Video Conference Discussion Notes

Video Conference Discussion Notes

CAMBODIA / INDONESIA / PHILIPPINES /VIETNAM

February 17, 2003

Round I

Participants Comments/Questions

In the first round of questions and comments from colleagues in Asia, Cambodia offered its Health Center Committees as an example of an accountability mechanism that works.

From Indonesia came comments about several needs: the need for campaigns to improve public awareness, the need to improve performance indicators and the necessity of linking a focus on the poor to budget priorities.

A participant form the Philippines asked how much of an increase in public spending is needed on average?

A policy analyst from Thailand asked: “Do you have any new ways to address all these problems, because the conventional way is not enough for a country like Thailand.” Another participant asked whether new technologies could be used to help close the gap between rich and poor in education and also commented on the “brain drain” from rural to urban areas which is exacerbating the problem of service delivery.

WDR Team Responses

In his responses, Shanta raised core themes and questions addressed in the report:

Public awareness and understanding among the poor: In general we should be careful not to underestimate the understanding of the poor or the power of poor people. That said, the general concern about awareness underscores the importance of information in equipping poor people to take advantage of service delivery innovations.

Modes of service delivery. The WDR is not advocating any particular technical solutions to problems. What the WDR is trying to do is find service delivery arrangements or institutional arrangements that would themselves generate these technical solutions.

Brain Drain. The critical and difficult issue of talented professionals migrating first from rural to urban areas and then out of the country may be symptomatic of a problem in the compensation arrangement in the public sector in developing countries. We really need to rethink how we approach the compensation of highly skilled public servants, particularly those in professions where there is a global market; and we need to do this before we can address the brain-drain problem.

Round II

Participants Comments/Questions

A participant from Vietnam asked a question about information delivery and how policy makers could help, as well as a question about co-payments. The fairness of making poor people pay for services is being hotly debated in Vietnam. The nation currently has a co-payment system and the question was if you remove co-payments, will poor people end up spending more through unofficial or illegal payments?

With Cambodia the need to build the capacities of CSOs was talked about, and the challenge of empowering poor people was made explicit: “How much opportunity is there for people to raise their voice and reach out to the point that they can monitor” asked an CSO representative. In this round also an informational question was asked about the El Salvador model of education discussed in the overview (EDUCO).

Indonesia raised a number of points. An architect and political activist, noted the need to focus on the near-poor and middle class as well as the poor, since they often suffer the same inequalities and are potentially coalition partners for the poor in building momentum for change. Another participant raised again the importance of information, alluding to Smartplan a concept of educating the client to ask the right questions from providers. He also cautioned against depending on the electoral process to get client-input to policy-makers and asked how the framework should be interpreted. “Is this a hypothesis to be tested? Is it a model to be implemented?…Where are we going with this?”

A speaker from the Philippines urged more emphasis on 1) the intermediation role of CSOs and academe in the interface between clients and policy makers 2) the need for investments in knowledge generation and 3) the need for more good practices on information dissemination to the poor. In particular he was concerned about the fact that although the report says information is vital for the poor to be empowered, “the government does not necessarily communicate enough or communicate effectively enough.” A second speaker also discussed information and knowledge management, and especially wanted to know what to do with the knowledge that organizations gain from their experience, how to use it and how to share it.

From Thailand came the question of what could be done for students who live in rural areas and don’t have access to schools, especially secondary schools. Another question/comment emphasized that the generation of knowledge and the dissemination of knowledge are both key “so communities can combine and distill their knowledge and provide lessons to other communities.”

WDR Team Responses

Co-payments. There were several separate but related points regarding co-payments:

1)An example: The Kyrgyz Republic had the reverse situation to Vietnam’s, they went from informal payments to official payments and found that the amount poor people had to pay went down by 30 percent.

2)When payments are illegal, the payer has much less ability to monitor and discipline the provider.

3)We have to separate the means from the ends when we discuss notions of fairness. The notion of fairness or human rights is a notion of outcomes. What is fair is that poor people have the ability to achieve the same health and education outcomes as non-poor people. That’s a different issue from the means we use to ensure that poor people get those outcomes. It could be that the only way you can guarantee that poor people will have those beneficial health and education outcomes, which is fair, is to have co-payments.

Middle-class buy in. First, the WDR is defining poor people broadly as the non-rich—the people who get bad services and don’t have the option of going to the private sector. Second, often to make services work for poor people you need to make services work! It’s often a question of getting services to work for everybody so poor people can benefit. There are political reasons for this and economies of scale.

