing mechanisms Common challenges Case studies of four OIC member countries Turkey Bangladesh Lebanon Indonesia 2

3 Introduction Poverty is a challenge for most of the OIC member states. Approximately 1 out of every 4 extremely poor people in the World live in OIC countries 350 million people in OIC countries live in extreme poverty (1.2 billion people live in extreme poverty worldwide) Access to basic services is closely linked with material poverty 3

4 Basic Services and Their Link with Poverty Poverty is multi-dimensional Different aspects of multi-dimensional poverty reinforce each other and trap people into a vicious cycle of poverty. Vicious cycle of poverty 4

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6 Basic Services and Their Link with Poverty What are basic services? Basic education services: Services that should meet basic learning needs of every individual. Basic health care services: Primary health care services that are essential for individuals at a minimum level. Drinking water services: Improved drinking water sources are by nature of its construction or through active intervention, the sources that are protected from outside contamination Sanitation services: Improved sanitation facilities are defined as a facility that hygienically separates human excreta from human contact Electricity services: Electricity is delivered to end users by using mainly three types of systems: (i) grid systems, (ii) minigrid systems, and (iii) off-grid systems 6

7 What is the role of the Government? Improving education and health outcomes is a government responsibility Why? Social reason: Markets fail to provide equitable services since only the people who can afford their services could have access Economic reason: Markets generally fail to absorb externalities Governments responsibility is also backed by international treaties signed by the governments Governments allocate a significant share of their budget to finance basic services. 7

8 Doing more of the same might not help the poor Higher public spending alone does not necessarily result in better provision of services. Doing more of the same will not be enough to overcome inequalities in access to basic services Case of Uganda Public Spending Might Not Reach the Poor Public health spending may be pro-rich Bangladesh, Nepal, India, Indonesia and China The distribution of existing services matter. 8

9 General Framework: Actors and Accountability 10 Source: World Development Report 2004, World Bank

10 Models of Basic Service Delivery 1. Central government provision 2. Decentralization 3. Contracting out 4. Community participation 5. Private provision 11

11 Models of Basic Service Delivery Each model has its own advantages and possible challenges Model Advantages Possible challenges Central provision Economies of scale Failure in the long route of accountability Better management and control over homogenous services Clientelism Decentralization Better management at the local level Inequalities between localities Improving voice Lack of capacity in local governments Contracting out Increase in access to services Weak government capacity to manage contracts Increase in quality and efficiency of services Community participation Increasing access Increasing quality Capture (Not representing the disadvantaged community) Low capacity of communities A question of Fairness (Government staying away from its own responsibilityies) 12 Private provision Increase in access Inequality in access Increase in quality

12 Overview of OIC Member Countries Access to Services Financing Delivery Models Common Challenges 13

13 Data and Methodology Data collected from : 1. Publicly available data sources. e.g. World Bank, UNESCO, OECD. 2. Meta-analysis of published research and reports to identify service delivery models in the member countries Review of 185 sources. Literature review identifies the service delivery models employed in 4 different sectors in the OIC member countries. 3. In-depth interviews in case countries with experts 14

14 Saudi Arabia Bahrain United Arab Emirates Oman Qatar Kuwait Brunei Darussalam Turkmenistan Iran Azerbaijan Kazakhstan Iraq Libya Algeria Gabon Jordan Lebanon Maldives Malaysia Turkey Tunisia Albania Suriname * Uzbekistan Sudan Syria Djibouti Yemen Cameroon Egypt Mauritania Palestine Pakistan Cote d Ivoire Nigeria Morocco Kyrgyz Republic Guyana* Indonesia Senegal Somalia Tajikistan Guinea-Bissau Chad Afghanistan Gambia Guinea Togo Uganda Comoros Bangladesh Sierra Leone Niger Mali Burkina Faso Mozambique Benin OIC World voice and accountability index Voice in OIC Strength of voice does not seem to be directly related with income group (Voice and accountability index, 1996 and 2013) 0,50 0,00-0,50-1,00-1,50-2,00-2,50 High Income Upper Middle Income Lower Middle Income Low Income Average index for each income group 15 Source: World Bank, Worldwide Governance Indicators

