2008年-世界发展银行全球_Nicaragua_Social_Protection_Public_Expenditure_Review_94页_921kb

报告摘要

Summary of Nicaragua Social Protection Public Expenditure Review

Core Content

This report, prepared by Jose Silverio Marques for the World Bank in March 2008, analyzes the public expenditures on Social Protection (SP) in Nicaragua, focusing on the risks and vulnerabilities faced by different age groups and households, and the effectiveness of existing social protection programs.

Main Viewpoints

Social Protection (SP) is defined as public interventions aimed at helping individuals, households, and communities manage risks and support the critically poor.
The report emphasizes the importance of social risk management (SRM), which includes both social insurance (SI) and social assistance (SA), to mitigate risks that threaten livelihoods and survival.
SP should serve as a safety net for the poor who are likely to fall through the gaps of existing programs, and as a springboard to help them escape poverty.
The report highlights the need for targeted and effective public programs to address microeconomic risks, which are more prevalent among poor families, and to a lesser extent, natural disaster risks.
The analysis is structured around age groups and households, with a focus on relevance, coverage, targeting, cost-effectiveness, equity, and institutional arrangements of SP programs.

Key Information

I. Analytical Framework

Social Protection is a key component of poverty reduction, especially for the poor who lack the means to self-protect.
The concept of social risk management (SRM) is used to evaluate the SP system.
SRM includes market insurance, self-insurance, and self-protection strategies, as well as fiscal and sectoral policies.
The report also addresses natural disaster management and the need for civic education and preparedness.

II. Source of Risks

Macroeconomic disturbances (employment, income, consumption) are a major source of risk.
Natural disasters (earthquakes, hurricanes, floods, droughts) significantly affect the population, especially the poor.
Microeconomic conditions such as lack of assets, employment, and access to basic services increase vulnerability.
Poor education and health outcomes can exacerbate the risks associated with economic and natural shocks.

III. Risks and Groups-At-Risk

1. 0-5 Years Old

Main Risks: Low birth weight, diseases, inadequate diet, lack of early stimulation.
Health Issues: Maternal mortality is among the highest in Latin America, with rates of 86.5 per 100,000 live births.
Malnutrition: 18.5% of children under 5 suffer from chronic malnutrition (height for age), with higher rates in rural areas and the Atlantic region.
Breastfeeding: Only 31% of women breastfeed exclusively for the first 6 months, which is critical for child health.
Coverage of ECD Programs: Very low, with only 3.3% of children under 3 attending preprimary education programs, mostly in urban areas.

2. 6-17 Years Old

Main Risks: Lack of education, early childbearing, child labor, and poor health.
Education: Preprimary and primary net enrollment is low, especially in rural areas. Many children are not enrolled due to financial constraints, distance, and lack of facilities.
Child Labor: 12.5% of children in 2005 were working, which is a significant risk for their development and future.
Early Childbearing: A major risk for girls, affecting their educational and health outcomes.
Health: Poor access to health services and high rates of illness and malnutrition.

3. 18-59 Years Old

Main Risks: Poverty, unemployment, underemployment, lack of access to health and education services.
Employment: High levels of underemployment and low employment rates among the poor.
Health Insurance: Limited access to medical and old age insurance.
Productivity: Malnutrition and poor education reduce productivity and economic opportunities.

4. 60 Years Old and More

Main Risks: Lack of access to pensions, health care, and social services.
Pensions: Only 23% of the elderly receive a retirement pension.
Healthcare: Elderly face significant challenges in accessing health services due to financial and geographic barriers.

5. Households

Main Risks: Poverty, lack of access to basic services, and vulnerability to economic and natural shocks.
Household Participation: Limited participation in associations and community programs.
Basic Services: Inadequate access to water, electricity, and housing, especially in rural and marginalized areas.

6. Indigenous and Ethnic Groups

Main Risks: Higher rates of poverty, lower access to education and health services, and greater vulnerability to natural disasters.
Poverty Incidence: Indigenous groups have significantly higher poverty rates than the general population.
Disparities: Regional disparities are evident, with higher malnutrition and poverty rates in the Atlantic region compared to urban areas.

