04年世界银行报告

SEPTEMBER24,2002WORLDDEVELOPMENTREPORT2004MAKINGSERVICESWORKFORPOORPEOPLEIntroductiontotheOutlineoftheWorldDevelopmentReport2004,“MakingServicesWorkforPoorPeople”Whyisfreedomfromillnessandilliteracy—twowayspoorpeoplesaytheescapefrompovertycanbemostmeaningful—deniedtosomany?Healthandeducationoutcomesdependonmanyfactors,buteffectivedeliveryofbasicservices,suchaseducation,health,waterandsanitation,isclearlyoneofthem.Theseserviceshaveoftenfailedpoorpeople.Wheresocietieshaveimprovedservices,ithasusuallybeenbecausepoorpeopleortheiradvocates—theclients—haveplayedanactiverole.Learningfromfailuresandsuccesses,the2004WorldDevelopmentReportseekstounderstandhowhealth,education,water,andsanitationservices—servicesthathaveadirectimpactonimprovinghealthandeducationoutcomes—canbemadetoworkforpoorpeople.Healthandeducationoutcomesdepend,amongotherthings,ontheincomesofthepoor,choiceshouseholdsmake,andtechnologicalchange.EconomicgrowthalonewillnotbeenoughtoreachtheMillenniumDevelopmentGoals,especiallythoseforhealth,nutrition,education,genderequalityandenvironmentalsustainability.Spendingmoremoney—badlyneededinmanypartsoftheworld—willalsonotbeenough.Publicfundsareoftenspentonthewrongservicesandpeople;aresuckedawaybycorruption;and,whentheyarenot,reachteachersandhealthworkersmiredinasystemwheretheyhavelittleincentivetodotheirjobs.Inmanycountries,teachersareabsent50percentofthetime.Governments,societies,anddonorscan—andshould—changethis.Todosowillrequireashiftinthewaywethinkaboutservices.Thetraditionalmodeofservicedelivery,whereacentralizedpublicagencyprovidedtheservicewithlittleinvolvementoftheclient,hasbeenextremelysuccessful—evenforpoorpeople—whentheserviceisrelativelyuniformandcanbemeasuredwithquantitativetargets,e.g.,thepostofficeandvaccinationcampaigns.Butwhenthenatureoftheservicevariesacrossclients(maternalandchildhealth,forinstance),anditisthequalityratherthanthequantitythatmatters(learningoutcomesratherthanschoolenrolment),thenthetraditionalmodeoftenbreaksdown.Fortheseservices,theclientmustbeatthecenterofprocess—indeterminingthemixandqualityofservices,aswellasinholdingserviceprovidersandpolicymakersaccountableforeffectivelydeliveringtheservice.Manygovernmentsaretryingtoachievethisshiftbydecentralizingservicestolocalgovernments,community-drivendevelopmentandusingprivateorNGOproviders.Some,butnotall,oftheseeffortshavebeensuccessfulinimprovingservicesforpoorpeople.TheWDRproposestoshedlightonthesuccessesandfailuresofthetraditionalandalternativeapproaches,byunbundlingservicedeliveryintothreesetsofactorsintheservicechain—clients,providers(publicorprivate),andpolicymakers.Inlow-incomecountries,thereisafourthactor:donors.Eachoftheseactorsrespondstodifferentinstitutionalincentives,toproduceservicesthateitherworkordonotworkforthepoor.TheWDRwillseektoshowhowtherelationshipsbetweenpolicymakers,providers,clients,anddonorscanbestrengthenedbythechoiceoffinancing,regulation,production,andmonitoringarrangements.Publicprovision,contractingout,decentralization,community-based-andprivate-provisionwithorwithoutsubsidiescaneachmakesensedependingonthecontextandcircumstance.Finally,theWDRwillexaminewaysinwhichaccountabilityforserviceoutputsandtheirmonitoringcanbestrengthened.Givingchoicetoclientsbybringingcompetitiontotheclient-providerrelationship,andstrengtheningtheirvoiceandparticipation—betterpublicdisclosurerules,well-functioningcourts,anindependentmedia—canhelp.Communitydrivenco-productioninitiativescanmakesensewhereinstitutionsareweakallaround,enhancingclientownershipasanentrypointformakinglocalserviceswork.Fundamentalshiftsinthinkingandactiondonotcomeeasily.Achievingsystemic,institutionalreforminbasicservices—asdistinctfrommanagerialortechnocraticchanges—isverydifficultbecauseofhistory,politics,andsocialnorms;becauseitchangespowerrelationshipsamongthekeyactors;becauseitoftenrequiressweepingreformsinbudgetmanagementandthecivilservice,aswellasindonorpractices;andbecausesometimesmakingservicesworkforpoorpeoplerequiresmakingservicesworkoverall.Applyingthe2004WDR’sproposedmessageofincentives,choices,andaccountabilitytomakeservicesworkforthepoorwillyieldreformagendasforeducation,health,water,andsanitationservices.Makingeducationservicesworkforpoorpeoplewillrequirenational-governmentoversightandhigh-qualityproviderswithautonomy,butthebiggestpayoffislikelytocomefromstrengtheningthepowerofcitizenstodisciplinethesystemthroughvoiceandchoice.Inhealth,thebiggestpayoffswillcomewhentheaccountabilityofpolicymakers,providers,andhouseholdsshiftstoimprovingoutcomes;greateruseofpro-poorcontractualarrangements,betterinformationtohouseholds,andenhancedcivil-societyoversightwillhelp.Inwaterandsanitation,whereclientwillingness-to-payishigh,thekeywillbetoachieveagenuineseparationbetweenpolicymakersandserviceproviders,freeingupthelattertobefarmoreresponsivetowhatclientsandcommunities,largeandsmall,want.Alloftheseserviceswillbenefitfrommorewidelyavailableinformationontheperformanceofservices.TableofContentsOverview/ExecutiveSummaryOpeningVignettes:ServicesCanWorkf