15 Kuwait Saudi Arabia Oman Bahrain Brunei Darussalam Qatar United Arab Emirates Libya Turkmenistan Iraq Gabon Iran Algeria Kazakhstan Azerbaijan Lebanon Albania Maldives Jordan Tunisia Suriname Turkey Malaysia Sudan Syria Yemen Djibouti Cote d Ivoire Nigeria Uzbekistan Mauritania Egypt Cameroon Pakistan Palestine Kyrgyz Republic Senegal Indonesia Guyana Morocco Somalia Chad Guinea-Bissau Comoros Afghanistan Togo Guinea Sierra Leone Tajikistan Mali Bangladesh Gambia Niger Mozambique Burkina Faso Uganda Benin OIC World government effectiveness index 1,50 1,00 0,50 0,00-0,50-1,00-1,50-2,00-2,50 Compact in OIC Compact (government effectiveness) is stronger than voice on average, still lower than the World average Strength of compact decreases with income level on average (Government effectiveness index, 1996 and 2013) High Income Upper Middle Income Lower Middle Income Low Income Average index for each income group 16 Source: World Bank, Worldwide Governance Indicators

16 Access Financing Delivery Models Common Challenges Access to Education On average primary school enrolment rate in OIC is close to the World average (87.1% vs 91.1%) Primary school enrolment remains low in a number of member countries (Primary school adjusted net enrolment rate, 2010s) 17 Source: UNESCO Institute for Statistics, Education Statistics

17 Access Financing Delivery Models Common Challenges Disparity in Access Poverty and gender determine access to education in many of the OIC member countries (Primary school adjusted net attendance rate, by gender and wealth quintile) 18 Chad 2004 Niger 2006 Burkina Faso 2010 Mali 2006 Pakistan 2012 Nigeria 2008 Afghanistan 2011 Guinea 2005 Yemen 2006 Côte d'ivoire 2006 Benin 2006 Mauritania 2007 Gambia 2006 Senegal 2011 Cameroon 2011 Mozambique 2011 Sierra Leone 2013 Morocco 2004 Iraq 2011 Turkey 2004 Togo 2010 Uganda 2011 Bangladesh 2011 Tajikistan 2006 Egypt 2009 Azerbaijan 2006 Albania 2009 Syrian Arab Republic 2006 Indonesia 2008 Maldives 2008 Kyrgyzstan 2006 Guyana 2009 Jordan 2007 Kazakhstan 2006 Uzbekistan 2006 Source: UNESCO Institute for Statistics, Education Statistics Poorest female Poorest male Richest female Richest male Primary school adjusted net attendance rate

18 Access Financing Delivery Models Common Challenges Access to Health Care Wide variations in child mortality exist in between OIC member countries (Under-5 Mortality rate -per 1,000 live births, 2013) Source: World Bank, World Development Indicators 19

19 20 Access Financing Delivery Models Common Challenges Rich-Poor Disparity in Access (1) Basic health care services continue to fail reaching the poor Source: World Bank, Health, Nutrition and Population Statistics by Wealth Quintile Poor children are less likely to be delivered at birth by skilled health personnel (Assistance during delivery (any skilled personnel), by wealth quintile) Chad 2010 Nigeria 2013 Somalia 2006 Bangladesh 2011 Niger 2012 Afghanistan 2011 Yemen, Rep Cameroon 2011 Guinea 2012 Guinea-Bissau 2010 Mauritania 2011 Togo 2010 Senegal 2011 Morocco 2004 Pakistan 2013 Mozambique 2011 Gambia, The 2010 Cote d'ivoire 2012 Mali 2013 Uganda 2011 Sudan 2010 Burkina Faso 2010 Sierra Leone 2013 Egypt, Arab Rep Indonesia 2012 Benin 2012 Comoros 2012 Tajikistan 2012 Azerbaijan 2006 Gabon 2012 Syrian Arab Republic 2006 Guyana 2009 Iraq 2011 Suriname 2010 Algeria 2006 Turkey 2013 Maldives 2009 Tunisia 2012 Turkmenistan 2000 Jordan 2012 Kyrgyz Republic 2012 Albania 2009 Kazakhstan 2011 Uzbekistan 2006 Poorest fifth Richest fifth Assistance during delivery (% of births)

