2011年-世界发展银行全球_Equity_in_Public_Services_in_Tanzania_and_Uganda_87页_2mb

Summary of Report No. 56511 - AFR: Equity in Public Services in Tanzania and Uganda

Core Content

This report examines the issue of inequity in the distribution of public services in Uganda and Tanzania, with a focus on education and health sectors. It explores the causes of service delivery disparities, evaluates current policies and practices, and proposes potential solutions to improve equity.

Main Points

1. Problem Definition

• Inequity in public service delivery is a significant issue in both countries, especially in 'hard-to-reach and stay' (HTRS) areas, which are characterized by lower quality services and persistent poverty.
• The report highlights the need to identify and target under-served areas effectively to address these disparities.

2. HTRS Criteria

• Uganda: HTRS areas are defined as remote or insecure districts that struggle to attract and retain motivated staff due to difficult living conditions.
  • Criteria include remoteness (geography, infrastructure, transport, and access to basic services) and insecurity (conflict, limited mobility, and poor infrastructure).
  • The Ministry of Public Service designates HTRS areas based on these criteria, with 18 currently identified.
  • These areas are reviewed annually, and they may 'graduate' if conditions improve.
• Tanzania: The definition of HTRS areas is less clear. The 2005 study used staffing numbers and budgets per capita to identify under-staffed councils, but this criterion was not applied to the Special Budget allocation.
  • The report suggests that a clearer, more consistent criterion based on staffing per capita should be used.
  • The selection of districts for Special Budget seems to be based on a mix of criteria, including remoteness and infrastructure, which may not align with the study's findings.

3. Human Resource Management (HRM) Results Chain

• An analytical model is presented to understand the drivers of inequity:
  • Step 1: Staffing establishment is created.
  • Step 2: Resources are allocated and funded.
  • Step 3: Qualified staff are attracted and retained.
  • Step 4: Staff performance is managed.
  • Step 5: Quality services are delivered.
  • Step 6: Developmental outcomes are realized.
• The first three steps are within the state's control, and improving them requires policy and system changes.
• Steps 4 and 5 are influenced by both state actions and external factors such as staff motivation and public demand.
• Absenteeism is a critical issue in HTRS areas, leading to poor service delivery and reinforcing inequity.

4. Inequity in Service Delivery

• Uganda:
  • HTRS areas face significant challenges in staffing and service quality.
  • Data shows that a large proportion of health and education professionals are concentrated in urban areas.
  • The report recommends using staffing per population as the main criterion for identifying HTRS areas.
• Tanzania:
  • Under-staffed councils are identified, but the criteria for selection are inconsistent.
  • The report emphasizes the need for a more systematic approach to identifying HTRS areas and allocating resources accordingly.

5. Potential Solutions

• A typology of solutions is proposed, distinguishing between:
  • Supply-side approaches: Enhancing the supply of professionals through incentives and policy changes.
  • Demand-side and accountability approaches: Empowering communities to demand better services and improving internal accountability.
  • Market-based approaches: Leveraging market mechanisms to improve service delivery.
• Uganda:
  • The government has implemented financial incentives and improved living conditions.
  • Recommendations include addressing fiscal constraints, improving accountability, and considering market-based solutions.
• Tanzania:
  • The report suggests a review of current criteria and the implementation of a more consistent and results-based approach.
  • Emphasis is placed on improving the targeting of resources and enhancing the implementation of the current pay and incentive policy.

Key Information

• Fiscal Year: July 1 to June 30.
• Currency Equivalents:
  • US$1 = UGS 2446.15
  • US$1 = TZS 1558.50
• Key Acronyms:
  • HTRS: Hard-to-Reach and Stay
  • GBS: General Budget Support
  • PE: Personnel Emoluments
  • PETS: Public Expenditure Tracking Survey
  • P4P: Pay for Performance
  • QEI: Quality Enhancement Initiative

Conclusion

• Both countries face significant challenges in achieving equitable service delivery, particularly in HTRS areas.
• Current criteria for identifying HTRS areas are inconsistent and may not effectively target under-served regions.
• A more systematic and results-based approach to defining HTRS areas and allocating resources is needed.
• The report recommends a combination of supply-side, demand-side, and accountability measures to address the issue.
• A time limit on the 'fix the state' approach is suggested, with the possibility of market mechanisms being the best long-term solution.

Recommendations

• Use staffing numbers per population as the main criterion for identifying HTRS areas.
• Improve government accountability and ensure that resources are well-targeted.
• Address fiscal constraints by adjusting policies on allowances and providing greater financial management flexibility to HTRS areas.
• Consider market-based approaches as a potential long-term solution.