public social expenditures education (2.3 percent of gdp) health (1 percent of gdp) social...
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Public Social Expenditures
Education (2.3 percent of GDP)
Health (1 percent of GDP)
Social protection (1 percent of GDP)
-- equal to $12 per capita and low by international standards on account of low revenue mobilization
(India -$21; Sri –Lanka $37; Pakistan-$13)
Data Requirements for BIA
Data on utilization rates, income level and other background characteristics:
2000 Household Income and Expenditure Survey;
Data on public expenditure, to infer unit cost:
RIBEC and HEU data
accuracy of analysis depends on the level of accuracy of analysis depends on the level of disaggregation of these two types of data disaggregation of these two types of data
Five Steps for Calculating Benefit Incidence:
1. Rank all individuals from poorest to richest by the chosen measure of current welfare—form “Expenditure Quintiles”;
2. Identify which individuals used each type of the publicly
provided services; 3. Calculate the average unit cost of providing each type of
publicly provided service (net of fees, where applicable); 4. Multiply the utilization figures by the government's unit cost
of provision. This then gives the amount of public spending on the good or service going to each group;
5. Summarize results by expressing the subsidy received by a groups as a percentage share in the total subsidy.
Yardsticks to Assess the Distribution of Benefits
Compare benefits:
1. Across population groups (e.g., bottom income quintile, next quintile group, etc.).
Do the poor receive a greater share of benefits compared to their population share?
2. With share of income across population groups.Do the poor receive a greater share of benefits
compared to their share of total national income?
3. With the comparable distribution in other countries.Do the poor in Bangladesh receive a greater
share of benefits compared to their counterparts in other countries?
0
20
40
60
80
100
120
Primary Junior Secondary Secondary High secondary
Gross Enrollment Rates (GER)across income groups
Poorest 20% 2 3 4 Richest 20%
Annual per-pupil expenditure in the education sector, 2000 (Government and Government-aided sector*)
Primary Secondary Tertiary (Subsidy: (government revenue expenditures) Tk 656
($12.6) Tk. 1,404
($27) Tk. 8,063
($155) Private contribution: Fees as a percentage of school cost
19 37 20
Private contributions as a percentage of the overall cost **
36 67 44
* including private Bengali-medium schools and Madrasahs that receive government assistance **using combined (revenue and development) GOB education expenditures
8
12
16
22
42
12
15
17
23
32
22
23
22
19
14
6
11
16
28
40
6
6
10
21
57
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Per-capita expenditure All education Primary Secondary Tertiary
Distribution of Benefits from Public Education Expenditures (in percent, across income groups)
Poorest 20% 2 3 4 Richest 20%
`
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bangladesh Cote d’Ivore Albania Vietnam Bolivia Chile Costa Rica
Distribution of Primary Education Subsidies in Various Countries
Poorest 20 percent 2 3 4 Richest 20 percent
• Similar rates of self-reported morbidity across poor and non-poor, except for Similar rates of self-reported morbidity across poor and non-poor, except for the young and the oldthe young and the old
• Propensity to seek any curative medical services is higher for the non- poor, Propensity to seek any curative medical services is higher for the non- poor, especially for 6 to 10 year old childrenespecially for 6 to 10 year old children
• Government is not the main provider of curative health services, Government is not the main provider of curative health services,
44
8.6
24.2
4.7
9.5
9
33.4
6
24
4.1
21
11.5
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Poor Non poor
Structure of Health Care Utilization (visits to a particular provider as a percentage of the total number of visits) across poor and non poor
Pharmacy Informal Private formal Other, including NGO Government doctor, private practice Government
……but is a main provider of pre-natal, post-natal and but is a main provider of pre-natal, post-natal and immunization services, especially for the poorimmunization services, especially for the poor
5.12.20.63.13.1
18.1
15.9
21.8
30.2
5.7
12.2
2.33
6.1
19.2
13.5
16.3
21.6
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Poor Non poor
Structure of Utilization of Pre-Natal Services across poor and non poor
Other Private Medical college NGO health center District hospital Thana health complex Family welfare center Union sub-center Satellite clinic
Annual Subsidies in the Health Sector, 2000 All Family planning
and control of communicable
disease
Curative care
Child health
Maternal health
Overall Per capita (Tk.) 97.7 23 44.8 18.8 10.5 Per treatment (Tk.)