20 Access Financing Delivery Models Common Challenges 21 Rich-Poor Disparity in Access (2) Basic health care services continue to fail reaching the poor Source: World Bank, Health, Nutrition and Population Statistics by Wealth Quintile Poor children are less likely to get vaccinated against measles (Vaccinations (Measles), by wealth quintile (% of children ages months)) Nigeria 2013 Chad 2010 Somalia 2006 Pakistan 2013 Azerbaijan 2006 Afghanistan 2011 Guinea 2012 Cameroon 2011 Yemen, Rep Sudan 2010 Togo 2010 Benin 2012 Cote d'ivoire 2012 Mauritania 2011 Niger 2012 Mali 2013 Comoros 2012 Iraq 2011 Guinea-Bissau 2010 Indonesia 2012 Syrian Arab Republic 2006 Guyana 2009 Gabon 2012 Suriname 2006 Senegal 2011 Mozambique 2011 Uganda 2011 Burkina Faso 2010 Bangladesh 2011 Sierra Leone 2013 Morocco 2004 Algeria 2006 Turkey 2013 Tunisia 2012 Jordan 2012 Turkmenistan 2000 Tajikistan 2012 Kazakhstan 2011 Maldives 2009 Gambia, The 2010 Uzbekistan 2006 Egypt, Arab Rep Kyrgyz Republic 2012 Albania 2009 Poorest fifth Richest fifth Vaccinations (Measles) (% of children ages months)

21 Access Financing Delivery Models Common Challenges Access to Water On average OIC countries have a lower level of access to an improved drinking water source compared to the World average (80.9% vs 89.3%) There are wide disparities in access to an improved water source in between member countries (Improved water source (% of population with access), 2012) 22 Source: World Bank, World Development Indicators

22 Access Financing Delivery Models Common Challenges Urban-Rural Disparity in Access In many member countries people living in rural areas have lower access to an improved water source or improved sanitation facility compared to people living in urban areas (Improved water source, improved sanitation facility (% of population with access), by location, 2012) Water Urban Sanitation Rural 23 Source: World Bank, World Development Indicators

23 Access Financing Delivery Models Common Challenges Access to Electricity Services Average access to electricity is lower in OIC countries, compared to the World. Percent of the population with access to electricity (1990 and 2010) 24 Source: World Bank, World Development Indicators

24 25 Access Financing Delivery Models Common Challenges Urban-Rural Disparity in Access A significant number of member countries have wide disparities in terms of access to electricity between urban and rural areas Source: World Bank, World Development Indicators Chad Burkina Faso Sierra Leone Niger Mauritania Mozambique Guinea Mali Uganda Togo Benin Djibouti Cameroon Somalia Sudan Guinea-Bissau Gambia, The Senegal Afghanistan Yemen, Rep. Gabon Nigeria Cote d'ivoire Comoros Bangladesh Brunei Darussalam Guyana Syrian Arab Republic Pakistan Indonesia Bahrain Kuwait Oman Qatar Saudi Arabia United Arab Emirates Palestine Iraq Iran, Islamic Rep. Morocco Kazakhstan Algeria Malaysia Tunisia Jordan Azerbaijan Tajikistan Libya Lebanon Egypt, Arab Rep. Turkmenistan Maldives Albania Kyrgyz Republic Suriname Turkey Uzbekistan Urban Rural Access to electricity (% of population), by location, Access to electricity (Percent)

