ECSHD Projects

1. ECSHD Projects Governance and Accountability Agenda An Assessment of PADs October 1, 2008

2. Definition of Governance and Accountability Governance Defined: We (World Bank/WBI/Daniel Kaufmann) define governance as The traditions and institutions by which authority in a country is exercised for the common good. This includes: • the process by which those in authority are selected, monitored and replaced, • the capacity of the government to effectively manage its resources and implement sound policies; and (ojo!) • the respect/trust of citizens and the state for the institutions that govern economic and social interactions among them. Accountability defined: • Liable to be called to account, or to answer for responsibilities and conduct; answerable, responsible. (OED – Oxford English Dictionary) • "A is accountable to B when A is obliged to inform B about A’s (past or future) actions and decisions, to justify them, and to suffer punishment in the case of eventual misconduct.“ (Andreas Schedler 1999). • “pro-active process by which public officials inform about and justify their plans of action, their behavior and results and are sanctioned accordingly” and distinguishes it from similar concepts such as transparency, oversight, and responsiveness (John M. Ackerman / WBI, 2005)

3. What is this exercise about? • This is a review and stocktaking of Project Appraisal Documents (PADs) for their discussion of GAC in enhancing service delivery in HD sectors. • It is not a review or stocktaking of any activities in implementation.

4. The Process of This GAC Assessment • A questionnaire with key questions was designed • In order to answer the questionnaire, All 64 PADs or the total portfolio of ECSHD projects was reviewed (when projects were restructured, the restructuring documentation was examined too) • The questionnaire was filled out and sent to the TTLs for comments • The questionnaire was in the form of a series of Yes or No answers accompanied by explanations • There were no right or wrong answers as the situation in each country/sector differs • Results were then aggregated for all ECSHD active projects

5. The questionnaire includes three (GAC) sections about what was written in the PAD regarding: • Changes in the processes and/or rules for service delivery • Allocation of project resources/activities to key GAC areas • Ways to measure/track Governance indicators

6. The questionnaire

7. Questionaire (continued)

8. ECSHD Projects! • 64 active project PADs were assessed • They include: • 22 Health Projects • 19 Education Projects • 23 Social Protection Projects (Pensions, Social Protection, Employment, Social Funds, Community works)

9. Health (22)

10. Education (19)

11. Social Protection (23)

12. Overall Results

13. Overall Results

14. Outcome and Process Indicators • 95% or 61 PADs included GAC indicators. • A total of 441 GAC related indicators in the 64 projects • On average there were 7 GAC related indicators per project • Most of the GAC indicators were process related intermediate indicators • 156 or 35% were outcome indicators • In some cases , the project is entirely focused on building and measuring governance and accountability (15 to 19 GAC Indicators ) • In 3 projects, or about 5 %, no GAC indicators were identified • Sometimes, GAC indicators are too diffused and subsumed in broader indicators • In most cases, indicators track progress in processes (Intermediate Indicators) • GAC outcome indicators in most PADs (PDO Indicators)

15. GAC Related Outcome and Process Indicators

16. Examples of Heath Projects and GAC Indicators • Uzbekistan Second Health • (O) Rationalization of outpatient and hospital services extended to new regions; new payment systems replicated for primary care and new payment systems piloted for specialty and hospital services. Facility type resource allocation formulae are refined. • Capitation formula simplified; decisions for input mix and allocation for services are decentralized to regional and rayon levels; community organizations more involved in management of local facilities. • Primary care facilities obtain independent juridical status, establish bank accounts, have flexibility over management of input mix. • (O) increase in SVP utilization; referral decreasing; admissions decreasing; beds and facilities consolidating/or decreasing • (O) Functioning training programs for GPs and universal nurses, public health experts, health policy experts and financial managers successfully established and in place. • (O) Well functioning monitoring and evaluation process in place, utilizing both facility and surveys and household surveys on periodic basis. • (O) Measurable shift in allocations from impatient to outpatient care; improved allocative efficiency in urban pilot centers; improved technical efficiency for hospitals (secondary level) services in hospital pilot regions. • Improved share of expenditures for i) recurrent costs relative to fixed assets, and ii)cost effective primary care services relative to secondary/tertiary care services • Introduction of a nation-wide provider payment system based on capitated financing for rural PHC facilities. • Conversion of at least half of rural PHC facilities in Uzbekistan as independent legal entities with sufficient financial and management autonomy • Improved health information system for financing strategies/systems and use of HIS data at all levels of the financial system. • Introduction of hospital payment systems in 3 regions.

