2015年-世界发展银行全球_Madagascar_2015_Review_of_Public_Expenditure_in_Social_Sectors___Executive_Summary_7页_519kb

Madagascar 2015 Review of Public Expenditure in Social Sectors Summary

Core Content

Madagascar has faced persistent economic and social challenges over the past decade, marked by slow economic growth, high poverty rates, and a dual burden of disease. The country's public expenditure on education and health has been significantly impacted by the 2009 political crisis, which led to the suspension of donor activities and a decline in investment. Despite some initial progress in achieving social development goals, these gains have been reversed, and the systems remain underfunded and inequitable.

Key Findings

• Economic and Social Context:

  • Madagascar's annual economic growth has averaged 1% over the last five years, far below the sub-Saharan average.
  • Income per capita has declined significantly since 1970, and extreme poverty rates have remained high.
  • Inequality is moderate, with a Gini coefficient between 0.39 and 0.47.
  • About a third of the population is deprived in multiple dimensions, including education and health.

• Public Spending Trends:

  • Total public expenditure on education and health in 2013 was 3.1% and 2.8% of GDP, respectively, far below the average for low-income countries.
  • External aid constitutes a large share of health funding (80% in 2013), while its share in education is lower (20% in 2013).
  • Public spending on education and health is heavily weighted towards salaries, with education allocating 90% and health 85% of public funds to salaries in 2013.

• Sectoral Challenges:

  • Education:
    • Primary school enrollments have declined since 2009 due to financial constraints.
    • Learning outcomes have worsened, with significant drops in French and math scores.
    • Community teachers, who lack qualifications, now make up 80% of the teaching workforce, negatively affecting education quality.
  • Health:
    • Access to essential services, especially maternal and child health, is limited.
    • Immunization coverage has dropped from 62% in 2008 to 51.1% in 2012.
    • The share of out-of-pocket spending is high (30% for health, 42% for education), and this has increased over time.
    • The health system is regressive, with benefits skewed towards the richest quintile.

Recommendations

1. Cross-Cutting Recommendations

• Improve Spending Efficiency:

  • Revisit execution of regulation rates to ensure flexibility and equitable impact.
  • Strengthen and harmonize the use of budget tools like SIGFP to record external financing accurately.
  • Link financing to results through Results-Based Financing and Conditional Cash Transfers (CCTs).
  • Deconcentrate resources to lower levels of management to increase autonomy and efficiency.

• Evidence-Based Decision Making:

  • Collect regular data on demographics, health, and poverty to enable better analysis and policy design.
  • Conduct a robust review of external aid financing to align with national strategies.

2. Education Sector Recommendations

• More Equitable Spending:

  • Maintain programs that reduce financial barriers to education for vulnerable populations.
  • Ensure civil servant teacher recruitment prioritizes rural and vulnerable areas.
  • Explore scaling up support for children with high opportunity costs through CCTs and vouchers.

• Improved Quality of Education Services:

  • Allocate incremental resources to improve the learning environment (e.g., training, materials).
  • Adopt a progressive timeline for integrating community teachers into civil service.
  • Develop a renewed teacher strategy, including contractual frameworks.
  • Secure additional resources to support equitable distribution of education quality.
  • Invest in supervision and monitoring at lower levels of education.

3. Health Sector Recommendations

• Improved Access to Health Services:

  • Reduce out-of-pocket costs through targeted fee exemptions and CCTs.
  • Prioritize wage increases for rural populations and first-line health facilities.
  • Increase domestic financing for health by reallocating budget shares.
  • Expand community health initiatives like Strategie Avances and community health workers.
  • Improve functionality of CSB1s (Community Health Centers).

• Quality of Health Services:

  • Allocate resources to operational budgets and investments.
  • Develop and implement the Human Resource National Plan and the National Quality Plan for Health.
  • Re-balance spending to address critical health needs, such as immunization.
  • Invest in supervision and monitoring at lower levels of the health system.

Key Indicators

Conclusion

Madagascar's education and health systems are under severe financial strain and marked by inequity. While public spending is prioritized, it is not sufficient to meet the needs of the population, especially the most vulnerable. The heavy reliance on external aid in health and the concentration of spending on salaries in both sectors have hindered the delivery of quality services. There is an urgent need for more efficient and equitable resource allocation, supported by evidence-based decision-making and stronger domestic financing.