25 Overview of OIC Member Countries Access to Services Financing Delivery Models Common Challenges 26

26 Saudi Arabia Kuwait Oman Brunei Darussalam Bahrain Qatar United Arab Emirates Malaysia Gabon Tunisia Iran, Islamic Rep. Maldives Kazakhstan Algeria Albania Turkey Azerbaijan Lebanon Iraq Jordan Libya Suriname Turkmenistan Cote d'ivoire Senegal Syrian Arab Republic Kyrgyz Republic Indonesia Morocco Cameroon Mauritania Yemen, Rep. Djibouti Guyana Pakistan Egypt, Arab Rep. Nigeria Palestine Sudan Uzbekistan Comoros Benin Mali Togo Mozambique Niger Tajikistan Burkina Faso Sierra Leone Uganda Bangladesh Gambia, The Chad Guinea Afghanistan Guinea-Bissau Somalia Public spending on education, (% of government expenditure) OIC World Access Financing Delivery Models Common Challenges 30 Government Spending on Education On average OIC countries allocate a similar amount of their government budget to education as the World Higher income countries tend to allocate a lower share of the total government expenditure on education (Public spending on education, total (% of government expenditure), 1990s and 2010s) High Income Upper Middle Income Lower Middle Income Low Income 1990s 2010s Average public spending on eduction for each income group in 2010s 27 Source: World Bank, World Development Indicators. The figure here presents the earliest data available in 1990s and the latest data available in the 2010s. In some cases the earliest data from 1990s is actually from early 2000s, and for 2010s, it might actually be from late 2000s. Some countries do not have data available in the indicated time periods. (World averages are for ).

27 total aid to basic education per primary school-age child (constant 2012 US$) Oman Saudi Arabia Bahrain Brunei Darussalam Kuwait Qatar United Arab Emirates Jordan Lebanon Suriname Iran, Islamic Rep. Gabon Azerbaijan Iraq Turkmenistan Libya Kazakhstan Turkey Algeria Maldives Albania Malaysia Tunisia Djibouti Senegal Kyrgyz Republic Guyana Pakistan Yemen, Rep. Cote d'ivoire Mauritania Syrian Arab Republic Indonesia Egypt, Arab Rep. Uzbekistan Cameroon Nigeria Morocco Palestine Sudan Afghanistan Bangladesh Burkina Faso Tajikistan Mozambique Benin Gambia, The Somalia Mali Sierra Leone Guinea-Bissau Comoros Niger Guinea Chad Uganda Togo OIC World Access Financing Delivery Models Common Challenges Aid for Education Financing 200 Aid is an important source of financing for education in OIC countries Almost half of the total aid received on education in the World was received by OIC member countries at a total of $5,553 million in Low income countries on average do not receive larger amounts of aid per child compared to countries in higher income groups (Total aid to basic education per primary school-age child (constant 2012 US$), average and 2012) High Income Upper Middle Income Lower Middle Income Low Income annual average 2012 Average aid per primary school age child for each income group in Source: UNESCO, EFA Report 2015, Statistical Tables for Aid. For some countries no data was available for one of the years or both years.

28 Health expenditure, public (% of government expenditure) Bahrain United Arab Emirates Brunei Darussalam Saudi Arabia Kuwait Oman Qatar Jordan Iran, Islamic Rep. Tunisia Turkey Suriname Kazakhstan Albania Algeria Maldives Lebanon Turkmenistan Gabon Libya Malaysia Iraq Azerbaijan Djibouti Guyana Kyrgyz Republic Sudan Mauritania Uzbekistan Senegal Cameroon Cote d'ivoire Indonesia Nigeria Morocco Egypt, Arab Rep. Syrian Arab Republic Pakistan Yemen, Rep. Palestine Togo Mali Sierra Leone Burkina Faso Gambia, The Niger Benin Uganda Comoros Mozambique Guinea-Bissau Bangladesh Afghanistan Tajikistan Guinea Chad Somalia OIC World Access Financing Delivery Models Common Challenges Government Spending on Health Care 20 OIC member countries allocate a lower share of their government budget on health care on average compared to the World Almost all of the member countries allocate a lower share of their government budget on health compared to the World average, and this has been more or less stagnant over time (Health expenditure, public (% of government expenditure), 1995 and 2012) High Income Upper Middle Income Lower Middle Income Low Income Average public health expenditure as a percent of government expenditure in 2012 for each income group 29 Source: World Bank, World Development Indicators. (Note that the World average is for year 2009).

