Report No. 24450-RU Russian Federation Child Welfare Outcomes During the 1990s: Public Disclosure Authorized The Case of Russia (In Two Volumes) Volume II: Main Report November, 2002 Human Development Sector Unit Europe and Central Asia Region Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Document of the World Bank ABBREVIATIONS RF - Russian Federation MLSD - Ministry of Labor and Social Development MOE - Ministry of Education MOH - Ministry of Health MOF - Ministry of Finance RLMS - Russia Longitudinal Monitoring Survey HH - household IMR - infant mortality rate WHO -World Health Organization MMR - matemal mortality rate PPE - preprimary education PE - primary education LSE - lower secondary education FSE - full secondary education TE - tertiary education. GDP - Gross Domestic Product ECA - Europe and Central Asia SWSCS - Social work and social care services NGOs - non-governmental organizations MHI - mandatory health insurance CIS - Commonwealth of Independent States CRC - The Convention on the Rights of the Child UN - United Nations PMPC - Psycho-Medico-Pedagogical Commissions MDRI - Mental Disability Rights International Vice President: Johannes F. Linn Country Director: Julian F. Schweitzer Sector Director: Annette Dixon Task Team Leader: Aleksandra Posarac Table of Contents Abbreviations ............................................................. 2 Preface ................................................... ..... 5 Acknowledgements ................................................... 6 Part I: Child Welfare in Russia during the 1990s: A Review of the Trends, Outcomes, Institutions, and Policies ...................................................... 7 Chapter 1: What Happened to Child Welfare in Russia during the 1990s .................................. 8.............8 1.1 The case for investing in children ..................................................... 8 1.2 The child welfare situation and trends during the 1990s ...................................................... 8 Chapter 2: Factors Affecting Child Welfare Outcomes in the 1990s? .................................................... 26 2.1 Economic developments ................................................................ 26 2.2 Demographic and family formation changes ................................................................ 28 2.3 Public programs in health, education, and social protection ..................................................... ... 31 Chapter 3: Social Protection, Health, and Education in the 1990s .......................................................... 32 3.1. The social safety net-Policies, institutions, and impact ............................................................. 32 3.2 Health ................................................................ 61 3.3 Education ................................................................ 63 Chapter 4: Conclusions ................................................................ 65 Part II: Well-Being of Children Deprived of Parental Care and Children with Disabilities ........................ 66 Chapter 1: Children Deprived of Birth Parental Care ................................................................ 67 1.1 Overview of the situation ................................................................ 67 1.2 What has the Government done? ................................................................ 72 1.3 The public care system for children deprived of parental care ..................................................... 75 1.4 Financing ................................................................ 100 1.5. Private and NGO sector involvement ................................................................ 103 1.6. Experience of some of the Russian regions in reforming the child care system ........................ 104 1.7. Summary and conclusions ................................................................ 104 Chapter 2: Children with Disabilities ................................................................ 107 2.1 Trends in disability among children in Russia ................................................................ 107 2.2 Protection and support to children with disabilities and their families ....................................... 110 2.3 Education of children with disabilities ................................................................ 112 2.4 Toward better, cost-effective welfare outcomes for children with disabilities ........................... 117 2.5 Conclusion ................................................................ 118 Bibliography ................................................................ 120 Annex 1 (Statistical Annex) ......................................................... 127 Annex 2 ......................................................... 181 Annex 3 ......................................................... 184 Annex 4 ......................................................... 188 Annex 5 ......................................................... 190 Annex 6 ......................................................... 192 Annex 7 ......................................................... 208 Annex 8 ......................................................... 254 3 Table of Figures Figure I. 1: Poverty ratesfor children 0-16 and overall population in Russia........................................... 10 Figure I. 2: Poverty ratesfor individuals in Russia in 1998 (in %, RLMS data)......................................... 11 Figure I. 3: Poverty ratesfor households in Russia 2000' (in %; Goskomstat data) .................................. 11 Figure I. 4: Poverty rates by household characteristicsin Russia in 1998 (in °/; RLMS data).................. 12 Figure I. 5: Poverty ratesfor households with different composition in Russia in 1998 ............................. 12 Figure I. 6: Relative poverty riskfor different types offamilies with .......................................................... 13 Figure I. 7: Relative poverty risk and relative extreme poverty riskfor ...................................................... 13 Figure I. 8: Infant mortality in Russia 1990-99 (per thousand live births)................................................. 15 Figure I. 9: Under-five mortality in Russia 1990-1999 (per thousand live births)...................................... 16 Figure I. 10: Under-five mortality rates in the Europe and CentralAsia Region 1999 .............................. 17 Figure I. 11: Vaccination ratesfor children under two years of ................................................................. 17 Figure I. 12: Real GDP indices in Russia 1990-2000 (1990=100)............................................................. 27 Figure I. 13: Real GDP in 2000 in comparison to 1990....................................................................... 28 Figure I. 14: Social benefits coverage by per capita expenditure quintiles in 2000.................................... 39 Figure I. 15: The share of specific social benefits in the total..................................................................... 43 Figure I. 16: Benefit coverage of households in 1998 and 2000-RLMS data................. ........................... 45 Figure I. 17: Child benefits coverage in 2000 (RLMS) ....................................................................... 46 Figure I. 18: The average amount of transfersper recipient household in 2000; -.------*--------*--------*---*-------47 Figure I. 19: Distribution of benefit expenditures in 1998 (RLMS) ............................................................. 48 Figure I. 20: Distribution of benefit expenditures in 2000 (RLMS) ............................................................. 49 Figure H. 1: Children deprived ofparental care in Russia and their placement 1990-2000...................... 70 Figure II. 2: Children with disabilitiesin special schools ....................................................................... 115 Table of Tables Table I. 1: Diseaseprevalence among children in Russia 1994-2000 ...................................................... 18 Table I. 2:: Net enrollment rates in education in Russia in 1998 (as percent of the relevant cohort)....... 23 Table I. 3: A Summary of major social protection programs in Russia...................................................... 34 Table I. 4: Expenditures on social protection in Russia: An estimate for 1999 ................ .......................... 36 Table I. 5: Public expenditures on health in Russia 1991-99 ..................................................................... 61 Table I. 6: Consolidatedpublic spending on education in Russia 1992-2000 ........................................... 63 Table II. 1: Children deprived ofparental care in Russia in 1990 and 2000 and theirplacement into care .............................................................................................................................................................69 Table I. 2: Termination ofparentalrights in Russia ........................................................................... 76 Table I. 3: Children in infant homes in Russia, 2000-by legal status and reasonsfor placement........... 89 Table I. 4: Infant homes in Russia 1990-2000 (end-of-year data) .............................. .............................. 90 Table I. 5: An estimate of needed public resourcesfor thefinancing of residentialcare, guardianship/trusteeshipand social care services in Russia in 1999 .............................................