- 23 625.8 49.2 866.6
Urban Per capita (Tk.) 189.4 38 100.4 30.8 19.4 Per treatment (Tk.)
- 38 980.0 88.9 1489.4
Rural Per capita (Tk.) 74.6 19 31.5 15.8 8.2 Per treatment (Tk.)
- 19 529.8 39.2 707.8
*per-visit expenditure less recovered fees, information on fees available for users of curative care only
Annual Subsidies in the Health Sector, 2000 All Family planning
and control of communicable
disease
Curative care
Child health
Maternal health
Overall Per capita (Tk.) 97.7 23 44.8 18.8 10.5 Per treatment (Tk.)
- 23 625.8 49.2 866.6
Urban Per capita (Tk.) 189.4 38 100.4 30.8 19.4 Per treatment (Tk.)
- 38 980.0 88.9 1489.4
Rural Per capita (Tk.) 74.6 19 31.5 15.8 8.2 Per treatment (Tk.)
- 19 529.8 39.2 707.8
*per-visit expenditure less recovered fees, information on fees available for users of curative care only
8
12
16
22
42
16
19
21
18
26
18
18
19
19
24
11
21
22
18
28
20
13
20
18
29
23
21
19
18
18
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Per-capitaexpenditure
All healthexpenditure
Family planningand control ofcommunicable
disease
Limited curativecare
Maternal health Child health
Distribution of Benefits from Public Health Expenditures, (in percent, across income groups)
Poorest 20 percent 2 3 4 Richest 20 percent
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bangladesh Vietnam Ghana India (curative) Malaysia(inpatient) Malaysia (out patient)
Distribution of Health Subsidies in Various Countries
Poorest 20 percent 2 3 4 Richest 20 percent
Public expenditures in social sectors play important redistributive role, although not pro-poor overall;
Their pro-poor bias could be greatly improved;
The major constraints to more pro-poor incidence are:
• High private cost involved and the poor are less able to pay;• Under-the-table payments are comparable with actual fees;• Fees are charged for services that should be provided free;• Leakages in program resources;
…in addition it is not clear who ultimately benefits from private practices of government doctors.
In Summary,
How can equity and efficiency of social expenditures be improved?
Use area-based poverty indicators for allocating public funds to the social sectors:
• distribution of free teaching and learning materials in primary education;
• allocations to Female Stipends Program in secondary education;• budgetary allocations in the health sector (i.e. de-link them from beds
and staff, and anchor them on caseloads and poverty)
Increase public access to information through Client Satisfaction Surveys, Participatory Monitoring and Evaluation, Public Expenditure Tracking Surveys
Continue emphasis on primary education, especially on improving its quality and sustaining efforts to boost demand
Increase public expenditures for the expansion of pre- and post-natal care Intensify efforts to deliver basic health services to hard-to-reach
populations, especially urban slum dwellers
How can equity and efficiency of social expenditures be improved?
continued
Rebalance expenditures on labor and non-labor teaching inputs
Expand the program of contracting out to NGOs and the
private sector for the management of non-performing government schools and non-formal education
Increase community involvement, but with a critical evaluation of existing SMCs
Use examination results as well as other performance-based criteria to direct subvention payments to performing schools, particularly at the secondary and degree college levels
How can equity and efficiency of social expenditures be improved?
Shift university funding from financing private services (Undergraduate and Masters degree-level education) to those functions of higher education that are more nearly public goods
Introduce fees for university undergraduates and masters
courses, accompanied by a means-tested scholarship program and, possibly, by a government supported loan program
Develop an adequate regulatory framework for different health
providers --Government, NGO and private Set up health consumer councils at national and regional levels
to promote self-regulation and strengthening consumer voice