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Transparency and Accountability Program Independent Monitoring Organization Studies (2007

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Title: Transparency and Accountability Program Independent Monitoring Organization Studies (2007


1
Transparency and Accountability
ProgramIndependent Monitoring Organization
Studies (2007 2008)
2
Albania Center for Economic Research (ACER)
  • Expenditure tracking of health facilities
  • Primary Health centers, Hospitals
  • Survey of institution heads, local officials,
    patients
  • Results
  • Despite recent decentralization efforts,
    researchers found evidence that health funding
    decisions are made by a handful of Ministry
    experts and politicians
  • Rather than working to bolster public trust in
    primary care facilities, the central government
    allocates 50 of the health budget to hospitals,
    leaving primary facilities severely underfunded
  • Although the government ensures health insurance
    for all citizens, ACER survey provides evidence
    that less than half of the population is insured

3
Bandung Institute for Governance Studies (BIGS) -
Indonesia
  • To discover how well local governments are doing
    in health and education service delivery, BIGS
    examined budgets for 3 cities in West Java
  • Desk study (unpublished data), Interviews (Local
    and Central Level), and FGDs
  • Results
  • Lack of clarity about budgeting responsibilities
    among levels of government
  • By simply examining 2004 - 2007 budget data, BIGS
    found that local officials (like national
    officials) are not reaching the spending targets
    for health and education

Health Target ( budget) Health Actual ( budget) Educ. Target ( budget) Educ. Actual ( budget)
Banjar 15 9.7 13.4 20 -
Sumedang 15 7.7 10.3 20 5.6 25.6
Bandung 15 4.4 6.1 20 28.6 30.3
Provincial (W. Java) 15 1.9 20 4
National 15 1.8 20 4 7.1
4
Centro de Análisis y Difusión de la Economia
Paraguaya (CADEP) - Paraguay
  • Expenditure tracking in primary schools around
    Asuncion
  • Surveys of school directors, teachers, parents,
    and Ministry of Education officials
  • Reviewed budget data and primary site analysis
  • Results
  • Found that budgeting is too opaque to be
    monitored by civil society
  • Principals, though responsible for budgeting,
    lack skills/training to manage budget (20 out of
    23 principals unable to budget)
  • Parent associations frequently pay for
    maintenance and services such as electricity and
    water
  • Programs fail due to lack of knowledge by MoE (ex
    - Academic Kit program)
  • Researchers utilized the high interest and
    engagement of parent associations to develop
    posters for schools outlining how parents and
    students can start to monitor education services
    and to whom problems should be reported

5
Centre for Budget and Policy Studies (CBPS) -
India
  • Evaluated health and education budget data for
    two districts in Karnataka
  • Udupi richer, more progressive
  • Chitradurga more rural, worse development
    indicators
  • Results
  • Found that spending decisions do not reflect
    local needs requests of districts (ZPs) are not
    reflected in allocations from State
  • Incomplete and ineffective record-keeping on ZP
    spending (for example, no record of salary versus
    non-salary expenses)
  • Funding does not reflect deomgraphic changes
    drastic increase in patients in Chitradurga
    (2003-5) met with 11 cut in health spending
  • Recommend greater communication between ZP and
    State in determining budget allocations
  • Impact
  • Analysis, findings, and video are being used by
    advocacy NGOs that could not do this work
    themselves, one of the goals of CBPS.
  • Video showed some government officials explaining
    away the problems and other successfully acting
    to solve them.

6
Center for Democratic Development (CDD) - Ghana
  • Teacher absenteeism study in Ghana primary
    schools
  • Surveys (teachers, head teachers) and unannounced
    visits to schools in 3 districts
  • Results
  • Found 47 of teachers were absent at least once
    during 5 school visits
  • Absence rates higher among professional teachers
    (57 vs. 36), males (50 vs. 41)
  • School characteristics such as staff room, access
    to potable water, and close proximity to health
    clinic associated with lower teacher absence

Recommendation
Evidence that teachers miss class to collect
salaries
Absenteeism and active PTA negatively correlated
7
National Center for Economic Research (CIEN) -
Guatemala
  • Expenditure tracking of 6 primary school programs
    in Guatemala City
  • Scholarships, Meals, Milk, Textbooks, Supplies,
    Teaching Kits
  • Surveyed students, teachers, and parents
  • Results
  • Funding inadequate Meals and Milk programs
    especially underfunded (27 and 28 reported
    sufficient funds for all students respectively)
  • Major delays in funds/supplies arriving in
    schools

Impact
8
Center for Implementation of Public Policies
Promoting Equity Growth (CIPPEC) - Argentina
  • Estimated incidence and cost of high school
    teacher absenteeism and school closures in 2
    districts in province of Buenos Aires
  • Florencio Varela 27 households with unmet
    needs
  • San Martin 11 households with unmet needs
  • Results
  • Found 40 higher Absenteeism in Florencio Varela
  • Reported causes of absenteeism personal illness
    (40), family illness (14), unknown reasons
    (18)
  • Few principals try to curb absenteeism those
    who do use distribution of statistics about how
    disruptive absenteeism is, dock pay, or mark
    teachers down on annual evaluations (resulting in
    union pressure)
  • Recommend improving conditions for teachers and
    methods of record-keeping

