As Jennifer Adams notes in her paper, a number of studies within the U.S., as well as some studies in China and other low- and middle-income countries, have begun to address the ways that communities impact schooling outcomes. The potential role played by communities in local education has strengthened with the shift toward administrative and fiscal decentralization in many developed and developing countries. Often, fiscal decentralization results in a greater reliance on community financing of schooling, which, in turn, strengthens the association between where students live and the quality of educational services they receive (Bray, 1996a, 1996b).
Only for the recipients of foreign aid is something akin to central planning seen as a way to achieve prosperity. The end of poverty is achieved with free markets and democracy—where decentralized “searchers” look for ways to meet individual needs—not Poverty Reduction Strategy Papers (PRSPs) to achieve Millennium Development Goals (MDGs). The PRSPs and MDGs create lots of bureaucracy but hold no one specific agency in foreign aid accountable for any one specific task. Planners in foreign aid use the old failed models of the past—the “Financing Gap”, the “poverty trap”, the government-to-government aid model; and the “expenditures = outcomes” mentality. Searchers in foreign aid would imitate the feedback and accountability of markets and democracy to provide goods and services to individuals until homegrown markets and democracy end poverty in the society as a whole. An example of the more promising “searchers” approach in foreign aid is 2006 Nobel Peace Laureate Mohammad Yunus and Grameen Bank.
The Nicaraguan Autonomous School Programme is notable among the growing number of school governance decentralization reforms in the Americas in the degree of control given to parents, especially in decisions regarding the allocation of school resources. Much of schools’ discretionary spending was accumulated through various school charges. This paper analyses rare school‐level budget data to determine the proportion of resources that derived from parental contributions and other school‐based commercial activity. We find the contributions to be significant, highly varied, and correlated with income. The results have implications for many decentralization reforms that encourage local contributions as part of both their financing and accountability strategies.
Abstract In 2002 the World Bank issued a US $ 300 million loan to Mexico to finance an education reform project. The loan is the second phase of a three‐part Adaptable Program Loan (APL). A brief description of the 136‐page World Bank reform project is initially detailed and contrasted with a historical perspective. The Multiple Streams Model is used to determine why this education reform has come to fruition. Finally, the Frank Model is used to assess viability of this phase of the APL. It is concluded that this loan takes great national steps toward modernization, decentralization, and democratization. The adaptability of the loan is quite evident and proactive. Success of this project is promising, but the World Bank must not forget the cultural needs of the indigenous peoples.
Fundamental changes in China's finance system for social services have decentralized responsibilities for provision to lower levels of government and increased costs to individuals. The more localized, market-oriented approaches to social service provision, together with rising economic inequalities, raise questions about access to social services among China's children. With a multivariate analysis of three waves of the China Health and Nutrition Survey (1989, 1993 and 1997), this article investigates two dimensions of children's social welfare: health care, operationalized as access to health insurance, and education, operationalized as enrolment in and progress through school. Three main results emerge. First, analyses do not suggest an across-the-board decline in access to these child welfare services during the period under consideration. Overall, insurance rates, enrolment rates and grade-for-age attainment improved. Secondly, while results underscore the considerable disadvantages in insurance and education experienced by poorer children in each wave of the survey, there is no evidence that household socio-economic disparities systematically widened. Finally, findings suggest that community resources conditioned the provision of social services, and that dimensions of community level of development and capacity to finance public welfare increasingly mattered for some social services.
What is best strategy to reach the Millennium Development Goal of basic education for all will depend on the specific country context.This paper introduces an input-output method to estimate the financial inputs required to achieve the MDG for primary education and an additional target of enhancing access to secondary education. 1As such the approach followed here is not new, but the innovative element is combining educational demand and supply variables considering both cost dimensions and quality of services as measured among others through test scores (outcomes), quality of school inputs and the nature of delivery of services (privatepublic, centralized or decentralized).We take the following analytical steps: (i) define a production function for specific education outputs (enrolment), (ii) isolate the main determinants of such output (considering both demand and supply factors); (iii) estimate costs per unit of producing such output, and -based on estimated elasticity's and unit costs ensuing from the education production function -(iv) calculate the financing needs of reaching key education goals.We find that determinants of access to schooling are significantly different for urban and rural and for poor and non-poor children.Furthermore, the determinants also differ when referring to access to primary or secondary education.Quality of school inputs does matter in all cases though to varying degree.Particularly, class size, shares of trained teachers and greater school autonomy (in hiring teachers and managing schools) are relevant.Quality of education outcomes, i.e. test scores, while very poor in Ecuador does not seem to influence school enrolment.The upshot is that with a more cost-effective use of resources for primary education, the MDG target of 100% of net primary school enrolment in urban areas is within reach in a period of 4 to 5 years at virtually no additional budgetary cost.Meeting the target for the rural population seems more complicated.In secondary education, important progress can be made to reach a target of 70% net enrolment (with important expected positive externalities for economic growth) by enhancing the share of trained teachers, expand coverage of school demand subsidies and improve class infrastructure.This target is within reach for the poor and non-poor urban population by 2007 at an estimated additional cost of 1 Vos is with the Institute of Social Studies (ISS), The Hague and the Free University Amsterdam.Ponce is with FLACSO-Ecuador and is also a PhD candidate at ISS.