IV. Public Programs to Address Risks

The report reviews various social protection programs aimed at different age groups and household needs.
Programs include conditional cash transfers (CCTs), community kindergartens (CICO), health and nutrition programs, education initiatives, and disaster management strategies.
Innovative approaches in health, such as community-based health services, are highlighted.
Emergency aid and reconstruction assistance are essential during natural disasters.

V. Assessment of the Social Protection System

Spending: Public SP spending is low compared to international standards, and the distribution is not equitable.
Relevance and Coverage: Many programs do not adequately reach the most vulnerable populations.
Targeting: Programs often fail to target the poor effectively, leading to inefficiencies.
Equity: There is a significant gap in the distribution of SP benefits between different socioeconomic groups.
Cost-Effectiveness: Some programs are not cost-effective due to poor targeting and implementation.
Monitoring and Evaluation: The system lacks robust M&E mechanisms to assess effectiveness and impact.
Institutional Arrangements: The institutional framework for SP is fragmented and needs strengthening.

VI. Conclusions and Recommendations

Strategic Approach: A more integrated and comprehensive SP strategy is needed to address both microeconomic and natural disaster risks.
Program Priorities: Focus should be on early childhood development, education, health, and disaster preparedness.
Targeting and Transparency: Improve targeting mechanisms and ensure transparency in SP program implementation.
Monitoring and Evaluation: Develop a results-based M&E system to track the impact and effectiveness of SP programs.
Accountability: Enhance accountability and participation of the poor in SP program design and implementation.

Key Tables and Figures

Table 1: Mortality rates for different age groups in Nicaragua from 1998 to 2006.
Table 2: Chronic malnutrition rates among children under 5 years old from 1998 to 2005.
Table 3: Preprimary net enrollment for children aged 0-3.
Table 4: Primary net enrollment by department.
Table 5: Reasons for non-enrollment of children aged 7-12 in school.
Table 6: Secondary net enrollment by department.
Table 7: Reasons for non-enrollment of children aged 13-18 in school.
Table 8: Prevalence of disability by age group.
Table 9: Child labor and early childbearing statistics.
Table 10: Employment and underemployment rates.
Table 11: Illiteracy rates by age group.
Table 12: Land distribution and irrigation.
Table 13: Ownership of livestock.
Table 14: Farms that requested and obtained credit.
Table 15: Population with pensions.
Table 16: Utilization of health facilities.
Table 17: Access to basic services by consumption quintile.
Table 18: Impact of natural disasters.
Table 19: Social indicators in the Autonomous Regions.
Table 20: Selected programs for indigenous and ethnic groups.
Table 21: Population at risk, program coverage, and costs.
Table 22: International comparison of public SP spending.
Table 23: SP expenditures by different ministries.
Table 24: Distribution of SP spending.
Table 25: Typology of SP program coverage.
Table 26: Incidence and distribution of extreme poverty.
Table 27: Municipalities with the highest incidence of indigence.
Table 28: Characteristics of SP programs targeting the poor.
Table 29: Benefit incidence of public spending.

Key Boxes

Box 1: Defines risk and vulnerability in the context of SP and SRM.
Box 2: Highlights the cost of malnutrition in Nicaragua, estimated at US$224 million or 5.8% of GDP.
Box 3: Discusses the cost of health care and the need for improved access and affordability.
Box 4: Estimates the cost of domestic violence and its impact on health and development.
Box 5: Illustrates the cost of under-investing in natural disaster management.
Box 6: Discusses risk in the Atlantic region due to natural disasters and limited infrastructure.
Box 7: Reviews innovative approaches in healthcare.
Box 8: Highlights food insecurity and the Zero Hunger initiative.
Box 9: Describes emergency aid following Hurricane Felix.
Box 10: Evaluates the Poverty Reduction and Local Development Project.
Box 11: Provides guidance on building a results-based M&E system.

Conclusion

The report concludes that Nicaragua's Social Protection system is underdeveloped, inequitable, and ineffective in addressing the risks and vulnerabilities of the poor. It recommends a strategic approach to improve targeting, cost-effectiveness, and institutional arrangements, as well as the development of a robust M&E system to ensure accountability and effectiveness.

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