2009年-世界发展银行全球_Uganda_-_A_Public_Expenditure_Review_2008___With_a_Focus_on_Affordability_of_Pay_Reform_and_Health_Sector_98页_868kb

Uganda Public Expenditure Review 2008: Focus on Affordability of Pay Reform and Health Sector

Core Content

This report, titled Report No. 49361-UG, is a Public Expenditure Review (PER) conducted by the World Bank for the Government of Uganda (GOU) in 2009. It is the second in a series of three sector-oriented PERs, with the first focusing on education and the next on roads. The report specifically examines the efficiency and efficacy of public spending, with a special emphasis on the health sector and the affordability of pay reforms.

Main Viewpoints

1. Economic Overview and Trends in Uganda's Budget

• GDP Growth: Real GDP growth averaged 7.8% from 2000 to 2008. The service and industry sectors were key contributors, with construction (about 50% of industry) growing at 15% annually.
• Agriculture Decline: The agriculture sector, which employs the majority of Ugandans, has been shrinking, contributing only 15% of GDP in 2008, down from 27.5% in 2000.
• Inflation: Inflation averaged 5% from 2000 to 2008, with 6.8% in 2008.
• Fiscal Performance:
  • Government Revenue: Tax revenues contributed over 80% of total government revenue, rising from 10% to 13% of GDP.
  • Fiscal Deficit: Declined from 13% to 5% of GDP, remaining stable since 2006.
  • Government Debt: Reduced to 25% of GDP after a $3.4 billion debt forgiveness under MDRI, but nominal debt increased by 30% in 2008.
  • Government Expenditure: Increased from USh2.2 trillion in 2000 to USh4.6 trillion in 2008, but as a percentage of GDP, it declined from 24% to 19%.

2. Costing Policy Commitments in Public Service Pay Reform and Universal Secondary Education

• Pay Reforms: The report assesses the affordability of pay reforms approved in 2006. It concludes that without further cuts in non-salary spending, these reforms are unaffordable.
• Wage Trends: The wage share in the budget increased, with employee costs taking almost two-thirds of the budget changes between 2003/04 and 2006/07.
• Education Reforms: The report emphasizes the need for selective pay increases rather than across-the-board raises, especially in the context of the Universal Secondary Education (USE) program.
• Recommendations:
  • Reverse underfunding of non-salary budgets in districts.
  • Control employee-related costs in central ministries and Kampala.
  • Improve efficiency in ministries and agencies by reducing overheads.
  • Enhance integration of donor funds into the planning and resource framework.
  • Focus on sector-specific efficiency gains, particularly in education and health.

3. Getting More Health from the Budget

• Health Status: Uganda's health outcomes are not aligned with its high levels of donor funding and moderate public funding. The report highlights the need for improving the efficiency of public health spending.
• Health Expenditure: Public health expenditure as a share of total expenditure was less than 5%, while donor funding for health reached $1.1 billion in 2006.
• Performance Issues:
  • Absenteeism: Public health workers exhibit high absenteeism, affecting service delivery.
  • Drug Leakages: Significant waste occurs in clinics and stores due to drug leakages.
  • District Variability: There are wide differences in performance across district health teams.
• Recommendations:
  • Reduce public health worker absenteeism and improve human resources management.
  • Address drug leakages and waste in the health sector.
  • Investigate the causes of performance differences in district health teams.
  • Redirect funds from overheads to non-salary items in clinics and hospitals.
  • Improve the integration of donor funds into the health sector planning and resource framework.

