2014年-世界发展银行全球_Albania_Public_Finance_Review___Part_2_Improving_the_Efficiency_and_Quality_of_Public_Spending_115页_2mb

Summary of Albania Public Finance Review (Report No. 82013 - AL)

Core Content

This report, part of the second phase of the Albania Public Finance Review (PFR), evaluates the efficiency and quality of public spending in the education, health, and social assistance sectors. It also examines the progress and challenges of public administration reforms in Albania and their implications for fiscal sustainability and EU integration.

Main Viewpoints

Economic Context

• Albania's economic growth slowed post-2008 financial crisis, from 6% annually to less than 3%.
• Unemployment increased from 13% in 2007 to 16% in 2013.
• Fiscal space is constrained due to low revenues and high public debt.
• Productive investments in human capital, infrastructure, and a better business environment are needed to boost growth.
• Fiscal consolidation is necessary to free up resources for education, health, and infrastructure.

Education

• Access: Significant improvements in education access, with primary and lower secondary enrollment nearly universal.
• Enrollment Trends: Preprimary enrollment increased from 47.4% to 79% between 2009 and 2013; upper secondary enrollment rose from 76% to 92%.
• Equity: Inequities persist in access to preprimary and higher education, with the wealthiest quintile having twice the net enrollment in preprimary and four times in higher education compared to the poorest.
• Learning Outcomes: Despite improvements, learning outcomes remain low, with over 60% of 15-year-olds functionally illiterate in math and about 50% in reading.
• Funding: Albania's public spending on education is among the lowest in the region (3.06% of GDP in 2013), lagging behind Europe and Central Asia (4.6%) and Western Balkan peers.
• Institutional Complexity: The education system is managed by 13 Regional Education Departments (REDs) and 24 local Education Offices (EOs), with complex and opaque resource allocation.
• Recommendations:
  • Expand access and quality of preprimary education using savings from higher grades.
  • Improve sector governance and coordination across levels of government.
  • Introduce a transparent per capita financing (PCF) formula for pre-university education.
  • Strengthen tertiary education regulation and quality data generation.
  • Consider increasing public education spending to around 4% of GDP in the medium to long term.

Health

Health Outcomes

• Life expectancy at birth reached 77 years in 2011, surpassing Serbia and FYR Macedonia but still lagging behind EU averages.
• Infant mortality decreased from 18.1 to 15 per 1,000 live births, but remains high compared to the EU.
• Maternal mortality fell from 31 to 27 per 1,000, but still lags behind EU levels.

Public Spending

• Public health spending is among the lowest in the region at 2.6% of GDP.
• Over 50% of the health budget is allocated to hospital-based services, mainly the University Hospital Center Mother Theresa.
• Primary care accounts for about 30%, and public health services for 8.5%.

Financial Protection

• Out-of-pocket (OOP) spending is high, at 50% of total health expenditure, exceeding WHO recommendations of 15-20%.
• OOP health payments account for 8% of household income on average, with pharmaceuticals making up about half.
• The incidence of catastrophic and impoverishing health expenditures is high, with a 41% increase in the headcount poverty ratio and a 103% increase in the poverty gap in 2012 due to OOP payments.

Recommendations

• Improve pharmaceutical procurement and payment systems to increase transparency and reduce costs.
• Rationalize the hospital sector and increase public financing for primary care.
• Reduce OOP payments for essential medicines and expand insurance coverage, starting with the poorest.
• Shift to output-based purchasing and strengthen the Health Insurance Institute (HII) as a strategic buyer.
• Leverage IT to enhance efficiency and quality.
• Consider increasing public health spending over the medium to long term as fiscal space opens.

Social Assistance

Overview

• Social assistance includes cash benefits (Ndihma Ekonomike - NE) and social services.
• NE is the main poverty-targeted program, while disability assistance is a categorical benefit.

Funding and Coverage

• Public spending on social assistance is about 1.6% of GDP, similar to regional averages.
• NE spending has stabilized at 0.9% of GDP, with benefits concentrated among the poorest 40% of the population (66%) and the poorest quintile (46%).
• Disability assistance has grown significantly, from 0.4% of GDP in 2000 to 1.0% in 2010.

Targeting and Equity

• NE is fairly well-targeted but has low coverage.
• Disability assistance is modestly targeted but expanding in coverage.

Recommendations

• Improve targeting accuracy and coverage of NE.
• Enhance transparency and efficiency in the delivery of social assistance.
• Strengthen the disability assistance program to ensure better support for beneficiaries.

Public Administration Reform

Overview

• The public sector wage bill is not large and not growing rapidly.
• Civil service reforms are ongoing, with the new Civil Service Law (CSL) aiming to improve professionalism and merit-based recruitment.

Challenges

• Implementation of the CSL faces challenges, including a lack of clear criteria and transparency.
• Salary and pay reform has made steady progress, but disparities between public and private sectors persist.
• Civil service downsizing has been disruptive and costly, affecting service delivery.

Recommendations

• Enhance transparency and clarity in the institutional framework and resource allocation.
• Improve the attractiveness of the civil service through better pay and benefits.
• Strengthen the capacity of the Civil Service Commission (CSC) and the Department of Public Administration (DPA).

Fiscal Implications

• Increasing public spending on education and health is crucial for long-term growth and regional competitiveness.
• As fiscal space opens, additional budgetary allocations may be needed for the social sector.
• The report emphasizes the importance of efficiency gains in the short to medium term to improve outcomes without increasing public debt.

Key Information

• Currency: Albania Lek (LEK), with 1 LEK = 0.01 US$ and 1 US$ = 104 LEK.
• Fiscal Year: January 1 – December 31.
• Metric System: Used throughout the report.
• Key Acronyms:
  • PFR: Public Finance Review
  • PFM: Public Financial Management
  • PAR: Public Administration Reform
  • PCF: Per Capita Financing
  • OOP: Out-of-Pocket
  • CSL: Civil Service Law
  • REDs: Regional Education Departments
  • EOs: Education Offices
  • HII: Health Insurance Institute
  • EMIS: Education Management Information System
  • WHO: World Health Organization
  • OECD: Organization for Economic Co-operation and Development

Conclusion

The report underscores the need for efficiency gains in public spending on education and health, as well as improvements in social assistance targeting and public administration reforms, to support Albania's development and EU integration goals. It calls for greater transparency, better data systems, and more strategic fiscal planning to ensure sustainable growth and improved service delivery.