Introduction There is global consensus on speeding up action against HIV/AIDS to mitigate the impact of the epidemic as rapidly as possible. However, there are no common blueprints on how to organize and manage accelerated HIV/AIDS prevention, care and support programmes to be followed by countries. Countries have tried to develop their intervention measures on the basis of local realities and international experiences available to them. The Ethiopia HIV/AIDS programme implementation process involves a high degree of the learning-by-doing approach, which capitalizes on positive lessons learned further to speed up action against HIV/AIDS. This article is a modest contribution and an example of what can be done in Africa in response to the epidemic in terms of project preparation and implementation (Table 1). It is hoped that some of these experiences can provide useful lessons for the preparation and implementation of HIV/AIDS prevention and control programmes in other countries.Table 1: Landmarks in the history of HIV/AIDS interventions in Ethiopia. Brief history of HIV/AIDS in Ethiopia and rationale for intensified action AIDS is now the leading killer in sub-Saharan Africa. Globally, Ethiopia has the sixteenth highest prevalence of HIV/AIDS and the third largest number of people living with HIV/AIDS (PLWHA), after South Africa and India. The primary modes of transmission in Ethiopia are sexual contact (heterosexual) and perinatal/mother-to-child transmission. Although the magnitude of the problem has yet to be sufficiently assessed, harmful indigenous practices and unsafe needle injection may be considered to be mechanisms for the spread of the virus in view of the wide practice in Ethiopia. The first evidence of HIV in Ethiopia was noted in 1984, and the first two AIDS cases were reported in 1986. HIV prevalence remained low in the 1980s, but has increased rapidly since the early 1990s. HIV prevalence increased from 3.2% in 1993 to 7.3% in 2000 (Fig. 1) [1]. During the same period, increasing trends were noted among women attending antenatal clinics in sentinel surveillance sites with notable regional variations. Estimated adult HIV prevalence according to the Ministry of Health in November 2000 was 16.8, 13.4 and 5% for Addis Ababa (capital city), other urban areas and rural areas, respectively.Fig. 1.: Ethiopia – adult HIV/AIDS prevalence.Initial HIV/AIDS-related activities in Ethiopia A National Task Force for HIV/AIDS was established in 1985. Two medium-term HIV/AIDS prevention and control plans were designed and implemented between 1987 and 1996, with the emphasis on information, education and communication, condom promotion, surveillance, patient care and the expansion of HIV screening laboratories in different health institutions. However, the interventions were limited in scope and there was little involvement of communities, sector ministries, non-governmental organizations (NGOs) including religious organizations and private organizations. The extent of interventions did not correspond to the fast spreading nature of the infection. Factors leading to organizational changes in the management of HIV/AIDS programme Global evidence of the adverse effects of unchecked HIV/AIDS epidemics on the socioeconomic situation of countries and the international movement to scale up action against HIV/AIDS have in no small way influenced the Ethiopian government to take accelerated action against the HIV/AIDS epidemic. Also, the First International Conference on AIDS in Ethiopia held in Addis Ababa on 7–10 November 1999 provided an additional forum for generating the support and commitment of high government officials to enhance HIV/AIDS interventions in Ethiopia. The government of Ethiopia became conscious of: (i) the devastating effects of the increasing infection rate that had reached epidemic proportions; (ii) the devastating impact of HIV/AIDS with the huge number of deaths severely straining the traditional social coping mechanism (the EDIR, a social organization created by communities to support families during funerals); (iii) the weaknesses of the existing organizational set-up to handle the rapid progress of the infection; and (iv) the common understanding that if the epidemic is left unchecked, it will alter the trajectory of the country's development by retarding growth, weakening human capital, discouraging investment, exacerbating poverty and increasing inequality. Ethiopia, therefore, in August 1998 approved a comprehensive HIV/AIDS policy to provide guidance and direction to the preparation of a multi-sectoral and multi-partner HIV/AIDS prevention and control programme. A National HIV/AIDS Council composed of ministers, regional heads of state, civil society, religious leaders, NGOs and PLWHA was established under the chairmanship of the President of the Federal Democratic Republic of Ethiopia in April 2000. The National Council has appointed the National Advisory Board, which meets monthly to provide direction and guidance to the implementation of the multi-sectoral HIV/AIDS control and prevention programme through the National HIV/AIDS Secretariat and its Project Coordinating Unit (PCU). Regional and local coordinating bodies were also established to facilitate the implementation of HIV/AIDS interventions at the community level. Influence of global HIV/AIDS movements on HIV/AIDS programmes in Ethiopia Globally, HIV/AIDS is now treated as an economic crisis and not merely a health problem. Successful HIV/AIDS interventions under such circumstances require actions as broad as the epidemic itself and intense enough to respond effectively to the level reached by the epidemic. The resource needs of such massive interventions are too enormous to be sufficiently addressed by many developing countries. A number of international agencies have expressed readiness to increase their commitment substantially in the fight against HIV. In order to realize this commitment, an International Partnership Against HIV/AIDS in Africa was formed, and UNAIDS was established co-sponsored initially by UNICEF, UNFPA, UNDP, UNESCO, WHO and the World Bank. The number of co-sponsors has since increased. The co-sponsors and UNAIDS secretariat met in Annapolis, Maryland, USA, on 19–20 January 1999, and agreed to work together to slow the spread of HIV in Africa drastically, and enhance a sustainable political and social mobilization at an unprecedented scale in order to reduced HIV transmission and suffering and to mitigate the impact of HIV/AIDS. The World Bank, conscious of the crisis created by the epidemic and the consequences of inaction, and convinced that it could play a greater role in HIV/AIDS prevention and control, prepared a strategic document in May 1999 [2] entitled ‘Intensifying action against HIV/AIDS: responding to a development crisis'. The Bank's new strategic plan placed HIV/AIDS at the centre of its development agenda to combat the epidemic, in partnership with African governments and UNAIDS. To stimulate and support the implementation of the strategy, the World Bank took three major actions: (i) established a multi-sectoral AIDS Campaign Team for Africa (ACTAfrica); (ii) directed all bank projects to include an HIV/AIDS component; and (iii) made available an initial US$500 million fund to be drawn by African countries to scale-up their HIV/AIDS interventions. A second amount of US$500 million was recently approved by the board of the World Bank. The global mobilization efforts have to a great extent encouraged the government of Ethiopia to intensify the action against HIV/AIDS to reverse the tragic situation. Enabling environments (internal and external) created to scale-up HIV/AIDS interventions in Ethiopia The global movement to accelerate and expand action against HIV/AIDS has created a potential for the increased availability of essential resources to developing countries. In Ethiopia a number of international and bilateral donors (e.g. WHO, UNICEF, UNDP, UNFPA, UNAIDS, ILO, USAID, DFID, GZT, DANIDA, Irish Aid, Norway, the Netherlands, Italy, the World Bank) have either provided support or are finalizing their project support. The government of Ethiopia approved a multi-sectoral and comprehensive HIV/AIDS policy that created an enabling environment for a wide range of HIV/AIDS prevention and control activities. The establishment of the National HIV/AIDS Council, the Advisory Board, National and Regional HIV/AIDS Secretariats, and their decentralized bodies have established potentially appropriate organization and management structures to lead expanded and intensified HIV/AIDS interventions throughout the country (Fig. 2).Fig. 2.: Organizational structure for HIV/AIDS management programme. NGOs, Non-governmental organizations.The World Bank has made funds available to countries including Ethiopia to draw from its initial allocated fund for HIV/AIDS. The Ethiopia Multi-sectoral HIV/AIDS Project (EMSAP) finances a 3-year (2000–2003) government HIV/AIDS strategic plan that is estimated initially to cost US$63.4 million [3,4]. The World Bank has approved US$59.7 million to help pay for the project, of which more than US$28 million is earmarked to support civil societies and community-driven HIV/AIDS initiatives. The process undertaken during the preparation of the Ethiopia Multi-Sectoral HIV/AIDS Project After formulating the national HIV/AIDS policy and preparing the National HIV/AIDS Strategic Framework [5], the Government of the Federal Democratic Republic of Ethiopia requested the World Bank to