Lessons from Ethiopia

Khan, Qaiser M., Faguet, Jean-Paul, Gaukler, Christopher and Mekasha, Wendmsyamregne Improving basic services for the bottom forty percent: lessons from Ethiopia Report Original citation: Khan, Qaiser M., Faguet, Jean-Paul, Gaukler, Christopher and Mekasha, Wendmsyamregne (2014) Improving basic services for the bottom forty percent: lessons from Ethiopia. A World Bank study, 90430. World Bank Group, Washington, DC. ISBN 9781464803314 Originally available from: The World Bank This version available at: http://eprints.lse.ac.uk/59516/ Available in LSE Research Online: September 2014 © 2014 The Authors LSE has developed LSE Research Online so that users may access research output of the School. Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Users may download and/or print one copy of any article(s) in LSE Research Online to facilitate their private study or for non-commercial research. You may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain. You may freely distribute the URL (http://eprints.lse.ac.uk) of the LSE Research Online website. A WORLD BANK STUDY Public Disclosure Authorized Public Disclosure Authorized Improving Basic Services for the Public Disclosure Authorized Bottom Forty Percent LESSONS FROM ETHIOPIA Qaiser M. Khan, Jean-Paul Faguet, Christopher Gaukler, Public Disclosure Authorized and Wendmsyamregne Mekasha Improving Basic Services for the Bottom Forty Percent A WORLD BANK STUDY Improving Basic Services for the Bottom Forty Percent Lessons from Ethiopia Qaiser M. Khan, Jean-Paul Faguet, Christopher Gaukler, and Wendmsyamregne Mekasha © 2014 International Bank for Reconstruction and Development / The World Bank 1818 H Street NW, Washington DC 20433 Telephone: 202-473-1000; Internet: www.worldbank.org Some rights reserved 1 2 3 4 17 16 15 14 World Bank Studies are published to communicate the results of the Bank’s work to the development com- munity with the least possible delay. The manuscript of this paper therefore has not been prepared in accordance with the procedures appropriate to formally edited texts. This work is a product of the staff of The World Bank with external contributions. The findings, inter- pretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. 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Improving Basic Services for the Bottom Forty Percent • http://dx.doi.org/10.1596/978-1-4648-0331-4 Contents Foreword xi Acknowledgments xiii About the Authors xv Executive Summary xvii Abbreviations xxiii Introduction and Background 1 Context and Structure of This Book 3 The Promoting Basic Services Program 3 Notes 8 Chapter 1 Conceptual Framework and Methodology 9 Notes 13 Chapter 2 Citizen Direct Voice and Accountability 15 Decentralization and the Quality and Appropriateness of Local Services 16 Financial Transparency and Accountability 17 Social Accountability 18 Grievance Redress Mechanisms 18 Notes 19 Chapter 3 Effectiveness of Woreda Block Grant Spending on Education, Health, and Agriculture 21 A Positive Association between Woreda Block Spending and Results in Education 21 A Positive Association between Woreda Block Grant Spending and Results in Health 22 A Positive Association between Woreda Block Grant Spending and Results in Agriculture 25 Notes 28 Improving Basic Services for the Bottom Forty Percent • http://dx.doi.org/10.1596/978-1-4648-0331-4 v vi Contents Chapter 4 How Equitable Is Decentralized Spending at the Woreda Level? 29 Woreda Block Grant Spending on Health Improves Outcomes, Especially for the Rural Poor 29 Incidence Analysis of Woreda Block Grant Spending on Health and Education 32 Catalytic Effect of Spending on Extension Services by Plot Size 33 Gender Equity Analysis for Woreda Block Grant Spending 33 Notes 35 Chapter 5 The Federal System’s Role in Helping Lagging Areas and Groups 37 Regionally Disaggregated Analysis of Woreda Block Grant Spending 37 Ethnically Disaggregated Analysis of Woreda Block Grant Spending 39 Notes 41 Conclusions and Recommendations 43 Appendix A Detailed Methodology and Data Sources 45 Appendix B Financial Transparency and Social Accountability under the PBS Program 53 Appendix C The Center and the Periphery in Ethiopia: The Evolution of Today’s Federal State 55 Appendix D Detailed Regression Results 59 Bibliography 105 Boxes I.1 The Indirect Route of Accountability Through Policy Makers to Service Providers 5 1.1 Some Caveats on Interpreting the Results of This Study 10 2.1 The Direct Route of Accountability—Citizen Direct Voice and Accountability Models in Ethiopia 15 3.1 Ethiopia’s Health Extension Program and Health Extension Workers 22 Improving Basic Services for the Bottom Forty Percent • http://dx.doi.org/10.1596/978-1-4648-0331-4 Contents vii Figures I.1 The Triangle of Accountability in Service Delivery 4 1.1 Conceptual Model of the Results Chain of PBS Spending 9 1.2 Woreda-Level Expenditure in the Five PBS Sectors, 2011 12 3.1 Growth in Extension Services and Woredas’ Expenditure on Agriculture, 2008–11 25 3.2 Production by Crop, 2011 27 4.1 Percent Improvement in Selected Health Indicators Among Rural People between 2005 and 2011, by Wealth Quintile 30 5.1 Woreda Total Recurrent Expenditure Per Capita, 2010 38 Tables I.1 Federal Block Grants and PBS Program Disbursements 6 I.2 Total Woreda Recurrent Expenditures by Region 7 3.1 Association of Log of Per Capita Education Expenditure with Log of Education Outcomes 22 3.2 Association of Log of Per Capita Health Expenditure with Health Outcomes 24 3.3 Effect on Farmers’ Use of Extension Services of ETB 1 Per Capita Spending on Agricultural Extension Workers 26 3.4 Association of Log of Per Capita Spending on Agricultural Extension Workers with Log of Yield 28 4.1 Predicted Probabilities for “Successful” Health Outcomes by Place of Residence and Wealth Quintile if an HEW Visited the Household in the Past Year 31 4.2 Incidence of Woreda-Level Spending by Wealth Quintile 32 4.3 Effect of ETB 1 Spending on Agricultural Extension Workers on Probability of Using Improved Farming Techniques, by Plot-Size Quintile, 2011 33 4.5 Association of Log of Education Expenditure with Log of Net Enrollment Rate and Log of Net Intake Rate, by Gender 34 4.5 Predicted Probabilities of Improved Farming Techniques Being Used on a Field, by Gender of Household Head, 2011 35 5.1 Woredas Spending More Than 110 Percent of the National Average

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