Box 2: Failures in public service delivery One reason for the weak link between public expenditures and outcomes is that public service delivery in many developing countries is notoriously poor. The following examples illustrate the extent and nature of the problems.

1) A study in India documents teachers arriving ,drunk with some regularity and high levels of absenteeism.

2) In a survey in Zimbabwe, 13% of respondents gave as a reason for not delivering babies in public facilities that "nurses hit mothers during delivery", 22% that nurses ridiculed mothers for not having baby clothes, and 16% that mothers were ordered to clean linens soon after delivery; these results were confirmed by a survey of nurses where 11 % explained it as harassment by nursing staff.

3) In Guinea in 1984, 70% of government drugs disappeared.

> 4) World Bank studies (1994) find 30-40% misappropriation of drugs in dleveloping countries.

5) In outlying regions of Indonesia, vacancy rates in public services are 50% or more.

6) Costa Rica's absenteeism rate is 30% in public health facilities.

inefficient (see Box 1 on Uganda and Box 2 on examples of failures in public service delivery). Fourth, in the case of infant mortality for example, it is not a single, public-health intervention such as immunization, but a combination of factors, including access to potable water and mothers' education, that influences its decline. Finally, in the case of maternal mortality, data quality is so poor that it is difficult to estimate the size of the problem, much less the cost of meeting the goal.

The most accurate way to estimate the cost of meeting the social and environmental goals is at the country level. Country work, and in some cases, even sub-national studies, allow an assessment of the efficiency of public service delivery, the costs of reaching the most vulnerable populations and the ability to identify speci,fic interventions which are required to accelerate progress toward the targets. Estimates of the relationship between economic growth and poverty reduction are also much more meaningful at the country level. The World Bank is undertaking work in a selected group of countries, through the Poverty Reduction Strategy Paper (PRSP) consultative process, to identify the major constraints to accelerating progress toward the education, health, and environmental goals, including assessments of the resources (time, human capital, institutional, policy as well as monetary) required to meet the goals. Some country-level work has already been advanced, including estimates of the cost of meeting the health and education goals in Honduras and estimates for meeting the universal primary education objective in several African countries. This country-level work, together with other international experience in these sectors, including cross-country analytical work on the links between public expenditures and outcomes, form the basis for the estimates provided in this section.

# _Eduicationr_

Estimating the cost of attaining universal primary education by 2015 is an exercise beset by many of the problems described above: weak, and sometimes contradictory, evidence on the relationship between public expenditures on education and enrollments (due in part to problems in public service delivery); difficulty in disentangling the complementary roles of supply and 22