17. Examples of Heath Projects and GAC Indicators • Macedonia Health Sector Management • (O) Reduction in administrative costs and personnel input for the issuance of the health insurance cards. • (O) Reduction in the number of drugs purchased in the non-HIF contracted pharmacies and reimbursed by HIF • (O) Decline in out of pocket payments for health care and drugs amongst groups eligible for co-payments waivers • (O) 15 guidelines developed according to international standards and distributed • (O)Yearly HIF audits acceptable • (O)Average length of drugs registration reduced by 25% • (O) All practicing doctors, dentists and pharmacists licensed in accordance with the new procedures. • (O) 30% of contracted health care providers complying with newly developed clinical guidelines • Mid term MoH health sector strategy developed and approved. The strategy should specify MoH policies on: privatization of health care services; pharmaceutical regulations; licensing of primary health care providers. • Public information strategy for health reforms developed and applied to health sector policy development in privatization of health care services and pharmaceutical regulations. • Public expenditure tracking survey (PETS) of funding for priority public health services completed • HIF providing guidelines on budget development • Action plan for improving revenue collection based on external audit of HIF implemented • HIF Board structure and operation revised • Internal audit unit functional • Hospital contracts revised on the basis of evaluation study of first phase of hospital contract implementation. • At least 75 percent of contracted primary health care providers and hospital are correctly collecting and analyzing data for contract compliance. • Business plans for improving quality and efficiency developed and implemented in at least 20 percent of all hospitals • Project deliverables are implemented and evaluated in an efficient manner and on a timely basis

18. Examples of Heath Projects and GAC Indicators • Russia: Health Reform Implementation Project. • Increase equity through geographical and financial accessibility of health services • Reduced percentage of funding from out of pocket (informal plus formal) payments • Increased efficiency through deployment of resources for evidence based health services • Increased proportion of population and service providers satisfied with specified aspects of health care system • (O) New evidence based clinical guidelines developed and issued by MOH • (O) New criteria and procedures for unified licensing issued by MOH • (O) New strategy developed and approved for human resource development including recruiting, staff development and deployment (related to new clinical guidelines) • (O)Health sector salary system is reformed • (O)Hospitals and other health care services complying with clinical guidelines. • (O)Degree of patient satisfaction with health services stratified by income strata. • Decrease in the number of re-admissions for the same conditions within a 3 month period.

19. Examples of Social Protection GAC indicators • Croatia Pension Systems Investment • (O)Continued operation of unified reporting and collection of mandatory contributions and income tax. • (O)Reduced institutional overlap in reporting and collecting of mandatory contributions and income taxes • (O) Improved functioning of Pension institute as measured by timeliness of overall functions • HAGENA and REGOS continue to function effectively • Monthly flow of data exchange between FINA and REGOS and other institutions done on timely and secure basis • Compliance rates in new revenue system including timeliness of reporting by employers and self employed. • Fund managers investing in different classes of assets in accordance with portfolio rules • Data flows form HAGENA and REGOS flowing to fund managers on agreed time basis and on agreed levels of reliability.