support its efforts to accelerate and expand action against the epidemic of HIV/AIDS in the country. As the request was in line with the global commitment and strategic plan of the Bank, the Bank agreed to the Government's request as long as there were institutional arrangements in place, such as the formation of a National AIDS Council, the establishment of the National Secretariat and the appointment of a National Task Force to lead the process of project formulation and development. The National HIV/AIDS Council was inaugurated in April 2000, and the appointment of the head of the National Secretariat was announced in the same forum. The preparation of EMSAP started in July 2000. Again at the request of the Government of Ethiopia, a multi-donor HIV/AIDS identification and preparation mission was undertaken to facilitate the preparation of a fundable project for an HIV/AIDS prevention and control programme in Ethiopia. A preliminary consultation workshop was held early in July 2000 to assess the prevailing HIV/AIDS situation in the country, and suggest the scope and actions to be undertaken to address the epidemic. The participants included members of the newly formed National HIV/AIDS Council, representatives of major sector ministries, regional state representatives, NGOs, and members of the civil society (women, youth, PLWHA, religious organizations, academic institutions) and donors. On the basis of the briefing on the status of HIV/AIDS and discussions that followed, the meeting agreed on actions that needed to be taken to mitigate the effects of the epidemic rapidly. The meeting stressed the following points during its deliberations: That HIV/AIDS activities should be guided and directed by the highest authority in the Government and the National HIV/AIDS Secretariat should be directly under such an authority that commands respect for its directives by all concerned. HIV/AIDS activities should be community based and driven. A special emergency grant fund should be created to support civil society and community-based initiatives. The fund should flow directly to communities, circumventing the normally bureaucratic financial system of the Government. The establishment of such a financial system would help ensure a fast flow of funds to support communities to engage rapidly in scaled-up HIV/AIDS interventions. NGOs, private organizations, community-based organizations and PLWHA should be actively involved and supported to expand their HIV/AIDS interventions by directly providing grant funding to support their activities. The project should be designed in a way that provides flexibility. The participants of the meeting outlined the objectives, components and logical framework for EMSAP. On the basis of the strategic plan and the logical framework, the National AIDS Secretariat Task Force, with technical support from World Bank staff and other donors, developed a draft multi-Sectoral HIV/AIDS Programme. The main objective of EMSAP is to help reduce the spread of the HIV/AIDS epidemic, alleviate its impact, and increase access to treatment, care and support for those infected and affected by HIV/AIDS. The components of the project were identified as including: (i) capacity building of public and private institutions; (ii) the Government multi-sectoral (iii) the response of communities, NGOs and the private sector to mitigate the and (iv) project and A draft project document was prepared and to a second The draft document was also for to of the during the initial meeting and an international mission composed of UNAIDS and bilateral institutions. The draft document was on the basis of the and provided by and a document was which the Government for funding to donors. Brief of components and activities The project components the scope of activities that have to meeting the agreed The country has a limited public capacity to the newly HIV/AIDS programme. It was to the institutional capacity of Government civil society and the private sector at and to accelerate the implementation of the HIV/AIDS programme. in this include the of human and other to the national and regional and and HIV/AIDS bodies in the were on EMSAP and were to the Project and other and the multi-sectoral implementation response of government agencies The of this is to support the multi-sectoral response of government organizations to scale up their interventions in the fight against the expansion of HIV/AIDS. The initial interventions prevention condom and and and care and support for those infected and affected of financial and support to PLWHA and in this government organizations at the level have established HIV/AIDS and their work plans and for and by the National Advisory the work plans and were approved and funds have to of (Table approved and for projects by non-governmental organizations, private organizations and people living with HIV/AIDS by the National HIV/AIDS The Ministry of has held and and HIV/AIDS for and and is the formation and of The Ministry of has up condom availability and the and of The authority has not the of HIV/AIDS interventions as and condom infection and as of the with but also is in the process of HIV/AIDS interventions among its and work regional sector have developed and their work plans and to the regional HIV/AIDS fund The emergency HIV/AIDS fund is an of EMSAP. A number of NGOs and community-based organizations in the country are to potential that could be by providing additional and including The is designed to support NGOs, the private religious organizations and community-based organizations to scale up their HIV/AIDS prevention and control activities in order to reduce the of the epidemic as fast as possible. The has two for and and the other for NGOs, private organizations, PLWHA and civil societies for all two with and NGOs religious and private organizations have from the of the fund (Table programmes and care and support to those infected and affected has increased in scale and scope in of the and communities supported by of funds by the Project Coordinating Unit to ministries, regional and HIV/AIDS Although there are in the country, International support for community-based programmes will be in for the There have to increase the number of support. The is not the of funds but the capacity to provide the support to The process of implementation also involves that require of the experiences the of an is to what has and what needs to be or The process involves a high degree of learning-by-doing a of experiences Project and management The main of this is to help develop a and management system that is of coordinating and the the National Secretariat is the management and is to a under the direction of the National HIV/AIDS Secretariat The is with structures that include programme and and The of funds to International Government of of NGOs, non-governmental National Project Coordinating people living with Regional The has established with the essential and The provides support to the establishment of the regional The has more than for funding at a national and has the of some funds to the appropriate A and has established and a and has appointed in an to a and system for HIV/AIDS in the country. process and impact have identified to help the and of the an HIV/AIDS system has developed with the of The Ethiopian and with support from the is actively involved in HIV/AIDS the support of USAID, Health International is a on HIV/AIDS. of these are to to and the effects of the interventions. of the Ethiopian project EMSAP is by communities, NGOs and donors. the US$63.4 the is US$59.7 million The is to be by donors, NGOs and The financial management system two of the funds is provided through the government fund flow and the other is directly to that have established and financial control the of the preparation of many expressed a to support the project, but the created an that in a After the of in the a number of donors have to support the Government's HIV/AIDS programme. became on January this the World Bank is the major to the The major and experiences in the implementation of the project National and regional and have established and The and have formed in the first of and were appointed and are in and coordinating community-based activities. have funds from the centre and have started up HIV/AIDS interventions. activities have is as by the increase in the number of HIV/AIDS is with by private and public in a of in the for HIV/AIDS is through the UNAIDS In briefing are by the to on the status of implementation of the The financial and system and organization and have prepared to the management of the project at and other have provided to the and the regional to facilitate and activities. have placed for the of and to and the of by health institutions. for have prepared and In view of the by the of the epidemic, the management of the national and regional had to be rapidly and in a There was little for the and to and the implementation process of the project In the project has a a number of and which made In view of these the progress in implementation is not as fast as for an emergency The project is implemented by many and decentralized and were prepared and to coordinating and bodies to the implementation of the project the have useful in the implementation However, there is a to ensure to facilitate the of the to different The project by massive involvement of NGOs, the private sector and community-based organizations to scale up HIV/AIDS prevention and control interventions to mitigate the impact