2008年-世界发展银行全球_Ukraine_-_Improving_Intergovernmental_Fiscal_Relations_and_Public_Health_and_Education_Expenditure_Policy___Selected_Issues_170页_15mb

Ukraine: Improving Intergovernmental Fiscal Relations and Public Health and Education Expenditure Policy

Core Content

This report, prepared by the World Bank, focuses on the challenges and opportunities for reform in Ukraine's intergovernmental fiscal relations and public health and education expenditure policies. It outlines the need for systemic improvements to enhance efficiency, equity, and sustainability in public spending across these sectors.

Main Views and Key Information

1. Fiscal Overview and Challenges

• Ukraine's public fiscal envelope is 43% of GDP, which is considered too large for an emerging economy and biased towards consumption and current transfers, with low public (fixed) capital investments at 2.3% of GDP in 2006.
• Social spending accounts for around 25% of GDP, including health, education, pensions, and social protection.
• Local governments account for 80% of health sector spending and 64% of education sector spending, and provide the bulk of services in these areas.
• Out-of-pocket (OOP) payments in health and education are relatively high, contributing to inequities and catastrophic spending for lower-income households.
• The demographic profile of Ukraine presents fiscal challenges, including an aging population and a shrinking school-age population, which will require rationalization of service networks and staffing.

2. Intergovernmental Fiscal Relations

• Local governments are central to service delivery, but face significant limitations in spending autonomy and revenue generation.
• Reforms in 2001-02 improved the decentralization process and intergovernmental relations, but the reform agenda remains incomplete.
• Key issues include:
  • Overlapping expenditure responsibilities leading to inefficiencies and duplication.
  • Limited revenue autonomy, with local governments over-reliant on shared revenues and transfers.
  • Lack of predictability and transparency in intergovernmental transfers, which affects planning and efficiency.
  • Underdeveloped sub-national borrowing frameworks, limiting the ability of local governments to finance investments.
• Local governments are responsible for 55% of public fixed capital investments, but the framework for capital budgeting is weak.

3. Public Health Spending

• Health outcomes in Ukraine are poor compared to new EU member states, with life expectancy at 67.1 years, male mortality at 61.7 years, and rising incidence of diseases like tuberculosis and HIV/AIDS.
• The health system is overstaffed and over-supplied, with more hospitals, beds, doctors, and nurses per 100,000 inhabitants than in the EU.
• Inefficient resource allocation leads to under-spending on quality-enhancing investments and low utilization of public facilities.
• Out-of-pocket payments are high, contributing to financial burdens and inequities, especially among the poorest income groups.
• Informal payments are common and hinder service delivery.
• Redistributive effect of OOP payments is negative, exacerbating inequality.

4. Public Education Spending

• Education spending accounts for 6.3% of GDP, with local governments responsible for 4.0% of GDP.
• Student-teacher ratios are among the lowest globally, with 9.4 students per teacher in primary and secondary education.
• Class sizes are extremely small, and teaching hours per teacher are low (60% of US levels, 85% of OECD average).
• Education quality is declining, with increasing dispersion in learning outcomes and shortages of skilled labor.
• Out-of-pocket payments in education are also high, and formal and informal OOP are not well differentiated.
• Public education is underfunded and inefficient, with limited capacity for quality improvements.

5. Local Capital Budgeting

• Local governments are key players in capital investments, spending 55% of the total national budget in this area.
• Investment needs are estimated at around US$29 billion over the next 10 years, with the private sector expected to contribute only a smaller portion.
• Capital budgeting at the local level is weak, with inadequate planning, evaluation, and selection mechanisms.
• Fixed capital investments have been increasing, but efficiency gains are limited due to weak budgeting frameworks.
• Facility-level budgeting is still input-driven, rather than demand-based, which reduces local flexibility and efficiency.

Conclusion

• Reforms in intergovernmental fiscal relations and public spending policies are essential for improving service delivery and economic growth.
• Efficiency, equity, and fiscal sustainability are key challenges in health and education sectors.
• Local governments need greater autonomy, predictable revenue streams, and improved capital budgeting frameworks to allocate resources more effectively.
• The government must reallocate fiscal savings within the current envelopes to enhance quality and efficiency.
• Public-private partnerships (PPPs) and regulatory improvements are necessary to increase private sector participation in local investments.
• The fiscal space for local investments is limited, and reforms must be coupled with structural improvements in budgeting and governance.

Key Recommendations

• Clarify expenditure responsibilities and reduce overlaps to improve efficiency and service delivery.
• Strengthen local revenue generation, including the introduction of property tax.
• Improve transparency and predictability in intergovernmental transfers.
• Enhance local capital budgeting frameworks, including strategic planning and evaluation mechanisms.
• Reduce out-of-pocket payments and improve targeting in health and education spending.
• Improve the quality and efficiency of public services through better resource allocation and capacity building.
• Promote PPPs and regulatory reforms to increase private investment in local infrastructure.
• Address demographic challenges by rationalizing service networks and staffing levels in health and education.