20. Examples of Social Protection GAC indicators • Macedonia Social Protection • (O) Evidence of improved solvency and improved effectiveness of the pension system following implementation of the reform program. • (O) Evidence of improved targeting and administration of cash benefits. • Regular monthly reporting on pension contributions paid on individual basis introduced and individual accounts established. • Further pension reform measures identified and implemented to improve long term sustainability, adequacy and transparency of the pension system. • Actuarial models of the pension system developed and the MLSP, PDF and MAPAS staff trained in using them and developing options for further policy changes. • Evidence of established business processes and practices within MAPAS • Regulatory framework established. • Pension fund custody rules and regulations developed and used • NBRM Custody staff trained in custody issues • Financial and management structures for coherent management of cash benefits and employment and labor market policies developed and implemented and staff skills and capacity enhanced. • Monitoring and evaluation systems established information and data management system, budget, accounting, audit and financial system and inspection and quality assurance function established. • Evidence that an improved MIS system is in place and is being used for its intended purpose. • Technical data management protocols and standards developed. • Business process development and user requirements developed • Application software developed for finance/accounting payments eligibility and case management etc.

21. Examples of Social Protection GAC indicators • Azerbaijan Pension and Social Assistance • (O) Improved financial viability (collection) of the social insurance system • (O)Significant increase in the number of participating system contributors (compliance rate of 90 percent) • (O)eligible beneficiaries of pensions and social assistance receive proper payments, timely manner (absence of arrears). • (O) Improved user satisfaction (beneficiary surveys) • Computerized record keeping in all social welfare offices • Targeting errors are no more then 40% • MIS used to test eligibility and monitor targeting efficiency • MLSPP uses M & E results for knowledge based policy formulation • A centralized register provides comprehensive computerized record keeping of participants and flow of funds • Internal administrative processes are functioning according to guidelines. • Actuarial analysis used for long term forecasting • Functioning public information system in place

22. Examples of Education Project GAC Indicators • Ukraine Equal Access to Quality Education • (O) New external assessment instruments (tests and exams) accepted by education stakeholders. • (O) Student teacher ratios of rural schools in pilot Rayons increased to 12 to 15 students per teacher. • 10% of school directors’ training in educational leadership piloted • Management training conducted at all RITCCs • New policy/system of certification (attestation) of teachers competence formulated and approved • Ukraine participating in PISA and TIMSSS • Framework document for new national curriculum agreed and disseminated with all relevant stakeholders • National external standardized exams taken by 70% of secondary school leavers • Sustainable, transparent, efficient policy on textbooks approval, production, distribution and evaluation agreed with Bank and approved by MES. • MES and Oblast education department training on planning, management and use of data for policy monitoring completed. • Information system for general secondary education statistics processing in place. • Studies on issues of public finance and accountability conducted • General secondary education statistics are collected from all Oblasts and processed • MES ready to use appropriate country systems and procedures

23. Examples of Education Project GAC Indicators • Kosovo Institutional Development for Education • (O) MEST established baseline of the student learning outcomes at Grade 5 and 9 by 2010. • (O) MEST/MFE monitors, analyzes and publishes capital and recurrent expenditures (by level of education by municipality, per student, by spending composition) each year. • 60 percent of schools supported under the project produce annual school improvement plans and monitoring reports by 2011 • (O) 70 percent of teachers are licensed as regular teachers by 2011 • (O) A primary and secondary education law which clarifies roles and responsibilities for delivery of documentation among various levels of education system is developed and adopted by the parliament by December 2008. • The number of municipalities which prepare and implement municipal education development plans in accordance with procedures. • The number of municipalities which allocate non-recurrent budget to schools according to funding formula. • Council for Curriculum, Textbooks and Assessment (CCTA) and National Teacher Education Board (NTEB) are established and functional. • The availability and quality of annual EMIS report, consisting of statistics and analysis of education trends. • The Law on Higher Education is amended and adopted. • The study on size and shape of higher education in Kosovo is used by MEST to develop a concrete strategy which proposes a cost effective expansion of the system