of the epidemic rapidly. This epidemic a coordinating mechanism at all as the government would to facilitate the of these in the and management capacity of the and regional have the of all those to be actively The of government is an of EMSAP. Although it is to that some sector have expanded their HIV/AIDS a number of require and support to increase the scope of their HIV/AIDS interventions. The development of the and system was special from the of the composed of national and international organizations in and was established to and provide for and development. A national and was and in and held in South Africa. action is needed to the and system a in the of an appropriate and system will the process of project actions are taken by all to enhance the establishment of a and learned The Ethiopia HIV/AIDS project was prepared a fast project preparation a fast preparation process was by the to resources for an emergency situation that had started economic and a on the existing social coping The of the project has not increased but has also the establishment of management structures essential for intervention international partnership was in and generating government to take action against HIV/AIDS. The Government of Ethiopia established a comprehensive HIV/AIDS a HIV/AIDS strategic and a multi-sectoral HIV/AIDS National Council, under the of the President of the Federal Democratic Republic of Ethiopia. In the government established a National HIV/AIDS Secretariat under the a under the National and a policy that the of all of which are essential for up HIV/AIDS interventions in the country. The government has that of activities in limited areas are to slow the rapidly increasing epidemic, and has up regional and that are now leading a against HIV/AIDS It is that in the epidemic an expansion of community-based interventions. The Government of Ethiopia has taken unprecedented measures to interventions at a community level by a to funds to flow directly to communities, and public funds available to support NGOs and private organizations. This action has made the rapid of to communities to help the rapid implementation of community-based which would have slow if the flow of funds had followed government As a of such a rapid progress has noted in some of the communities as by the increase in activities and support to those affected and infected the to all the during the first was The to the number of to has created a forum for what a learning-by-doing an to assess the in the and to the and of the intervention measures during the first learned during the first of implementation were to some of the in the of The level of and capacity of communities is in terms of their to The that communities are provided with and is not should be supported by community-based NGOs or other development to in the The the government has an implementation in has encouraged many donors to in HIV/AIDS interventions in the country. than donors are now a new commitment to provide additional technical and financial support. EMSAP is of the first two HIV/AIDS programme projects by the World Bank in sub-Saharan Africa. The of project preparation and of implementation have for many other HIV/AIDS projects in with of the scope and of the epidemic, and the readiness of many of the to fast action at the project level is and However, rapid project preparation and implementation and that to be addressed as early as possible. EMSAP the of the of the implementation process in order to and early measures to the project to its the adverse consequences of and conscious of the limited capacity of the existing the World Bank has taken special measures to support the national and regional and to accelerate the implementation of EMSAP. In to the support provided by the and the at the country a bank was to support the and the regional This has substantially to project implementation at all The National Secretariat and have with regional to assess progress and on actions to be taken during the following such have and the discussions and taken in these have created common understanding on project implementation and common to during The and the taken to an HIV/AIDS programme in Ethiopia can provide and for other developing countries on this public health A of the major the actions taken and are in The fast preparation process undertaken by this project in Ethiopia was in funds available to scale up intervention activities by communities, NGOs, private organizations and the public sector rapidly. The project a learning-by-doing than to programme in during which would have by of major action taken and the process project funds were directly to NGOs, community-based organizations, and communities to scale up rapid HIV/AIDS interventions at the local the are the of the project and the of of the the during the first are not the HIV/AIDS project in Ethiopia, a number of national and international organizations have now developed a partnership with the government by providing financial and support to the project to be in Ethiopia, trends have in and the expansion of care and support at the community level. A number of World Bank staff and international organizations have to the preparation and implementation of the project, and it is to all and organizations. The to the special contribution of the following in the and implementation of and The would also to their of the and support by the national and regional the Project and the international and bilateral organizations. the special support and to the by World Bank President for and the have support and guidance to the preparation and implementation of the
Marjorie Opuni, Stefano Bertozzi, José-Antonio Izazola, Juan Pablo Gutiérrez · 5 authors
Introduction In the past 2 years, political commitment to respond to the HIV/AIDS pandemic has increased sub-stantially. The United Nations General Assembly Special Session on AIDS in 2001 and the recent creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria are two indicators of this commitment at the global level. At the regional level, HIV/AIDS has been an issue on the agenda of the Inter-American Development Bank, the Asian Development Bank, and the Organization of African Unity, to name but a few institutions. At the national level, low-income and middle-income countries, home to over 95% of people living with HIV/AIDS, have made important progress in HIV/AIDS planning and program development [1,2]. In this policy environment, the importance of information on resources for HIV/AIDS prevention and care has increased. More and more, policy-makers are looking for data on the level and flow of current allocations to HIV/AIDS. They want to know where money for HIV/AIDS prevention and care is coming from, the services and commodities that are purchased with these funds, and the population coverage of implemented interventions. At the same time, to identify gaps between what is and what should be and to plan strategically, policy-makers are seeking information on the scale of resources required to prevent the further spread of HIV and to provide adequate care for those people living with HIV/AIDS. Because the epidemic is so concentrated in low-income and middle-income countries, estimating HIV/AIDS resource allocations and requirements in these countries is key to responding effectively to HIV/AIDS world-wide. It is also in these countries that this task is most complicated. Program data, ideally produced by national health information systems, are required to monitor resource flows. In many of these countries, however, such systems are weak or nonfunctioning. Similarly, to derive estimates on resource needs, one requires a range of demographic, economic, and health data that are scarce or nonexistent in many developing countries. Notwithstanding these obstacles, significant progress was made during the past year in both monitoring the level and flow of current allocations to HIV/AIDS and estimating HIV/AIDS resource requirements in developing countries. The present article reviews the latest data and examines their policy implications. It identifies the gaps and limitations of current research. The article also discusses future directions to strengthen the quality of data on resources for HIV/AIDS prevention and care. Resources allocated to HIV/AIDS Few countries, whether low, middle or high income, regularly monitor resource flows to the HIV prevention activities conducted by government and nongovernmental institutions within their territory. To date, no country has developed a system that regularly tracks expenditures on HIV/AIDS care. The most well-established data collection activities documenting resource allocations to HIV/AIDS in developing countries are international initiatives. Each year, donors report their official development assistance (ODA) to HIV/AIDS and other sexually transmitted infections (STI) to the OECD Development Assistance Committee (DAC) [3]. Similarly, the Netherlands Interdisciplinary Demographic Institute surveys donors (annually) and developing countries (biannually) for UNFPA and UNAIDS on their HIV/AIDS/STI expenditures as part of their Resource Flows Project. The most detailed information on resource allocations to HIV/AIDS in developing countries comes from indepth country studies conducted on an ad hoc basis. Most recently, the Regional AIDS Initiative for Latin America and the Caribbean (SIDALAC) and the Partnerships for Health Reform have investigated HIV/AIDS financing in several countries using the National Health Accounts (NHA) framework [4]. The present section discusses the latest data from these sources. Table 1 presents the HIV/AIDS/STI ODA data reported to the Resource Flows Project between 1998 and 2000, with data reported to the OECD DAC imputed when no data was reported to the Resource Flows Project. Donor countries disbursed a total of US$ 454 million in 2000. According to reports to the OECD DAC, this represents 87% of the US$ 521 million that were committed or allocated to HIV/AIDS/STI projects during 2000. Total disbursements for 2000 represent a significant increase from the US$ 294 million and US$ 279 million disbursed by donors in 1998 and 1999, respectively.Table 1: HIV/AIDS/sexually transmitted infections official development assistance disbursements, 1998–2000 (US$ million)As in previous years, the United States was by far the largest donor of HIV/AIDS/STI ODA in 2000. However, when this ODA is broken down as a proportion of gross national income for each country, Luxembourg contributed the largest proportion of its gross national income (Fig. 1).Fig. 1.: HIV/AIDS/sexually transmitted infections (STI) official development assistance (ODA), 2000. Total amount obligated in US$ million and obligations per US$ million gross national income (GNI).What is revealed by these data and past surveys on HIV/AIDS/STI ODA [5–7] is that surveys provide reasonable information on these expenditures, albeit varying in comprehensiveness and accuracy. Past global surveys have also illustrated that questionnaires can provide relatively good data on HIV/AIDS resource allocations that flow into developing countries from the United Nations system and nongovernmental institutions in high-income nations. Although as HIV/AIDS is increasingly integrated into projects addressing broader health or development issues, HIV/AIDS expenditures are becoming more difficult to track even among these international institutions. However, questionnaires sent to national HIV/AIDS coordinating institutions to collect data on domestic resource allocations to HIV/AIDS are much less efficient tolls for gathering quality data. In part, this is because regularly updated information systems do not exist and it is difficult for national HIV/AIDS coordinating bodies to gather expenditure data from the many ministries and organizations implementing HIV/AIDS interventions in a country. In addition, for large portions of HIV/AIDS expenditure, data must be estimated with special studies. To estimate domestic expenditure on HIV/AIDS care, for example, studies costing selected services must be undertaken. Likewise, to capture how much individuals themselves spend on HIV/AIDS services (out-of-pocket spending), which in many countries constitutes the majority of overall AIDS spending, requires household or clinic-based studies of people living with HIV/AIDS. It is these information gaps that in-depth country studies using the NHA framework aim to fill. These studies attempt to account for all expenditures by looking not only at public sector financing, but also at spending within the private sector, including spending by individuals. They collect the data that are available and conduct special studies, such as limited household surveys, as necessary. Most of the studies on HIV/AIDS resource allocations using the NHA framework have been carried out in Latin America and the Caribbean (LAC) [8]. Referred to as National HIV/AIDS Accounts, they were first carried out in Brazil, Guatemala, Mexico and Uruguay in 1997/1998 [9–12], with substantial scaling-up of efforts occurring in the past year. SIDALAC recently completed studies in 12 countries (Argentina, Bolivia, Brazil, Chile, El Salvador, Guatemala, Mexico, Nicaragua, Panama, Paraguay, Peru, and Uruguay) and studies in three additional countries are underway (Costa Rica, the Dominican Republic, and Honduras)[13]. Total HIV/AIDS spending in the 12 countries in Latin America studied (representing 75% of the population of the region) [14] in 2000 was estimated at US$ 1.04 billion. This represents an average of US$ 2.70 per capita for the 12 countries, with individual country per-capita expenditure ranging from US$ 0.30 and US$ 0.60 in Bolivia and El Salvador to US$ 5.60 and US$ 4.90 in Uruguay and Argentina (Table 2). In terms of average expenditure per person living with HIV/AIDS (PLWHA) in the 12 countries, this translates into a little over US$ 1000 regionally, with over US$ 3000 spent per PLWHA in Uruguay and only US$ 175 per PLWHA spent in Guatemala.Table 2: HIV/AIDS expenditure in 12 countries of Latin America and the Caribbean, 2000.Overall, US$ 753 million (73%) of HIV/AIDS resources in the 12 countries were spent on care, with only US$ 283 million (27%) spent on prevention. This trend was true across countries with the exception of Bolivia and Nicaragua, countries with relatively lower prevalence rates, where only 34 and 36% of HIV/AIDS resources, respectively, were spent on care. Almost 72% of the resources spent on HIV/AIDS care in the 12 countries were spent on drugs, with the vast majority (almost 90% of drug expenditure) spent on antiretroviral drugs (ARV). Of course, social pressure for access to ARV in the region is high, and three of the 12 countries (Argentina, Brazil, and Uruguay) provide universal access to these drugs. However, this estimate does appear to be extremely high and may represent a bias since drug expenditures are easier to monitor than other components, especially when procurement of ARV is centralized through national HIV/AIDS programs, such as is the case in Brazil. With 60% of prevention expenditure on condoms and 14% on mass media campaigns, most of the prevention expenditure in the 12 countries was spent on interventions targeting the general population. This is notable in countries where HIV prevalence is still extremely low in the general population and the epidemic is concentrated among specific population groups [1]. In Mexico, Nicaragua and most of the Andean region, sex between men is the most prominent route of HIV transmission. Similarly, in Argentina, Chile, and Uruguay, injecting drug use is the main route of transmission. Given the epidemiology of the epidemic in the region, one would therefore expect that significant proportions of HIV prevention expenditures would be allocated to interventions targeting these population groups that are key to the expansion of the epidemic. However, only limited funds in the region (7% of prevention expenditure) were reported as allocated to such interventions. The major sources of HIV/AIDS funds also varied across countries. In Argentina, Brazil, Chile, El Salvador, Guatemala, Mexico, and Panama, the government health sector was the primary source of resources allocated to HIV/AIDS. In Paraguay, Peru, and Uruguay, private funds from enterprises, nongovernmental organizations and households were the primary sources of resources allocated to HIV/AIDS, while international sources provided most of the funding in Bolivia and Nicaragua. Even though studies using the NHA framework provide the most detailed estimates on resource flows in countries, they remain estimates that vary in completeness and accuracy. Although the studies attempted to account for all expenditures, the quality of the estimates depended on the availabilityand quality of financial and accounting data within relevant government and non-governmental institutions, and on the capacity of personnel within these organizations to formulate estimates where data were not available. It is probable, as mentioned earlier, that certain categories of expenditures, including spending on information, education and communication interventions, were underestimated because they were more difficult to track than expenditure on commodities such as drugs and condoms. It is also probable that expenditure by nongovernmental organizations, especially those that were community based, were under-reported since donated goods and services were not quantified adequately. Likewise, it is probable that in decentralized governments, with weak financial tracking at lower administrative levels, funds were missed or, alternatively, double counting occurred with expenditures being reported at higher and lower administrative levels. To estimate the expenditure on HIV/AIDS prevention and care for all countries in LAC, a regression was run to extrapolate the estimates for these 12 countries to the region. [A regression was run for these 12 countries with SIDALAC country totals as the dependent variable and the values from the care imputing exercise (described later) as the independnt variable.] The result is an estimate of US$ 1.4 billion for all countries in LAC. The only country outside of LAC where the NHA framework has also been used to estimate expenditures on HIV/AIDS is Rwanda. A study conducted for 1998 concluded that a total of US$ 10 million or US$ 1.27 per capita were spent on HIV/AIDS during that year [15]. This represents a total of US$ 25 per person living with HIV/AIDS, compared with the average of US$ 1000 per PLWHA in the 12 countries in Latin America already discussed. While spending in Latin America is large compared with spending in Rwanda (and presumably other countries in sub-Saharan Africa), even this expenditure is very small compared with expenditure by high-income countries such as the United States. The Federal Government spent US$ 10.8 billion on HIV/AIDS in the year 2000 [16]. If this amount is raised by the same proportion as that which prevails between public and total spending on health