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«Cambodia More Efficient Government Spending for Strong and Inclusive Growth Integrated Fiduciary Assessment and Public Expenditure Review (IFAPER) ...»

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Public Disclosure Authorized

Report No. 61694-KH

Cambodia

More Efficient Government Spending for

Strong and Inclusive Growth

Integrated Fiduciary Assessment and Public Expenditure

Review (IFAPER)

November 30, 2011

Public Disclosure Authorized

Poverty Reduction and Economic Management Unit

East Asia and Pacific Region

Public Disclosure Authorized

Public Disclosure Authorized

Document of the World Bank

GOVERNMENT FISCAL YEAR

January 1 – December 31

CURRENCY EQUIVALENTS

(Exchange Rate Effective as of May 25, 2011) Currency Unit: Cambodia Riel (CR) U.S. $1.00 = CR 4078

WEIGHTS AND MEASURES

Metric System Vice President: James W. Adams Country Director: Annette Dixon Chief Economist and Sector Director: Vikram Nehru Country Manager: Qimiao Fan Lead Economist: Mathew A. Verghis Task Team Leader: Ivailo Izvorski/Leah April

ABBREVIATIONS AND ACRONYMS

AOPs Annual Operational Plans NER Net Enrollment Rate ASSDP Agricultural Sector Strategic Development Plan NGOs Non-Government Organizations BCR Benefit-Cost Ratio NIS Newly Industrialized States BSP Budget Strategic Plans NPF Net Present Value CAR Council for Administrative Reform NSDP National Strategic Development Plan CDC Council for the Development of Cambodia O&M Operations and Maintenance CESSP Cambodia Education Sector Support Project ODA Official Development Assistance CMDG Cambodia Millennium Development Goals OECD Organization for Economic Cooperation and Development CMS Central Medical Store OOP Out of Pocket COA Chart of Accounts PAP Priority Action Plan CSF Commune Sangkat Fund PAR Public Administrative Reform D&D Decentralization and Deconcentration PASEC Program for the Analysis of Education Systems of the Confemen (Francophone Africa) DFID Department for International Development PB Program Budgeting ECE Early

–  –  –

On the government side, we benefitted greatly from frequent consultations with H.E. Dr. Hang Chuon Naron, Dr. Sok Saravuth, Dr. Youk Bunna, Mr. Bun Roith, Mr. Kim Phalla, and Mr. Pen Thirong (MEF); H.E. Dr. Rith Vuthy (CDC); H.E. Mr. Im Sethy and Mr. Proum Pheap (MoEYS); H.E. Mr. Chan Tong Yves and Mr. Mong Leng (MAFF); H.E. Mr. Hiv Sarim (MRD);

H.E. Mr. Veng Sakhon (MoWRM); H.E. Prof. Koeut Meach (MoH) and H.E. Dr. Youk Sambath (MoH); H.E. Mr. Ngo Hongly (CAR); Dr. Kun Nhem, Mr. Pha Eng Veng, and Kongsok Phallakun (Customs). We are grateful to the staff of the Departments of Budget and Finance and of Planning in the MAFF, MRD, MoWRM, MoH and MoE, to the Heads of the Departments of Extension and Crop Production in MAFF, to the Head of the Department of Rural Roads in MRD, to the Departments of Investment Cooperation, Budget and of Economic and Public Finance Policy, to the PFMRP Secretariat in MEF, and to the staff of CDC. Valuable comments were received at several rounds of presentations of the individual chapters to government officials, development partners, Bank staff, and for the agriculture chapter also students at the Royal University of Agriculture.

We received valuable suggestions, input and guidance from Qimiao Fan, Stephane Guimbert, Robert Taliercio, Mathew Verghis, Luc Christiaensen, Gary Reid, Patrick Labaste, Peter Murphy, and Jos Verbeek, Simeth Beng, Tsuyoshi Fukao, Frederico Gil Sander, Patrick Grady, Ronald Points, Ahsan Ali, Christopher Robert Fabling, Giovanni Ganelli, Joel Turkewitz, and Sudhir Chitale. Ray Purcell and his colleagues from Mokoro provided a background paper on agriculture. Timothy Purcell (consultant, unrelated to Ray Purcell) also contributed to the agriculture chapter. Diane Northway and Daniel Whitaker prepared the initial draft of the health chapter. Linna Ky, Sophorn Kith, and Narya Ou provided excellent logistical and administrative support. Shane Perkinson, Lynn Gross, and Narya Ou helped format parts of the document.