Interpretation of the Framework. Quite generally it’s a framework to enable us to understand better both successes and failures.

Investment in research: The products of research are global public goods; the whole world benefits from them, not just the government, which is why as with most public goods, you have a serious problem of under-provision. We say in the report that the World Bank should take responsibility for this kind of thing: We are the global organization and we should be investing in these kinds of global public goods; we should not expect individual governments to pay for the whole thing.

Schools: Building more schools is not always the right way to approach the problem of access; its too much from the supply side, not enough from the demand side. We need to address these problems at least as much from the demand side as from the supply side.

Round III

Participants Comments/Questions

First up in the third round, Cambodia raised concerns about “pushing too fast” toward privatization. Also noted in the Cambodia comments was the importance of Social Funds--funds that get resources directly to communities for infrastructure and other kinds of projects. In relation to Social Funds more support was urged for work that strengthens the capacity of communities to manage and sustain locally-driven development projects.

Indonesia shared news about governance reform programs being undertaken by CSOs, and wanted best practices regarding monitoring as well as mechanisms for sharing best practices on a regular basis. Also discussed was the need to change the system of incentives and disincentives to bureaucrats at every level—local to national. Finally there was a request that the report be explicit about what can be done to empower local people.

In the Philippines, a Department of Health representative voiced again the need for both widespread and systematic evaluation of services and more opportunities to document experience. Another health science professional asked for more case-study examples of situations where the poor have organized to become their own health service providers, and a third speaker asked to know more about the role of the media in information dissemination and wanted to hear success stories about partnerships between service providers and policy makers that show how they can work together to make information available. Also from the Philippines came a question about the impact of population growth on service delivery and a question about the framework. The framework question was: “Do you see a need for a fourth component in the framework to act as a catalyst to provide balance and to help monitor the three other groups.”

Thailand had a couple of questions: First, when its time to cut spending for social services are there right and wrong ways of doing it? Second, what are the preconditions or requirements for decentralization to indeed improve service delivery and are there recipes for how and what to decentralize and lessons that can be learned by countries that are early in the process?

The first question from Vietnam in this round was about promoting the role of CSOs in making services work for the poor, how to do that. Their main comment/question was this: Vietnam is a country where the service provider is state-owned, where the client’s capacity to influence the provider and policy maker or to enforce quality is quite limited but it also is a country where remarkable success in access to quality social services is being achieved. How do you explain this in terms of the framework? Another key comment was about the need to balance infrastructure and social-sector investment.

WDR Team Responses

Privatization: It isn’t really a question of privatizing services. Around the world, these services are already often privatized because the public sector is so dysfunctional poor people bypass it. The real question is how can we improve both the private and the public sectors so poor people will get better service. These improvements might, and often should, involve better regulation of the private sector by the public sector. It also might involve a positive public-sector response to private-sector competition.

The fourth wheel: Civil Society can be a catalyst. Civil Society have at least two roles in the framework: they can be service providers, in which case they are one of the three legs of that triangle; and they can be advocates and intermediaries, in which case they help to strengthen all three legs of the triangle. Donors can also be catalysts, although their behavior can also undermine existing relationships if they go outside them.

Right ways and wrong ways to cut social spending: We should start by identifying those programs that largely benefit the rich without providing equal benefit to the poor such as university subsidies.

Relevance of the triangle to countries like Vietnam: What we are finding is that weaknesses in some of the links can be compensated for if the other links are exceptionally strong. Vietnam may be similar to Cuba where there is not a strong citizen-policy maker relationship but the policy maker cares deeply about health and education outcomes and there is a very strong policy maker-provider relationship. Both are necessary because the policy maker caring about education doesn’t mean that he can make sure that the schools are staffed, that the clinics have medicines in them, that the sanitation is provided and the water in the pipes is running.

Balancing investments in service and infrastructure. One of the mistakes of the past has been to think that investment in roads, for example, is a bit of a luxury and that we should protect social-sector spending more than investment in roads. If you do that you could end up with clinics and schools but no way to get to them. (Case of Zambia)

Selecting services to cover in the WDR. An important thing about the whole report is that we are covering those services that are important for health and education outcomes! It is not just a report about health and education services, it’s about water and sanitation, rural transport and roads as well. We are covering a range of services but staying fixed on outcomes. There are other services that we would have liked to cover but we could not cover everything well so we narrowed our focus. The framework, however, can be applied to any number of other areas as well.