in the United States, then total HIV/AIDS spending can be estimated just below US$ 25 billion in 2000 [17,18]. This amount translates into nearly US$ 90 per capita, or just over US$ 30 000 per PLWHA. A check on the credibility of this seemingly high level of spending is provided by an analysis of spending on Medicaid-covered AIDS patients, which projected that expenditure would average almost US$ 36 000 per patient [19]. Resource needs for HIV/AIDS Similar progress was made in the area of estimating resource needs for HIV/AIDS over the past year. Two major studies of resource requirements estimates were published. The first, undertaken for the Commission on Macroeconomics and Health (CMH), estimated resources needed to scale-up a package of core interventions to address HIV/AIDS and other priority illnesses in 83 low-income and middle-income countries (including all of sub-Saharan Africa) by the years 2007 and 2015 [20,21]. The second, carried out in preparation for the UN General Assembly Special Session (UNGASS), estimated the cost of HIV/AIDS prevention and care needs in 135 low-income and middle-income countries in 2005 [22]. These two studies built on prior work on estimating resource needs for HIV/AIDS and used similar methodologies [23,24]. The methodologies used have been detailed previously [20–22]. Both studies included a selection of interventions that were costed based on published and unpublished project assessments (Table 3). Estimates were then made intervention-by-intervention and country-by-country using demographic, economic and epidemiological data to adjust the estimates to different country contexts. The main difference in methodology between the two studies was the inclusion in the CMH study of the costs for infrastructure strengthening necessary for scaling-up. In addition, there were differences in assumptions, with the most important being differences in target population coverage rates for the different interventions.Table 3: HIV/AIDS prevention and care interventions.The UNGASS study called for the annual spending of US$ 9.2 billion on HIV/AIDS prevention and care in low-income and middle-income countries by the year 2005, with up to US$ 6 billion coming from international sources. The CMH study concluded that, depending on coverage assumptions and price estimates, between US$ 13.6 billion and US$ 15.4 billion should be spent on HIV/AIDS prevention and care annually (including necessary infrastructure strengthening) in selected low-income and middle-income countries by the year 2007 in addition to what is already being spent, and that this should increase to between US$ 20.6 billion and US$ 24.9 billion by 2015. The ranges of the results within and across studies underline the fact that these are estimates with limitations. They underscore the data gap in low-income and middle-income countries and the many assumptions required while building each model to derive parameter estimates for which no data exist. As discussed further later, they should therefore be interpreted with caution and be seen as works in process that can be refined as new information becomes available on cost data, current intervention coverage estimates, and country capacity to expand services. Nonetheless, sensitivity analysis conducted usingthe UNGASS model confirms that study results provide a consistent estimate of the scale of resources needed. A probabilistic analysis that varied assumptions on intervention coverage, costs and country capacity to expand services produced a range of results that were comparable with the ranges reported in the CMH study. So, in short, the UNGASS and CMH estimates provide policy-makers with consistent information on the scale of the resources needed. But it would be inappropriate to use them to guide resource allocations among interventions at the national level. Although these two studies did differentiate across countries whenever possible, data limitations did not allow them to pay significant attention to individual country characteristics and the way in which those may affect overall costs. To improve the estimates so as to have them serve as tools for country strategic planning, both study teams recognized that additional country-level work would be necessary. This process has begun with individual country validations of the UNGASS estimates for the LAC region. The 10 countries to participate in a first phase of this effort were Brazil, Chile, the dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Jamaica, Mexico, and Trinidad and Tobago [25]. These countries increased the estimated resource requirement for HIV prevention by 15% and the estimated care requirements by 27%. The main differences in prevention estimates are accounted for by an increase in estimated resource needs for the social marketing of condoms and prevention of mother-to-child transmission, while the main differences in care estimates were due to important differences in the expected costs for highly antiretroviral Total expected resource needs for highly antiretroviral increased by compared with UNGASS To estimate the HIV/AIDS prevention and care needs for all countries in LAC, the estimates for these 10 countries were to the region using were run for the prevention and care estimates Because a was between the care data estimated by the countries and those estimated for used to the The used of to values for the countries that have not their The prevention exercise was similar in addition, it used the results of the care as an variable that was imputed with the regression than with the The UNGASS model called for US$ with US$ million for prevention and US$ million for care and prevention were refined the of the model estimates the estimate for Latin America and the Caribbean from US$ increased this by US$ million to almost US$ with US$ million for prevention and US$ million for care and the between the UNGASS estimates and those of the 10 is these estimates provide further for the overall of the To plan and to the policy-makers data on resources for HIV/AIDS prevention and care. a of public and private spending on the are to track and the of their to HIV/AIDS. estimate of the of resource needs to address the epidemic they are to plan and resources for the data that are available the for additional resources and for in the of those resources available. But to date, few policy-makers in low-income and middle-income countries countries that this information most have these data for their countries. are available on the annual official development assistance allocations to HIV/AIDS by high-income countries with limitations. These data that there was a significant increase in the flow of HIV/AIDS funding from high-income countries to developing countries in 2000, US$ represents only a of the estimated US$ billion in international resources required annually to respond to the epidemic in these countries. Similarly, in-depth country studies of which have been carried out in the vast in spending on people living with HIV/AIDS that exist These studies that an average of US$ 1000 per person living with HIV/AIDS was spent in Latin countries in 2000. This is more than estimates for sub-Saharan of people with HIV/AIDS of less than US$ and far less than estimates for the United States at over US$ 30 the results of the UNGASS model for LAC (almost US$ billion for the year with those of the National HIV/AIDS Accounts studies to the region (US$ 1.4 billion for further of the important policy that are raised by these of data. The higher estimates of current expenditure are due in part to the fact that the two estimates do not the resources with of interventions. The two also different assumptions on costs of and estimates of current intervention In addition, they are also based on different of countries and there are therefore different of in these estimates to the region. However, the difference in the assumptions made in the UNGASS model that the procurement of commodities such as and HIV is and that there is and in the of HIV interventions. The fact that estimates of current expenditure are higher than those for future resource needs in part the that result from that countries in the region to pay less for condoms and To strengthen the quality of HIV/AIDS financing data in developing countries, necessary the of studies to track National HIV/AIDS SIDALAC has that the process is The studies conducted in the region with the National Health Accounts by the Health Organization and the OECD have cost between US$ 25 000 and US$ 000 per year per country depending on country and This that in financial resources not be a to the of a system for monitoring HIV/AIDS resource flows. At the same time, estimates of country-level resource needs should be for all low-income and middle-income countries. are for the of the LAC region. Similar should be undertaken in sub-Saharan and one important HIV/AIDS prevention and care resources in developing countries is still estimates of resource needs should a not only resource needs, but also the provided by the resources on the expected from new would provide data to on the of resources within and across countries and The are to and of UNAIDS for the use of the HIV/AIDS/STI data reported to the Resource Flows Project. They the of the SIDALAC country from Argentina, Bolivia, Brazil, Chile, El Salvador, Guatemala, Mexico, Nicaragua, Panama, Paraguay, Peru, and Uruguay the data on the National HIV/AIDS They also of SIDALAC for assistance with the of the National HIV/AIDS Accounts data.