Key Information

• Currency: Ugandan Shilling (UGS), with 1 USD = 2,062 UGS.
• Fiscal Year: July 1 to June 30.
• Data Sources: The report uses a comprehensive annual data set of public expenditures, including budget estimates, fund releases, and actual expenditures, compiled with the Ministry of Finance, Planning and Economic Development (MOFPED).
• Data Gaps: Actual expenditure data is incomplete for many agencies, ministries, and districts. The report notes that release data is more widely available but still has gaps.
• Budget Composition:
  • The Development Budget has seen a decline in capital spending from 58% to 42%.
  • The Recurrent Budget increased from 38% to 43% of total budget.
  • Employee costs have become a major component of the budget, with 42-43% of the 2006/07 budget allocated to them.
• Efficiency and Value for Money: The report stresses the importance of reducing waste and inefficiency in public spending, especially in the health sector, to achieve better service delivery and outcomes.

Structure and Key Sections

• Chapter 1: Examines economic trends and budget composition from 2003/04 to 2006/07, highlighting budget variance, underfunding of non-salary budgets, and the need for fiscal space.
• Chapter 2: Focuses on pay reform affordability and the fiscal implications of different reform scenarios.
• Chapter 3: Assesses the health sector performance, cost drivers, and waste and inefficiency, offering recommendations for improving health outcomes through better budget management.

Annexes and Figures

• Annex 1: Draft PFM Platform - Predictability and Stability.
• Annex 2.1: Public Service Wage Tables and Wage Regressions.
• Annex 2.2: Modeling the Fiscal Effects of Pay Reform.
• Figures:
  • Figure 1.1: Economic Performance.
  • Figure 1.2: Composition of GDP Growth.
  • Figure 1.3: Government Revenue.
  • Figure 1.4: Government Expenditure as a percentage of GDP.
  • Figure 1.5: Shares of Expenditure in Each of the Budgets.
  • Figure 1.6: Expenditure in Each of Uganda's Budgets, 2003/04 to 2006/07.
  • Figure 1.7: GFCF Shares of Development Budgets.
  • Figure 1.8: Economic Classification of Spending.
  • Figure 1.9: Adjusted Economic Classification.
  • Figure 1.10: Economic Classification of the 2006/07 Budget (excluding debt and arrears).
  • Figure 1.11: Budgets by Service Level.
  • Figure 1.12: District Budgets by Type.
  • Figure 1.13: District School Budgets.
  • Figure 1.14: District Health Budgets.
  • Figure 1.15: Referral Hospitals' Budgets.
  • Figure 1.16: Sector Composition of District Development Budget.
  • Figure 1.17: Agency Grants as a Significant Share of the Budget.
  • Figure 1.18: Allocation of Grants to Semi-Autonomous Agencies.
  • Figure 1.19: Arrears Payments Relative to Additional Spending on District Services.
  • Figure 1.20: Structure of Arrears Payments.
  • Figure 1.21: Under-Budgeting: Comparing Estimated Budget for Constant Use with Actual Budget.
  • Figure 1.22: Budget vs. Release Variance by Level.
  • Figure 1.23: Budget vs. Release Variance by Budget.
  • Figure 1.24: Budget vs. Release Variance by Economic Classification.
  • Figure 1.25: Overspending by Economic Category.
  • Figure 1.26: Underspending by Category.
  • Figure 1.27: Net Four-Year Overspending by Budget Type.
  • Figure 1.28: Net Four-Year Overspending by Economic Classification.
  • Figure 1.29: Net Four-Year Overspending by Level.
• Tables:
  • Table 2.1 & 2.2: Median Monthly Nominal Wages (Public and Private Sector).
  • Table 2.3: Summary of Simulation Results on Spending Shares under Different Pay Reform Scenarios.
  • Table 3.1 & 3.2: Health Expenditure and Outcomes Comparisons across Countries.
  • Table 3.3: Budgets at Uganda's Frontline Public Health Facilities.
  • Table 3.4 & 3.5: Waste Estimates in the Health Sector.

Conclusion

The report concludes that improving efficiency in public spending, especially in the health and education sectors, is crucial for achieving value for money and better service delivery. It recommends a shift in budget composition to favor service provision, a review of expenditures in ministries and agencies, and the integration of donor funds into the public sector planning framework. The next report in the series will focus on road maintenance and construction.