Florencio Varela San Martin ALL
Class time lost to absenteeism and school closures () 32 19 25.5
Estimated monthly cost of absenteeism and school closures (per school) AR 1,165 AR 693 AR 913
9
Research Center of the University of the Pacific
(CIUP) Peru (1 of 2)
  • Analysis of implications of Results-Based
    Budgeting reform in Peruvian health and education
    sectors
  • Pilot primary education, maternal and neonatal
    care
  • National budget data and limited interviews
    (beneficiaries, program officials)
  • Results
  • Maternal and neonatal care government spending
    per doctor visit is significantly lower in poorer
    regions (lowest quintile resources are 70 of
    highest quintile resources)
  • Primary education significant variation in
    per-student spending which does not seem to
    follow a clear trend
  • Researchers argue that all of these issues need
    to be addressed for results-based budgeting to be
    effective in Peru

10
Research Center of the University of the Pacific
(CIUP) Peru (2 of 2)
  • Expenditure tracking in specific health programs
  • (1) Immunization and (2) Tuberculosis Prevention
    and Controls
  • Health centers in Lima Metropolitan Area
  • Surveys of staff and government data
  • Results
  • Complex processes of approving expenditures and
    obtaining funds means that facilities mitigate
    delays by getting credit from equipment
    providers, requiring staff to put in extra unpaid
    hours, or director pay out of pocket
  • Significant delays only 1 of 14 sampled
    facilities had not run out of essential supplies
    during the previous year
  • Undersupplied pharmaceuticals one facility
    reported undersupply of 25 of pharmaceuticals it
    should carry, and 18 of 33 Health Directorates
    lacked at least 1 pharmaceutical needed in
    treatment of TB (a national health priority)
  • Significant communication problems between Health
    Network and facilities 33 and 29 of
    facilities reported delays in Primary Plan TB
    medications and Vaccination supplies
    respectively, while the Health Network reported
    no delays in either
  • Personnel requests not filled in many facilities
    (5 of 13 that requested additional doctors
    received none)

11
Gdansk Institute for Market Economics (GIME)
Poland (1 of 2)
  • Investigates the financing system in health and
    education
  • Analysis of data from Statistical Office and
    Ministries
  • Results
  • Misinformation among officials regarding funding
    sources many politicians reported that they
    believed that national subsidies should cover
    100 of education costs
  • Questionable priorities in education subsidies
    subsidies to tertiary institutions increased 90
    between 1999 and 2006 while subsidies as a whole
    fell between 2001 and 2006
  • Examining the algorithm for education subsidies,
    GIME found that it did not take into account
    adverse circumstances of schools that lead to
    poor performance (ex overcrowding) or school
    ability to draw from local funding

12
Gdansk Institute for Market Economics (GIME)
Poland (2 of 2)
  • Study of hospital financing and debt in Poland
  • In-depth analysis of previously unanalyzed data
    of all hospitals in the country for 2004-2006
  • Case studies of hospital efforts to reduce costs
    and debt
  • Results
  • Hospitals operating by taking on massive debts
    (debt grew from PLN 6.7b to PLN 8b between 2004
    and 2006)
  • Indebted hospitals have difficulty paying
    suppliers, employee social insurance
    contributions, and salaries, increasing
    incentives for doctors to leave for private
    sector
  • Although debt is high, 62.7 of hospitals had
    declining debt between 2004 and 2006
  • Hospitals that had great success decreasing debt
    undertook strategies such as tailoring services
    to the greatest patient needs, employing doctors
    by contract, or receiving substantial help from
    local governments

13
Institute for Development and Social Initiatives
(IDIS) - Moldova
  • Evaluation of education financing in Moldova in
    context of recent decentralization efforts
  • Interviews with local officials and school
    directors
  • Results
  • Found that budgeting remains highly centralized
    despite decentralization efforts MoF defines
    salaries and draws up funding norms based on
    enrollment information from MoE, leaving local
    governments with little say over spending
  • Funds from MoF do not reflect norms 29 of 30
    surveyed schools reported that funding from
    central government does not cover costs
  • Gaps in funding often filled by donors or parents
    parents associations funded school repairs and
    improvements in 25 of 30 sampled schools

14
Indo-Dutch Project Management Society (IDPMS) -
India
  • Focused on service delivery in primary health
    centers in 2 districts of Karnataka (CR Nagar,
    Bellary)
  • Surveys of PHC personnel and patients
  • Results
  • Often no doctor is available for official and
    unofficial reasons (37 of days PHCs are open)
  • Replenishment of 6 common drugs can be delayed 6
    to 8 months
  • Pharmaceutical budget of 100,000 rupees/PHC is
    insufficient
  • Recommend specific activities for NGOs to support
    improved healthcare service delivery