The term "development finance \n institutions" (DFI) encompasses no only government \n development banks, but also nongovernmental micro-finance \n organizations, that match grants to attempt to promote \n community development, decentralization of power, and local \n empowerment. Measures of the social cost of DFIs that \n receive public funds, help to check whether DFIs are good \n uses of public funds, i.e., if the social benefit of a DFI \n exceeds the social cost, then public funds are indeed \n well-spent, further improving social welfare. This report \n describes the measurement of costs but not of benefits; but \n even without knowledge of benefits, knowledge of costs can \n help to adequately spend funds. Two measures of social cost \n are presented: first, the Subsidy Dependence Index (SDI) - \n the ratio of subsidy received to revenue from loans; and, \n subsidy is the social cost of the public funds used to run a \n DFI - which does not discount flows, rather it works in \n short time frames, or when the rate of time preference is \n low; second, the Net Present Cost to Society (NPCs) - like \n standard present-value measures, it discounts cash flows, \n and works in any time frame. Both SDI and NPCs are tools, to \n help establish benchmarks, chart trends, and compare a DFI \n with identical clients, and services. It is stipulated that \n measurement of the social cost of public DFIs matters \n because funds earmarked for development are scarce, while \n subsidies for DFIs could be adequate, provided social \n welfare improves in a broader scale.
Over the past decade, the multilateral development community' has espoused the fiscal and administrative decentralization of the social sectors and often specifically of primary and secondary schooling (e.g., see IDB, 1994: 194; Dillinger, 1995). Although nearly every country in Latin America has undertaken some form of educational decentralization, very little is known about the attributes of such policies. They often go hand in hand with a call for increased parental and community involvement (see Dimmock, Donoghue, and Robb, 1996) that has come both from the top down (e.g., from the multilateral community) and from the bottom up (e.g., from grassroots organizations and nongovernmental organizations [NGOs]). Since 1993, Nicaragua has set in motion one of the most radical educational decentralization experiments in Latin America. Its autonomous schools program implements a system of school-based management with local school-site councils that have a voting majority of parents and allocate resources that derive in part from fees charged to parents. Nowhere in Latin America have parents officially been given so much responsibility, and nowhere have they been asked to provide directly such a large proportion of school resources. The confluence of transferring responsibilities to schoolsite councils and the charging of fees is not coincidental. Both derive from social movements solidly within the so-called neoliberal reform model
This paper develops a framework by which the impact of decentralization of government on child welfare can be assessed. Consistent with the child welfare perspective, it is suggested that equity should be given greatest weight, in terms of both equality of opportunity and progress in reducing disparities in access. Allocative efficiency, a notion that has figured prominently in the economics literature about the merits of decentralization, is shown to have limited value once we accept the existence of externalities and public goods in the provision of basic services. The review of available evidence for Asian and transition countries suggests that there is a significant risk that equity can be adversely affected by the decentralization of education and the associated financing arrangements.
The government of Cameroon like that of many Sub-S aharan African countries is \nfaced with dwindling revenues and cannot provide the required fmances for the education \nsector. Since many other developing countries are facing similar fmancial constraints, \npolicy options have been proposed for the recovery of costs as a way of revitalizing and \nimproving the quality of education in these countries. The introduction of user charges is \none of the more prominent options that applies to all levels of education. In light of the \neducational financing situation in Cameroon, this study sets out to assess the possibility \nof implementing this option. It therefore seeks to analyze how secondary schools are \nfmanced and to measure private direct costs of secondary education so as to determine \nparental willingness to spend on schooling. \nA household and a school survey were conducted in Mezam Division of the North \nWest Province of Cameroon. 335 households in urban and rural areas were involved in \nthe household survey, while 16 principals and 750 students, selected from 16 secondary \nschools, took part in the school survey. Results from these surveys indicate that in \ngovernment secondary schools, although tuition is provided free, parents are obliged to \nmeet the costs of books and uniforms. Moreover, because government funding is \ninadequate, by default, parents are obliged to contribute further towards the provision of \nadditional facilities in these schools through the Parent-Teacher Association (PTA). Thus \nparents incur substantial costs for their children's education, in relation to household \nincome and Gross National per Capita Income. The study also reveals that in the private \neducational sector, fees and other parental contributions, including PTA levies, form an \nimportant source of finance for secondary schools. Parents of government school students \nvalue the education of their children highly, and therefore indicated willingness to pay \nmore, even though they already incur substantial costs. The findings further indicate that \nwillingness to pay will be increased if the quality of education is improved. However, \nability to pay is related to family income and number of children, which have important \nimplications for equity which are discussed in the thesis. Finally the study reveals that the \nhighly centralized financing policy and practice in government secondary schools does not \ntake into account the fmancial capacity of communities and private individuals \nsufficiently. \nThe thesis argues that, in order to improve access, quality and efficiency of \neducational provision, an appropriate cost-sharing strategy needs to be developed to \nfinance government secondary schools, with provision of scholarships or other selective \nassistance to the most needy. The thesis suggests further that, efforts be made to explore \nparental willingness and the inherent self help tradition of the people, by encouraging \nlocal management and fmancing of schools. Hence support from individual users and \ncontributions from local communities through Parent-Teacher-Associations should be \nactively solicited. It also suggests that the decentralization of educational management of \nschools will go a long way towards enhancing educational quality and efficiency. This \nwill require some adjustments to the existing financing structures, and changes in the \nregulation and management of the education system. The successful implementation of \nthese recommendations require immense political will on the part of the policy makers.
