世界银行-中非共和国主要人类发展部门的公共支出审查（英）-2024-106页_11mb

Public Expenditure Review in Key Human Development Sectors of the Central African Republic (2023)

Core Content Overview

This report provides a comprehensive analysis of public expenditure in the Central African Republic (CAR) across key human development sectors: education, health, and social protection (SP). It outlines the current state of public financial management (PFM) and the challenges faced by the country in terms of fiscal sustainability, service delivery, and human capital development. The review is conducted to support informed decision-making for resilient recovery, improved human capital outcomes, and stronger institutional frameworks.

Key Challenges and Trends

Macroeconomic and Fiscal Context

• Fragility and Conflict: CAR remains one of the most fragile and conflict-affected countries globally, with a history of political instability and security crises. The 2019 Political Agreement for Peace and Reconciliation (APPR Accord) failed to bring lasting peace, and post-election unrest in 2020 further exacerbated the situation.
• Economic Decline: Since independence in 1960, GDP per capita has dropped by nearly half, from US$620 in 1961 to US$384 in 2019. Extreme poverty remains high, with 71.4 percent of the population living in poverty in 2019.
• Human Capital Outcomes: CAR has some of the lowest Human Capital Index (HCI) scores in the world, significantly below the average for fragile, conflict, and violence (FCV) countries and Sub-Saharan Africa (SSA).
• Humanitarian Crisis: As of 2021, over half the population required humanitarian assistance, and 40 percent of households faced acute food insecurity. The number of internally displaced persons (IDPs) increased by 6.9 percent following the 2020 election.

Public Expenditure Trends

• Low Spending on Human Development: Public spending on health and education is below the regional average and CAR's income group, at less than 2 percent of GDP each. Social protection spending is similarly low.
• Fiscal Vulnerability: Domestic resource mobilization (DRM) is weak, and the country relies heavily on external assistance. In 2019, official grants from donor institutions accounted for 9.6 percent of GDP, more than half of total government revenues.
• Impact of the Pandemic: The COVID-19 crisis has led to budget cuts in education and health sectors, and increased risks of long-term human capital losses due to disrupted services and learning.

Key Sectors Analysis

Education

• Outcomes: CAR's education outcomes are poor. Students complete only 4.6 years of schooling by age 18, compared to the SSA average. Learning-adjusted years are even lower, at 2.7 years.
• Access and Quality: Access to education is limited, especially for girls. The quality of education is extremely low, with only 20 percent of grade 4 students able to read a familiar French word in one minute.
• Infrastructure and Services: Infrastructure such as electricity, mobile phone coverage, and road networks is underdeveloped. Only 10 percent of districts have electricity, and half of the districts report inaccessible roads to Bangui.
• Disparities: There is a stark gap in access to education between Bangui and the rest of the country. Only half of the 10 largest localities in each district have functional primary schools, and 18 percent have functional health centers.

Health

• Outcomes: Life expectancy is among the lowest globally at 52.9 years in 2017. Maternal mortality ratio (MMR) is one of the highest in the world, at 829 deaths per 100,000 live births.
• Service Access: Access to basic health services is limited, especially outside district capitals. Only 36 percent of districts report having clean water access points in their capitals.
• Health Challenges: Major causes of mortality include preventable diseases like HIV/AIDS, malaria, and tuberculosis, as well as conflict. Stunting rates are higher than the FCV and SSA averages, with 40 percent of children under five affected.
• Impact of Pandemic: School closures have led to widespread learning losses, and the crisis is expected to increase stunting rates and reduce access to essential health services.

Social Protection

• Coverage and Sustainability: Only 20 percent of the population received social security net (SSN) benefits in 2020, and the SSN is mainly composed of emergency projects. There is a lack of long-term sustainability in public spending on social protection.
• Equity and Access: Social protection systems are not adequately reaching the most vulnerable populations, including IDPs and food-insecure households. Equity in access to health services remains a significant issue.

Recommendations

General Recommendations

• Prioritize Human Capital Development: Human capital investment should be central to the budget process and policy development, recognizing its role in building a country's productive capacity.
• Strengthen Public Financial Management (PFM): Improving PFM systems, including budget preparation, execution, and evaluation, is critical for ensuring efficient and effective public spending.
• Protect Human Capital Spending: In the context of the pandemic, efforts must be made to protect essential expenditures in education, health, and social protection from budget cuts.
• Enhance Service Delivery: Strengthening service delivery systems to be resilient and inclusive is essential for improving human capital outcomes.
• Promote Fiscal Responsibility: A multi-year, outcome-oriented budgeting approach is needed to safeguard human capital spending in the face of fiscal adjustment.

Sector-Specific Recommendations

• Education: Increase investment in education to improve access, quality, and learning outcomes. Focus on teacher training, infrastructure development, and curriculum reform.
• Health: Expand access to health services, especially in rural and conflict-affected areas. Improve the quality of health services and address the root causes of poor health outcomes.
• Social Protection: Develop a more comprehensive and sustainable social protection system. Expand coverage to the most vulnerable populations and ensure equitable access to services.

Conclusion

The Central African Republic faces significant challenges in human development due to its fragile state, weak governance, and limited public spending. The Public Expenditure Review highlights the urgent need for increased investment in education, health, and social protection, supported by improved public financial management and a focus on equity and efficiency. These efforts are essential for achieving long-term peace, stability, and sustainable development.