24. Examples of Education Project GAC Indicators • Kyrgyz: Rural Education • Publication of annual yearbook of education statistics • Evaluation studies with peer review disseminated. • School report cards developed and disseminated • Community and parental involvement in the education process and support of pre-schooling initiatives. • Teacher and student satisfaction with learning conditions in the three target oblasts. • Kindergarten and school census implemented and results used in targeting the interventions to most needy oblasts and schools. • Uzbekistan Basic Education • (O) Students performance on standardized student assessment • (O) Percentage of school boards participating in school improvement activities • (O) Student learning achievement as measured by a new standardized test of learning achievement to be administered to a sample of students in project and non project schools • (O)More equitable distribution and increased efficiency in utilization of budget in general secondary education • (O) Information on baseline indicators is collected and analyzed at least once a year. • (O) Active participation of school boards in needs assessment and selection of learning materials. • (O)Student assessment piloted • and information used to inform decisions on teacher training

25. Service Feedback in Institutions • 59 % of the projects assist in building-up institutions for service feedback. Break-down by sub-sector is : • Education 56 % • Health 46 % • Social Protection 79 % • BUT, in some cases, feedback institutions may already exist in the country, even associated to previous Bank projects. PADs sometimes referred to existing institutions that provide feedback

26. Incentives to Follow Rules • Most projects allocate resources for building up environment and monitoring compliance with the rules (about 90%) • However, less than half of the projects (42 %) spend resources to provide incentives to follow the rules: • Education 26 % • Health 50 % • Social Protection 48 % • As we can see, in Education only 26 % of the projects spend resources to provide incentives. Health and Social Protection are above the average • Other type of incentives (i.e. salaries) do not count as incentives to follow the rules

27. Sanctions • Only two projects, or 3 % of the portfolio, spend resources to create sanction mechanisms in the provision of services (excluding Bank Fiduciary aspects). These projects are: Romania--Rural Education and Bosnia and Herzegovina--Employment 2 • Some institutional changes may incorporate sanctions but PADs do not fully reflect them • Almost all projects, 98 %, spend resources to enhance policy capacity: • Education 100 % • Health 95 % • Social Protection 100 %

28. Main Messages • ECSHD PADs prepared over the last decade or more do include GAC activities and indicators. GAC agenda not new for us. • ECSHDPAD focus on GAC agenda on Borrower/ Government Policy and Borrower/ Government Service Providing institutions. • Average of 7 GAC indicators per PAD. As many as 19 indicators in some PADs. • Only 3 PADs without any GAC related indicators. • Resources and Activities directed towards these GAC activities. • Sanctions for breaking rules included in very few PADs • Incentives to follow rules included in less then half of the PADs • Governance and Accountability are the nuts and bolts of our lending operations (as evidenced by our indicators) which directly and indirectly and perhaps, appropriately, given our World Bank mandate, Borrower relationship and authorizing environment address the anti corruption agenda.

29. For Further Discussion • We plan to look at ISRs and ICRs for a subset of these projects to see if these indicators were followed through in implementation • How can identify fewer indicators, which are focused on (GAC) outcomes? • It should be recognized that, in some cases, indicators have been refined/improved during project implementation • Looking forward to next steps we should look at what are projects actually achieving in terms of GAC? Are projects focusing on the most important GAC issues? What is their contribution to the overall CAS (GAC) objectives? • Looking forward could projects do more to assist in building up recipient-feedback mechanisms? By monitoring how these work if they already exist and then helping to strengthen them. • Looking forward, can we also recommend some regional ESWs - review of recipient feedback mechanisms or incentive mechanisms that already exist in some countries and how that could be used in other countries so there is some cross learning. • Looking forward and back Should we undertake an analysis of rent capture by parastatals to understand Governance issues in a region which has had the most rapid and severe demise of State institutions and transfer of assets to the private sector. • ECSHD is working on a video of Task Team members reflecting on Governance and Accountability measures in their projects. (insert clip here.)