While the theoretical arguments for fiscal decentralization developed over the past thirty-five years have proven compelling enough for the concept to win great favor, very little empirical work has proven the merits of such policies in the forms governments have actually implemented. We examine the results of educational fiscal decentralization in a developing country with an established framework for fiscal federalism and a concomitant history of intense centralization. The structure of the flow of funds in the Mexican education sector provide an example to study: (1) the importance of the spatial distribution of outcomes resulting from expenditures rather than simply the distribution of the expenditures alone; (2) the distribution of resources to subnational political units; (3) intergovernmental relations and the resulting incentive structure for service provision, particularly with respect to fiscal transfers and grants administration; (4) the effects from decentralization efforts over the past decade, and the resulting implications for probable outcomes from efforts to decentralize; and (5) the interplay of centralized versus decentralized finance and administration. We develop methods to analyze political and socio-economic factors that affect intergovernmental fiscal allocations. The results show that (1) the Federal Government does trade some efficiency for the sake of distributional concerns in the provision of educational resources, but in doing so may discriminate against subnational jurisdictions based on factors like voting behavior or marginalized minority populations; and (2) the pattern of Federal-to-state allocations may not be replicated at the state-to-municipal level, even by Federal agencies at the state level. We also provide evidence that states may not currently be as effective educational providers as the Federal Government, raising concern for efforts to decentralize. Policy implications and recommendations resulting from Mexico's experience revolve around the development of an accountable matching grant mechanism for fiscal transfers that would retain those aspects of centralized financial control beneficial to efficient and equitable service provision, while stimulating the improvements that may result from augmenting regional and local fiscal and administrative responsibilities for education.
Summary This article analyses the structure and organization of RDRS, one of the largest rural development NGOs in Bangladesh. RDRS's Comprehensive Project works with 120,000 households, through small groups of about 15, motivating and educating people on joint savings and investment, agricultural and off-farm income generation, primary health and family planning, literacy, social awareness, and women's development. Groups have access to credit provided by RDRS or banks. No free inputs are given. The Comprehensive Project's Community Health Unit runs 55 antenatal centres and a leprosy treatment service. The Rural Works Project plants 250,000 trees per year, and supervises construction of schools, markets and small bridges and culverts in isolated rural communities. RDRS has almost 1,700 staff. Field implementation is decentralized to area-based units, within a common policy, activity, financial and personnel framework. Six sectoral advisory units are responsible for innovation, quality control and coordination across the whole programme. Résumé Les ONG: le cas du Service rural de Rangpur Dinajpur Le présent article contient une analyse de la structure et de l'organisation du RDRS, l'une des plus importantes ONG (Organisation non gouvernementale) rurales du Bangladesh. Le Comprehensive Project du RDRS intervient auprès d'environ 120 000 ménages sous forme de petits groupes d'environ 15 personnes; le RDRS a pour rôle de motiver et d'éduquer les participants quant aux économies et investissements conjoints dans le ménage; la génération de revenus fermiers et outre-fermiers; les soins de santé primaires et le planisme familial; les campagnes d'alphabétisation; les programmes de sensibilisation sociale; et le développement des femmes dans la population. Les groupes ont accès au crédit fourni par le RDRS ou par les banques. Aucune contribution n'est gratuite. Le groupe des Soins de santé communautaires du Comprehensive Project organise 55 centres de consultation prénatale, ainsi qu'un centre pour le traitement des lépreux. Le service des prestations rurales plante environ 250 000 arbres par an et contrôle la construction des écoles, des marchés et des petits ponts et caniveaux dans les communautés rurales isolées. Le personnel du RDRS compte presque 1700 effectifs. Les antennes exécutives rurales sont décentralisées en unités à base géographique, or elles restent liées par une organisation de gestion commune des politiques, des activités, du financement, et du personnel. Six groupes de conseil sectoral se chargent des programmes d'innovation, de contrôle de la qualité et de coordination du programme au niveau de l'ensemble. Resumen Organizaciones no gubernamentales: el caso del Servicio Rural en Rangpur Dinajpar El artículo analiza la estructura y organización del RDRS, uno de los proyectos de desarrollo rural más grandes de las Organizaciones no gubernamentales en Bangladesh. Este proyecto exhaustivo comprende 120.000 familias, en grupos de quince familias, motivando y educando a la población en áreas como: ahorro colectivo e inversiones, producción de ganancias fuera de la granja, salud y planificación familiar, alfabetización, conciencia social y el desarrollo de la mujer. Los grupos tienen acceso a créditos provistos por RDRS o instituciones bancarias. No se otorga dinero gratis. La Unidad del Proyecto de Salud Comunitaria maneja 55 centros pre-natales y un servicio para el tratamiento de la lepra. El Proyecto de Trabajos Rurales planta 250.000 árboles por año, y supervisa la construcción de escuelas, mercados, puentes y alcantarillas en comunidades rurales aisladas. RDRS tiene un personal de casi 1700 empleados. La implementación de base se descentraliza en forma de unidades en cada área, que sin embargo siguen una línea común en cuanto a a criterios, actividades y estructuras financieras y de personal. Hay seis unidades consultivas responsables por las innovaciones, control de calidad y coordinación de la totalidad del programa.
Over successive five‐year development plans, Indonesia has channeled large sums of foreign loans and domestic funds into water supply projects with the aim of providing clean water for a majority of households. Most projects have been planned and financed through the central government's public works ministry, though a growing share of rural water projects are being funded through earmarked grants provided to local governments. This paper examines how these central government transfers, in the aggregate, have responded to various indicators of expenditure needs. Overall, past allocations have matched existing demand and supply levels closely–funding has generally favored provinces with large populations, large numbers of water enterprises, extensive distribution networks in place, and high production capacity. They have not, however, worked in favor of either equalization or economic productivity objectives, as reflected by per capita income or GRDP growth rates. This analysis suggests that equity would be promoted either by including income‐related factors in future block grant allocation formulas or by shifting funding emphasis in the water supply sector from grants‐in‐kind controlled by the central government to sectoral grants controlled mainly at the local level. Such policy reforms would also further promote the nation's professed goal of decentralizing infrastructure development.
In the highly centralized system of the Philippines, local funding provides the only source of flexibility to meet specific and urgent needs. The government in Manila, which pays all teacher salaries, finds it easier politically in times of fiscal belt-tightening to cut recurrent costs. Although local funds are a relatively small percentage of the education budget, they make an important contribution to covering maintenence and operating costs. The total cost of education per student also appears to lower in schools with greater local financing. Administrators and teachers have greater incentive to be cost-effective when forced to consider the effect of their behavior on the people who live and work in the local community. The policy implications of these findings for the Philippines, as well as other developing countries, are important. They strongly suggest that decentralization will increase efficiency. Without an increase in local funding, the quality of primary education will suffer.