OECD Development Pathways Multi-dimensional Review of Paraguay VOLUME 2. IN-DEPTH ANALYSIS AND RECOMMENDATIONS ACKNOWLEDGEMENTS │ 3 Acknowledgements Multi-dimensional Country Reviews (MDCRs) are the result of a collaborative effort of the OECD and the country under review. Work on the second phase of the MDCR of Paraguay was carried out by the OECD Development Centre, with support from the Technical Secretariat for Economic and Social Development Planning of Paraguay (Secretaría Técnica de Planificación del Desarrollo Económico y Social, STP). The review was produced under the guidance of Mario Pezzini, Director of the OECD Development Centre and Special Counsellor to the Secretary-General on Development, and the leadership of Jan Rieländer, Head of the MDCR Unit. The review was co-ordinated by Juan Ramón de Laiglesia (OECD Development Centre) and drafted by Ian Brand-Weiner, Juan Ramón de Laiglesia, and Juan Vázquez Zamora (OECD Development Centre). Deirdre Culley managed the workshop “Scenarios for the future of Paraguay” held in Asunción on 4 December 2017. The review also includes contributions made by Nathalia Montoya and Carine Viac (OECD Development Centre). Nathalia Montoya also provided excellent research assistance throughout the review. The team is grateful for guidance and comments provided by José-Luis Álvarez-Galván, Samuel Kim, and Elizabeth Fordham of the OECD Directorate for Education and Skills, as well as by Carline Berchet, of the OECD Directorate for Employment, Labour and Social Affairs. The team is also grateful for insightful comments provided by Riku Elovainio, Alexandre Kolev, Alexander Pick and Caroline Tassot (OECD Development Centre) as well as by those made by participants in the reviews session held on 26 and 27 April in Asunción and Paris. The report incorporates remarks and inputs provided during the review of the report by the Mutual Learning Group for Multi-Dimensional Country Reviews on its meeting held on 18 May 2018. The review was led by H. E. Ambassador Carlos Márcio Cozendey (Delegate of Brazil to International Organisations in Paris) and by Catalina Crane (Special representative of Colombia to the OECD. The Multi-dimensional Country Review of Paraguay is made possible by the financial support of the European Union. The team extends its gratitude to the Delegation of the European Union to Paraguay for its support during the process, the insights of its staff into the development of Paraguay and their efforts to seek synergies between this review and other actions financed by the European Union in Paraguay. The team is also grateful to Eurosocial for the invitation to participate in the activities of the programme on Social Protection in Paraguay. This review has greatly benefited from the support of Minister José Molinas Vega, Executive Secretary of the Technical Secretariat for Economic and Social Development Planning (STP) of Paraguay, and his staff. Jazmín Gustale (Deputy Minister of the STP), and her team have been valuable counterparts. The contributions of Gisella Dimodica, Verónica Gauto, Claudia Martínez and Marcos Martínez in ensuring the smooth interaction between the OECD team and the Paraguayan authorities were particularly helpful. The review has also benefitted from the reactivity and inputs provided by Martha Peña (Ministry of Finance), María Emilia Ayala, Verónica Bogarín, Octavio Ferreira, and Sebastíán Ortiz (Ministry of Foreign Affairs). The team extends its gratitude to the Directorate-General for Surveys, Censuses and Statistics (DGEEC) and to the Ministry of Employment, Labour and Social Security (MTESS) for providing household-level data MULTI-DIMENSIONAL COUNTRY REVIEW OF PARAGUAY: VOLUME 2. IN-DEPTH ANALYSIS AND RECOMMENDATIONS © OECD 2018 4 │ ACKNOWLEDGEMENTS used in this report. The following ministries, agencies and institutions provided useful inputs and contributions to the review throughout the process: the Central Bank of Paraguay (BCP), the Ministry of Agriculture and Animal Husbandry (MAG), the Ministry of Education and Culture (MEC), the Ministry of Employment, Labour and Social Security (MTESS), and its Labour Observatory, the Ministry of Finance (MH), the Ministry of Industry and Commerce (MIC), the Ministry of Justice, the Ministry of Public Health and Social Welfare (MSPBS), the National Agency for Evaluation and Accreditation of Higher Education (ANEAES), the National Anti-Corruption Secretariat (SENAC), the National Council for Higher Education (CONES), the National Council for Science and Technology (CONACYT), the National Development Bank (BNF), the National Scholarship Programme Carlos Antonio López (BECAL), the National Secretariat for Housing (SENAVITAT), the National Secretariat for Tourism (SENATUR), the National Technical College of Asunción, the National University of Asunción (UNA), the Secretariat for Social Action (SAS), the Social Security Institute (IPS), the Superintendence for Health, and the Technical Unit of the Social Cabinet (UTGS). The following individuals and organisations are also thanked for their inputs and engagement with the review process: Caja ANDE, Edgar Giménez Caballero , Investigación para el Desarrollo, Juntos por la Educación, Marta Lafuente, Sape’a, the Centro de Analisis y Difusion de la Economía Parguaya (CADEP), the Development Information Resource Center (CIRD), the Federation of Educators of Paraguay (FEP), the Federation of Production, Industry and Commerce (FEPRINCO), the Inter-american Development Bank, the Micro and Small enterprise chamber (Cámara de Mipymes), the National Union of Educators (UNE), the National Team for Country Strategy (ENEP) and its members, the National Worker’s Central (CNT), Paraguay Educa, the Paraguayan Association of Private Health Clinics, Paz Peña, Promed, the Workers Central Union of Paraguay (CESITP) and the World Health Organisation (WHO). The team is grateful to Andrew Brenner for editing the manuscript and to the OECD Development Centre Communication and Publications Unit, especially Delphine Grandrieux, Aida Buendía and Elizabeth Nash for their support in editing, laying out and producing the report. *This publication has been produced with the assistance of the European Union. The contents of this publication are the sole responsibility of the OECD and can in no way be taken to reflect the views of the European Union. MULTI-DIMENSIONAL COUNTRY REVIEW OF PARAGUAY: VOLUME 2. IN-DEPTH ANALYSIS AND RECOMMENDATIONS © OECD 2018 TABLE OF CONTENTS │ 5 Table of contents Acknowledgements ................................................................................................................................ 3 Executive summary ............................................................................................................................... 9 Achieving social protection for all Paraguayans.................................................................................. 9 Delivering quality healthcare to all requires systemic reform ........................................................... 10 Reforming the education and skills system to foster inclusiveness and improve school-to-work transitions ........................................................................................................................................... 10 Chapter 1. Overview and recommendations to meet Paraguay’s development ambition ............ 13 Progress and challenges in Paraguay’s development path ................................................................. 15 Achieving social protection for all Paraguayans requires larger investments and a systemic approach. ............................................................................................................................................ 18 Overcoming fragmentation and accelerating reform can improve the health of Paraguayan citizens ............................................................................................................................................... 22 Reforms in the education and skills system are necessary to foster inclusiveness and access to better jobs ........................................................................................................................................... 25 Anticipating trends and preparing for future challenges: scenarios for the future of Paraguay ......... 29 References .......................................................................................................................................... 32 Chapter 2. Towards Social Protection for all in Paraguay .............................................................. 35 Paraguay’s social protection system provides too little for too few .................................................. 37 Paraguay’s contributory pension system needs to become more equitable before expanding .......... 49 The way forward ................................................................................................................................ 60 Policy recommendations .................................................................................................................... 84 References .......................................................................................................................................... 88 Annex 2.A. Overview of social security and pension schemes ......................................................... 95 Chapter 3. Reforming to foster healthier lives in Paraguay .......................................................... 101 Introduction