The World Bank Brazil-Salvador Social Multi-Sector Service Delivery Project (P162033)

Sectoral and Institutional Context

##### Service Delivery Performance

In Brazil's federal arrangement, municipalities shoulder basic social service delivery such as pre -primary and fundamental education (grades 1-8), primary as well as some higher-complexity health care, and face-to-face social assistance services. In delivering these services, municipalities often follow federal (and sometimes state) policies and guidelines and receive fiscal transfers, both tied and untied to specific service responsibilities and performance. Many of the social services are guaranteed as c itizen rights in the 1988 Constitution. Municipalities therefore form the institutional frontline of Brazil's rights-based social policy systems, and capable municipal administrations are fundamental for effective delivery of these social services and hence for poverty reduction. In addition to managing networks of health and education facilities both under their direct administration and through service contracts, municipalities are also called upon to play specific roles in implementing programs and mandates that are constitutionally or legally assigned to the federal government. These include the conditional cash transfers program, Bolsa Família , and the social pension program, Beneficios Prestação Continuada de Assistência Social (BPC) for which municipalities are responsible for maintaining an up-to-date social registry ( Cadastro Unico ) and for identifying and enrolling new beneficiaries. In 2012, the year before the current mayor started his first term, Salvador's social service delivery was characterized with low coverage and relatively poor quality due to years of under-investments. Not only did Salvador lack sufficient numbers of basic service facilities, but manyofits existing facilities, such as early childhood education (ECE) facilities, schools, health facilities, or social assistance centers, were in suboptimal physical conditions. For example, the Centros de Referência de Assistêncial Social (CRAS) generally failed to meet the federal government standards, and as a result the Municipal Secretariat of Social Promotion and Fight against Hunger (SEMPS) was at the risk of losing some of the fiscal transfers associated with sustaining a minimum standard in social assistance service provision. Salvador ranked at the bottom of ranking among the state capitals in Basic Education Development Index (IDEB) in both 2011 and 2013 and its infant mortality rate (16.7 percent) lagged behind comparator cities like Fortaleza (11.2 percent) and Recife (12.2 percent). Starting in 2013, the administration resolved to arrest this trend and considerably increased investments in the social sectors as central elements of the city's strategic plan. The investments included construction of 26 new schools, eight new emergency care units ( Unidade de Pronto Atendimento, UPA ), four new Health Multi-centers ( Multicentros ) for specialist medical consultations and medium-complexity tests, and seven newCRAS, as well as reforms and refurbishment of numerous existing facilities. These investments not only expanded Salvador's physical capacity to offer these basic social services but also contributed to their improved quality. As a result, the basic coverage indicators improved in every sector. In education, the proportion of children attending daycare centers increased from 12.4 percent of children aged 0- 3 in 2012 to 16.7 percent in 2016. In health, Salvador's primary care coverage, through a combination of the Family Health Units/Teams and the traditional primary care units, was only 18.6 percent in 2012, but this improved to 44.2 percent in 2015. In social assistance, the coverage of Bolsa Família in 2012 was only 62.2 percent (compared to the national average of 100 percent), only 45 percent of the data on Cadastro Único had been updated (compared to the national average of 70 percent). By 2015, these figures reached 98.9 percent in Bolsa Família coverage, close to the parameter set by the Federal Ministry of Social Development, and the updating rate of the Cadastro Unico data was close to 90 percent thanks to the city's aggressive effort to increase the number of Cadastro Unico service points from 12 in 2013 to 35 by late 2016. Despite these improvements, Salvador still lags behind not only not only the front-runners in social development among Brazil's state capitals such as Curitiba and Belo Horizonte, but also its regional peers like Fortaleza and Recife. The gaps appear larg er on the quality front. For example, even though Salvador's IDEB performance improved somewhat between 2013 and 2015 (at least for early grades), its score (47) still compares poorly against Fortaleza (54), let alone the better