29 Out-of-pocket expenditure as a percentage of total expenditure on health United Arab Emirates Saudi Arabia Bahrain Kuwait Oman Qatar Brunei Darussalam Azerbaijan Iran, Islamic Rep. Albania Maldives Iraq Kazakhstan Gabon Lebanon Turkmenistan Tunisia Malaysia Jordan Libya Turkey Algeria Suriname Sudan Yemen, Rep. Nigeria Egypt, Arab Rep. Morocco Cameroon Pakistan Syrian Arab Republic Indonesia Uzbekistan Cote d'ivoire Djibouti Kyrgyz Republic Senegal Mauritania Guyana Palestine Sierra Leone Afghanistan Guinea Comoros Bangladesh Chad Mali Tajikistan Niger Uganda Benin Guinea-Bissau Togo Burkina Faso Gambia, The Mozambique Somalia OIC World Access Financing Delivery Models Common Challenges Out of pocket health expenditures 100 OIC member countries have high dependence on out of pocket expenditures in financing health care Out-of-pocket spending continues to be a posing problem for the member countries (Out-of-pocket expenditure (% of total expenditure on health), 1995 and 2012) High Income Upper Middle Lower Middle Income Low Income Average of each income group for Out-of-pocket expenditure as a percentage of total expenditure on health in Source: WHO, Global Health Observatory Data Repository. (Note that the data for World average is obtained from World Bank, World Development Indicators).

30 Saudi Arabia Bahrain Brunei Darussalam Kuwait Oman Qatar United Arab Emirates Suriname Jordan Albania Maldives Gabon Turkmenistan Azerbaijan Lebanon Tunisia Kazakhstan Iraq Turkey Libya Malaysia Iran, Islamic Rep. Algeria Morocco Cote d'ivoire Senegal Djibouti Kyrgyz Republic Guyana Cameroon Mauritania Nigeria Pakistan Yemen, Rep. Sudan Uzbekistan Indonesia Syrian Arab Republic Egypt, Arab Rep. Palestine Mozambique Gambia, The Guinea-Bissau Benin Mali Burkina Faso Uganda Afghanistan Niger Togo Comoros Sierra Leone Guinea Chad Tajikistan Bangladesh Somalia External resources for health as a percentage of total expenditure on health OIC World Access Financing Delivery Models Common Challenges Aid for Health Care Financing 100 OIC member countries have a dependence on aid in financing health care Low income member countries are increasingly more dependent on aid for health care financing (External resources for health (% of total expenditure on health), 1995 and 2012) High Income Upper Middle Income Lower Middle Income Low Income Average of each income group for external resources for health as a percentage of total expenditure on health in Source: WHO, Global Health Observatory Data Repository. (Note that the data for World average is obtained from World Bank, World Development Indicators).

31 Disbursed Official Development Assistance for Water and Sanitation (constant US$, per capita) Bahrain Oman Saudi Arabia Brunei Darussalam Kuwait Qatar United Arab Emirates Maldives Jordan Lebanon Albania Gabon Azerbaijan Malaysia Tunisia Iraq Turkey Suriname Algeria Iran, Islamic Rep. Kazakhstan Turkmenistan Libya Djibouti Palestine Guyana Mauritania Senegal Morocco Yemen, Rep. Kyrgyz Republic Uzbekistan Cote d'ivoire Sudan Nigeria Cameroon Indonesia Egypt, Arab Rep. Pakistan Syrian Arab Republic Sierra Leone Mozambique Benin Burkina Faso Comoros Mali Tajikistan Afghanistan Guinea-Bissau Niger Uganda Chad Togo Bangladesh Somalia Guinea Gambia, The COMCEC Access Financing Delivery Models Common Challenges Aid for Water and Sanitation Services 35,0 In most of the OIC member countries, except the ones in the high income group, financing through donor funds is common Per capita aid is highest for the upper middle income states on average (Disbursed Official Development Assistance for Water and Sanitation (constant US$, per capita), 2004 and 2013) 30,0 25,0 20,0 15,0 10,0 5,0 0,0 High Income Upper Middle Income Lower Middle Income Low Income Average per capita aid disbursed in 2013 for each income group 32 Source: Author s calculations. Data source for disbursed ODA is OECD, Aid Activities Database (Creditor Reporting System). Data source for population is World Bank World Development Indicators.

