2015年-世界发展银行全球_Madagascar_2014_Public_Expenditure_Review___Education_and_Health_20页_528kb

Summary of the MADAGASCAR 2014 Public Expenditure Review: Education and Health

Core Content

The 2014 Public Expenditure Review of Madagascar's education and health sectors highlights significant structural and contextual weaknesses, along with policy recommendations aimed at improving quality, equity, and efficiency in both sectors.

Education Sector - Key Findings

• Education outcomes have declined sharply since 1998, as evidenced by low learning scores in assessments.
• Teacher training and performance lack a sustainable and quality mechanism, leading to poor educational quality.
• Out-of-school children are increasing, putting pressure on the system to expand and integrate strategies to attract these children.
• Community teachers now make up 80% of the teaching force in primary schools, but their qualifications and training are low, and they are unequally distributed.
• Public spending on education is low (2.75% of GDP), the lowest among comparable countries, though it has consistently been prioritized in the government budget.
• Execution rates are relatively high, but budget reallocations and poor data capture in SIGFP undermine budget credibility.
• Public spending is skewed towards salaries, with 90% of total education spending allocated to salaries, leaving little for quality improvements.
• Household education costs have increased, with the poorest spending 3.5% of their budget on education in 2012, compared to 2% in 2005.
• Inequities in education spending exist, especially in secondary and higher education, where the poorest do not benefit directly.

Education Sector - Policy Implications

Invest in Quality

• Create a sustainable supply of trained and qualified teachers.
• Ensure equitable distribution of teachers, especially to the most vulnerable regions.
• Reestablish administrative and pedagogical support at local and school levels.

Create Conditions for Learning

• Improve teacher skills through pre-service and in-service training.
• Enhance the supply and quality of learning materials.

Address Out-of-School Children

• Expand school grant programs in a targeted manner.
• Scale up effective interventions for vulnerable groups, such as conditional cash transfers and school feeding.
• Pilot second-chance education programs.

Better Use of Budget as a Strategic Tool

• Implement program budgeting to improve budget preparation and analysis.
• Refine categorization of salary and non-salary costs.
• Reclassify subsidies to community teachers as "salary-type" spending for better budget tracking.

Health Sector - Key Findings

• Health outcomes have stagnated since the 2009 crisis, with high maternal and child mortality rates and chronic malnutrition.
• Health service delivery is inequitable, with affordability and accessibility issues disproportionately affecting the poor.
• Human resources for health (HRH) are unevenly distributed, with over 50% of staff over 50 years old and nearing retirement.
• Public health spending is low (around 4-5% of GDP), with domestic financing being very limited and unstable.
• Budget execution is centralized, and non-wage expenditures are often not fully executed due to high regulation rates.
• Labor costs dominate public health spending (84% of domestic financing in 2013), while other operational and investment expenditures have decreased.
• External aid has been a major source of funding, but its lack of alignment with the Ministry of Health (MoH) limits synergies and sustainability.

Health Sector - Policy Implications

Spending More

• Increase public financing for the health sector, both through domestic and external sources.
• Develop a comprehensive national health strategy to guide financing and resource allocation.

Executing Better

• Strengthen budget tools, especially SIGFP, to include more comprehensive data on external aid.
• De-concentrate budget execution to district and primary care levels.
• Adjust regulation rates to ensure equitable impact across programs.
• Align budget planning with the Ministry of Finance's calendar.

Redirecting Spending

• Shift focus from wage expenditures to operational and investment spending.
• Address the imbalance in salary growth, particularly at the central and regional levels.
• Improve capacity and service delivery at the primary level by redistributing the wage bill.

Better Use of Resources

• Redirect budget increases to operational budgets and investments.
• Consider output-based funding approaches over current input-based methods.
• Improve coordination and alignment of external aid with national strategies to maximize impact.

Key Recommendations

• Education: Focus on teacher training, quality inputs, and equitable distribution of resources. Consider slower regularization of community teachers and targeted school grant programs.
• Health: Prioritize increasing domestic financing and reducing reliance on external aid. Improve HRH distribution, especially in rural areas, and enhance budgeting and execution mechanisms to support sustainable service delivery.

Conclusion

Both sectors face critical challenges in terms of quality, equity, and efficiency. The education system is underfunded and lacks a sustainable teacher training mechanism, while the health system is heavily reliant on external aid and suffers from inequitable resource distribution and high out-of-pocket costs. Addressing these issues requires a combination of increased public spending, improved budget management, and a focus on strategic resource allocation to support long-term development goals.