2015年-世界发展银行全球_Central_America_Social_Expenditures_and_Institutional_Review___El_Salvador_84页_3mb

报告摘要

El Salvador Social Expenditure and Institutional Review Summary

Core Content

This document provides a comprehensive analysis of social spending in El Salvador, focusing on three key sectors: Education, Health, and Social Protection and Labor. It evaluates the trends, performance, and institutional challenges in these areas, offering policy recommendations to improve the efficiency, targeting, and impact of social expenditures.

Main Points

I. Context

El Salvador's development over the past decade has shown a dichotomy: low economic growth and limited fiscal resources, but progress in social indicators.
Social spending has increased, now accounting for 12.4% of GDP, contributing to improvements in social outcomes despite economic constraints.
The report emphasizes the need to enhance the quality and efficiency of social spending to ensure sustainable progress and reduce inequalities.

II. Recent Trends in Social Spending

Education: Public spending on education has been steadily increasing but remains below regional and international averages.
Health: Public health spending has increased, and the free health care policy has improved access, but disparities in access and quality persist.
Social Protection and Labor (SPL): SPL spending has increased from 3.5% to 5% of GDP, but it is still below regional standards and suffers from inefficiencies and poor targeting.

III. Education Performance and Challenges

III.1 Recent Evolution of Public Spending on Education

In 2013, public education spending was 3.6% of GDP, lower than the LAC average (4.9%) and OECD average (5.6%).
68% of public education spending goes to basic education.

III.2 Results and Outcomes

Achieved universal primary education (MDG 2), but upper secondary enrollment is low at 48% (lowest in Central America).
Learning outcomes remain poor, with international comparisons showing lower performance than countries with similar GDP levels.
Gross enrollment ratio and attendance rates are higher in urban areas than rural, highlighting geographic disparities.
TIMSS scores in 4th-grade mathematics show lower performance compared to GDP peers.

III.3 Institutional Reforms and Challenges

The Full-Time School (FTS) model is being implemented, but challenges remain in teacher recruitment, student-teacher ratios, and quality of education.
Early Childhood Development (ECD) is a necessary strategy for long-term learning improvements.
The Ministry of Education (MINED) needs to modernize its information systems for better monitoring and evaluation.
Standardized test scores are underutilized due to lack of training and policy dissemination.

IV. Health Performance and Challenges

IV.1 Recent Evolution of Public Spending on Health

Public health spending has increased, and the free health care policy has reduced out-of-pocket expenses.
Per capita public health spending is relatively low, and disparities exist between urban and rural areas.

IV.2 Results and Outcomes

Health outcomes have improved since the 1990s, including declines in child and maternal mortality.
El Salvador is the only CA country to achieve MDG 4 (under-five mortality) before 2015.
Despite progress, neonatal and maternal mortality rates are still high, indicating a need for better quality of care.
Chronic non-communicable diseases (NCDs) are increasing, requiring more comprehensive strategies.

IV.3 Institutional Reforms and Challenges

The National Health Strategy aims to improve comprehensive primary health care (PHC) and human rights, but implementation is limited.
Health Community Teams (ECOS) are an innovative program, but funding is donor-dependent and sustainability is uncertain.
Fragmented public health institutions with varying service packages and per capita expenditures reduce effectiveness.
Monitoring and evaluation systems in the Ministry of Health are weak, limiting policy effectiveness.

V. Social Protection and Labor Performance and Challenges

V.1 Recent Evolution of Public Spending on Social Protection and Labor

SPL spending increased from 3.5% to 5% of GDP between 2007 and 2013.
The Conditional Cash Transfer (CCT) program (Comunidades Solidarias Rurales) is well-targeted but has low coverage.
Electricity and gas subsidies disproportionately benefit the wealthy, with 70% of the richest families receiving them.

V.2 Results and Outcomes

The PATI program (Temporary Income Support Program) is effective in urban areas, combining income support with training.
High leakages in social assistance and subsidies reduce their impact on poverty reduction.
Social security coverage remains at around 30%, and the system faces unsustainable deficits.

V.3 Institutional Reforms and Challenges

The Universal Social Protection System (SPSU) aims to coordinate social policies, but lacks a central ministry for implementation.
Social security reforms are needed to address fiscal sustainability and coverage gaps.
Active Labor Market Programs (ALMPs) are underdeveloped and do not effectively target priority groups.
The occupational training system lacks information on program quality and market relevance.

Key Information

Social spending in El Salvador is 12.4% of GDP, with a focus on basic education and health care.
Education spending is below regional and international standards, with disparities in access and quality.
Health spending has improved access but faces quality and coverage gaps, especially in rural areas.
Social protection has expanded, but inefficiencies and leakages remain, particularly in subsidies.
Institutional reforms are needed to improve coordination, efficiency, and sustainability in all three sectors.
Policy recommendations include improving targeting, enhancing monitoring and evaluation, and reforming the social security system.

Conclusion and Policy Recommendations

Education: Focus on improving access to pre-primary and secondary education, enhancing teacher quality, and strengthening monitoring systems.
Health: Revise the RIIS strategy, improve targeting and coverage, and develop a comprehensive NCD strategy.
Social Protection and Labor: Reform subsidy mechanisms, improve targeting and efficiency, and prioritize social security reform.

Annex and Bibliography

Includes detailed figures, tables, and boxes that support the analysis.
References to international databases and policy frameworks such as the MDGs Accelerating Framework (MAF) and World Bank tools.

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