32 Low Income Lower Middle Income Upper Middle Income High Income Access Financing Delivery Models Common Challenges Electricity subsidies Many of the member countries provide subsidies for the electricity sector Source: Clements et al Countries at the top of each income group with no data are classified as n.a. by the authors. Bahrain United Arab Emirates Saudi Arabia Kuwait Qatar Oman Brunei Darussalam Albania Gabon Maldives Suriname Turkey Lebanon Iran, Islamic Rep. Jordan Turkmenistan Tunisia Libya Kazakhstan Algeria Iraq Azerbaijan Malaysia Guyana Morocco Sudan Syrian Arab Republic Kyrgyz Republic Uzbekistan Cote d'ivoire Cameroon Egypt, Arab Rep. Pakistan Senegal Yemen, Rep. Nigeria Indonesia Mauritania Djibouti Palestine Comoros Gambia, The Guinea Guinea-Bissau Sierra Leone Togo Bangladesh Mozambique Uganda Benin Tajikistan Mali Burkina Faso Afghanistan Chad Niger Somalia Percent of government revenues Pre-tax Subsidies for Electricity, percent of government revenues OIC World Pre-Tax Subsidies for Electricity, percent of government revenue, 2011

33 Overview of OIC Member Countries Access to Services Financing Delivery Models Common Challenges 34

34 Access Financing Delivery Models Common Challenges Models of Education Service Delivery 35 High Income Upper- Middle Income Lower- Middle Income Low Income Central government provision Decentralization Contracting out Community participation Private provision Kuwait x x Qatar x x x Saudi Arabia x x United Arab Emirates x x x Albania x x Algeria x x Azerbaijan x x Iran x x x Iraq x x Jordan x x Kazakhstan x x Lebanon x x x Libya x x Malaysia x x x Maldives x x x x Tunisia x x Turkey x x x Turkmenistan x x Cameroon x x x Egypt x x Indonesia x x x Kyrgyz Republic x x Morocco x x x Nigeria x x x Pakistan x x x Senegal x x x Uzbekistan x x x Bangladesh x x Benin x x x Burkina Faso x x x Mali x x x Mozambique x x x Sierra Leone x x x Tajikistan x x Uganda x x x Central provision is common among uppermiddle income members Decentralization is observed through giving more authority to regional directorates or local governments Contracting out is not very common in education Community participation via parent-techer associations. Responsibilities of PTAs change from country to country.

35 United Arab Emirates Qatar Kuwait Brunei Darussalam Bahrain Oman Saudi Arabia Lebanon Gabon Jordan Iran, Islamic Rep. Albania Libya Tunisia Maldives Turkey Malaysia Suriname Kazakhstan Algeria Azerbaijan Iraq Turkmenistan Pakistan Cameroon Indonesia Senegal Morocco Mauritania Cote d'ivoire Palestine Djibouti Nigeria Egypt, Arab Rep. Guyana Sudan Yemen, Rep. Syrian Arab Republic Kyrgyz Republic Uzbekistan Bangladesh Mali Gambia, The Togo Guinea-Bissau Guinea Comoros Benin Burkina Faso Uganda Chad Sierra Leone Niger Afghanistan Mozambique Tajikistan Somalia Private primary school enrollment (% of total primary) OIC World Access Financing Delivery Models Common Challenges Private Provision in Education 100 Private provision is common and increasing in OIC member countries (School enrollment, primary, private (% of total primary), 1990s and 2010s) High Income Upper Middle Income Lower Middle Income Low Income 1990s 2010s Average private school enrolment rate in primary school for income groups 36 Source: World Bank, World Development Indicators. The figure here presents the earliest data available in 1990s and latest data available in the 2000s. In some cases the earliest data from 1990s is actually from early 2000s, and the data from 2010s might be from late 2000s.

36 Overview of OIC Member Countries Access to Services Financing Delivery Models Common Challenges 40

37 Access Financing Delivery Models Common Challenges Common Challenges in Education Lack of human resources, low quality of human resources Pupil/teacher ratio 12.7 in high income members states, 42.2 in low income member states In high income Qatar, percent of trained teachers is 48.9, in low income Guinea- Bissau Poor quality of education Absenteeism of teachers. In Uganda 53%, in Senegal 29% of teachers were not found in classroom at a random check In MENA teacher absenteeism is reported to be a serious problem for 22% of the students on average. Informal payments and private tutoring One third of the citizens in MENA countries reported paying informal fees in education sector In Azerbaijan and Tajikistan, almost 40 percent of parents reported that teachers expect parental contributions to increase their salaries Signs of failure in accountabililty relationships 41