Cases per PHC - Bellary Cases per PHC CR Nagar Medicine Costs Required Budget - Bellary Required Budget CR Nagar
Fever 218 83 224 48,729 18,609
Resp. Ailments 728 1,188 132.8 96,669 157,813
Food/H2O diseases 993 1,275 132.8 131,855 169,325
Vector-borne diseases 502 1,011 320 160,646 323,635
TOTAL 437,900 669,382
15
Institute for Policy Research and Analysis (IPAR)
- Kenya
  • Expenditure tracking of Secondary Education
    Bursary Scheme in Nairobi province
  • Survey of principals and Constituency Bursary
    Fund Committees, FGDs with students
  • Disbursement records
  • Results
  • Delays in fund disbursement up to 99 days
    delay, with only one of eight constituencies
    recording a lag of less than 10 days (especially
    problematic because beneficiaries must miss
    classes until funds arrive)
  • Potential leakage of funds Ministry records
    reports 52 more beneficiaries than IPAR surveys
    reveal (similar result in monetary disbursement
    data)
  • Misallocation of funds 20 of sampled schools
    report funds allocated to students no longer in
    school, 27 report students receiving double
    bursaries
  • Per-student bursaries insufficient less than
    0.5 of students in sampled constituencies
    receive highest bursary amount (KES 15,000) which
    does not fully cover cost of boarding or national
    schools (84 received lowest award KES 5,000)
  • Recommendations include better record-keeping,
    timely release of funds, and shifting allocation
    of funds to fewer students who can actually use
    them

16
Institute for Policy Research and Analysis (IPAR)
- Kenya
  • Evaluated incidence and causes of health worker
    absenteeism in Machakos district
  • Hospitals, sub-hospitals, health centers,
    dispensaries
  • Unannounced visits (am, pm) and interviews with
    facility directors
  • Results
  • Estimated 25 absenteeism for health workers
  • Estimate cost of KES 6.7m (85,000) per month
  • Skilled technical workers more likely to be
    absent
  • Recommendations
  • Decentralize hiring/firing authority
  • Improve methods for monitoring absenteeism

Profession Absence ()
Nurses 18.9
Lab Techs 39.1
Clinical officers 21.5
Medical doctors 28.5
Public health staff 13
Pharmacists 41.6
17
Integrated Social Development Center (ISODEC) -
Ghana
  • Examined local, regional, and national budgeting
    in health and education
  • Budget data 2001 2007
  • Surveys and FGDs with range of stakeholders
  • Results
  • Found failure of communication between
    departments and agencies (horizontal and
    vertical)
  • Long-term development planning is difficult
    because investments in health and education are
    fully funded by donors (highly variable)
  • With one exception (education spending in
    Northern Region), planned expenditures
    consistently significantly exceed actual funding
    from central government
  • Recommend promoting monitoring of budgets by CSOs

18
Institute for Urban Economics (IUE) - Russia
  • Evaluated whether spending in 2 districts
    (Chuvash, Kalingrad) reflected stated Russian
    priorities in health and education
  • Study of budget data from Statistical office and
    Ministries
  • Results
  • Central government devoting increasing resources
    to health (2.8 to 3.2 of GDP) and education (3.5
    to 3.8) between 2004 and 2006, with regions
    echoing this trend
  • Governments shifting towards a single channel of
    health care spending
  • Regions taking on greater share of education
    funding
  • Increased spending is in part being directed
    towards investment in both health and education
  • Government still falls short of target for health
    spending (5 of GDP) and pre-primary education
    coverage

19
Centre for Regional and Information Studies
(PATTIRO) - Indonesia
  • Evaluated specific education funding schemes
  • Central, Provincial, and District
  • Schools receive money from 7 different funds (2
    operating funds and 4 investment funds from
    various levels, plus 1 textbook fund)
  • Quantitative questionnaires and qualitative
    interviews, FGDs in 38 schools
  • Results
  • Delays in operating funds up to 3 months
  • Unplanned cuts in allocated funds (for district
    operating funds, unplanned cuts in every school)
  • Allocations do not reflect needs of schools (ex
    school requests money to renovate classrooms,
    instead gets funds to build 100m fence around
    500m perimeter)
  • Reports of funds leaked as payoffs to
    influential persons and as gratitude money to
    bank and post office employees in transfer stage
    (in 12 out of 20 transfers for one operating
    scheme)

20
Romanian Academic Society (SAR)
  • Focused on study of piloted decentralization
    effort in education financing
  • Survey of general schools in urban and rural
    areas, mixed ethnicity
  • Questionnaires, interviews, and data from MoE and
    School County Inspectorate
  • Results
  • Expenditures do not reflect demographic changes
    although 75 of surveyed schools experienced
    declines in students, expenditures did not
    decrease
  • Regression analysis found no good predictors of
    per-student spending, leading researchers to
    conclude that budgets are inert rather than
    changing to reflect needs of schools
  • School structure does not empower principals to
    lobby for resources they need no clear channel
    for principals to request changes in funding from
    local governments
  • Recommendations
  • Shape recommendations around three possible
    scenarios of education spending reform
    increasing the status quo, implementing
    decentralized spending, and linking spending with
    educational quality
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