38 PIRLS Reading Achievement Average Scale Score Access Financing Delivery Models Common Challenges Poor quality in education 600 OIC member states do not score well in the international reading test PIRLS for 4th graders by being at the bottom of the country list regardless of their income level (Average PIRLS reading achievement test scores, 2011) OIC countries Overall reading average scale score PIRLS scale average 42 Source: PIRLS 2011

39 Access Financing Delivery Models Common Challenges Common challenges in Health Care Staff shortages Number of physicians per 1,000 people was: 1.1 on average in OIC 1.5 in the World Low levels of quality in public hospitals Deterioration of materials and facilities Long waiting times in public hospitals Lack of access to water or electricity in health facilities: In Uganda 64 percent, in Senegal only 39 percent of primary health care facilities in the country have available clean water, sanitation and electricity at the same time Work force absenteeism In Senegal, 20 percent, in Uganda 46 percent of the personnel were found absent in the health facilities during random spot checks. Signs of failure in accountabililty relationships 43

40 Access Financing Delivery Models Common Challenges Common challenges in Water and Sanitation Water Low level of access of the poor and the people living in rural areas In Indonesia, only percent of the poor living in urban areas are connected to the piped water network. Unconnected population obtain water from individual wells, small-scale providers, or water vendors Water sold by private water tankers and water vendors could be as high as 8 to 10 times that of water sold through house connections, in Sub-Saharan Africa. Clientelism Low quality of water supply (Intermittent supply) In Lebanon continuity of supply ranges from 3 to 22 hours during the summer season In Albania and Azerbaijan, water service availability is low with an average of 11 hours and 7 hours per day Sanitation Low level of access of the poor and the people living in rural areas Lack of a central authority responsible for sanitation In Sierra Leone, there is confusion related to which institute has the responsibility on promotion and implementation of sanitation In Cameroon, since there are no plans targeting to improve rural sanitation, the directorate under the Ministry of Energy and Water that is responsible for rural areas only implements activities to improve the situation in water Lack of subsidizing or regulating on-site sanitation In Benin, Uganda and Mozambique, the government does not take part in financing latrines or regulating on-site sanitation facilities Signs of failure in accountabililty relationships 44

41 Access Financing Delivery Models Common Challenges Common challenges in Electricity 45 Low level of access of the people living in rural areas On average, 59.6 percent of the rural population in member countries have access to electricity compared to 82.1 percent in urban areas. Countries with solutions: Morrocco s rural electrification: The program started in 1996, and between 1990 and 2010 Morocco increased its rural electricity access rate from 15.6 percent to 97.4 percent. Bangladesh s home-based solar system: Asolar home system program was initiated in 2003 which led to electrification of three million households in 10 years. Low quality of services (Frequent blackouts) In Tajikistan, Lebanon and Iraq, there are power shortages especially during times of heavy usage. Low financial viability In Jordan, and Mauritania the increasing costs are not reflected in consumer tariffs In Uganda, Chad, Burkina Faso, Guinea, Mozambique, Cameroon and Senegal, electricity subsidies are found to be very regressive Signs of failure in accountabililty relationships

42 Recommendations & Conclusion Delivery of services can be improved by strengthening the accountability relationships between actors in the delivery chain. Accountability relationships in the long route of accountability could be strenghtened Voice can be improved by strengthening civil society engagement and democratization Compact can be improved by Better monitoring and evaluation Contracting out services In the short run, the short route of accountability or client power can be strengthened by Increasing the citizens choice, Participation, level of information. 46

43 Acknowledgements This. study has been prepared for the COMCEC Coordination Office by a team of experts at Development Analytics comprised of Meltem Aran, Nazlı Aktakke, Kimberly Colopinto, Semuhi Sinanoğlu and Aytuğ Şaşmaz and Merve Uzunalioğlu. We would like to thank Mehmet Akif Alanbay, Mehmet Fidan, Hande Hacımahmutoğlu, and Sırma Şeker Demir from the COMCEC Coordination Office for their overall support throughout the project. 47

44 Thank you. Development Analytics 31 Mektep Sokak Emirgan Istanbul