Galina Andronova-Vincelette, Sajitha Bashir, Ron Hood, and Sergiy Zorya were the peer reviewers.

Table of Contents Table of Contents

Overview

Agriculture

Health

Education

Conclusions and pricing of recommendations

Chapter 1. The Strategic Setting: Restoring and Expanding Fiscal Space

A. Introduction

B. Recent Economic Developments and Challenges

C. The Fiscal Setting

D. Government Debt and Debt Sustainability

E. Fiscal Space

F. Conclusion and Policy Recommendations

Chapter 2. Composition of Government Spending, Priorities, and Opportunities

A. Introduction

The Level of Public Expenditures

The Composition of Government Expenditures

Private Spending on Public Goods

Conclusion and Policy Recommendations

Chapter 3. Government Spending on Agriculture

A. Introduction

B. Overview of Agriculture, Irrigation, and Rural Roads

C. The Level and Composition of Government Spending on Agriculture

D. Budget Processes and Performance

E. Efficiency and Effectiveness of Government Spending in Agriculture

F. Conclusion and Policy Recommendations

Chapter 4. More Health for the Money

A. Introduction

The Health Sector in Cambodia

Trends and Composition of Health Expenditures





The Efficiency and Equity of Health Expenditures in Cambodia

Conclusion and Policy Recommendations

Chapter 5. Structure and Quality of Education Expenditures

A. Introduction

Achievements and Challenges of the Education Strategic Plan

Education Expenditures: Patterns and Trends

Teachers and Teacher Wages

Provision of Textbooks

Household Spending on Basic Education

Public-Private Partnership in Higher Education

Conclusion and Policy Recommendations

Chapter 6. Sustaining Budget Credibility and Moving Toward Greater Financial Accountability.

..... 63 A. Introduction

B. The State of Public Financial Management

C. Deepening Platform One Reforms, Advancing Platform Two Activities

D. FMIS Implementation: Challenges and Risks

E. Public Administration Reforms and Decentralization and Deconcentration

F. Conclusion and Policy Recommendations

Annexes

References

FIGURES

Figure 1. Output is growing anew after a crisis-induced contraction in 2009

Figure 2. The fiscal deficit remains large after widening in 2009

Figure 3. Growth and inflation have been high since the mid-1990s

Figure 4. Real exchange rate is depreciating

Figure 5. Revenues excluding grants are lower in Cambodia than in other low-income countries.

............. 8 Figure 6. The value of exemptions from paying taxes remains large

Figure 7. General government spending is in line with that in countries with similar per-capita income.

. 17 Figure 8. Wages are rising but outlays on maintenance and operations are trending down

Figure 9. Wage outlays rose sharply in 2009, largely due to increases for defense and security staff.

...... 19 Figure 10. The number of public employees other than in defense and security is small …

Figure 11. … as is the civilian wage bill

Figure 12. The share of wages for education has declined since 2007

Figure 13. Capital spending is larger than in countries with similar levels of income per capita.

.............. 20 Figure 14. Government education outlays are low compared with other countries

Figure 15. Schools, and rural roads account for half of private spending on public goods

Figure 16. Political parties provide the bulk of contributions

Figure 17. Overall government spending on agriculture has increased …

Figure 18. … while donor support has declined

Figure 19. Recurrent spending has grown steadily in all three ministries

Figure 20. Government capital spending has increased substantially

Figure 21. The key outputs achieved have been broadly on an upward path

Figure 22. But the record on costs has been mixed

Figure 23. BCRs for agriculture and rural roads are rising …

Figure 24. … but they are still below potential

Figure 25. Infant and child mortality are down sharply, neonatal only modestly

Figure 26. High rates of malnutrition persist

Figure 27. Facilities deliveries have increased significantly, with slower progress on contraception.

....... 40 Figure 28. Private providers are most frequently consulted for curative care

Figure 29. Government spending has increased sharply in nominal terms …

Figure 30. … and as share of GDP and overall government spending

Figure 31. Spending on drugs and medical supplies is more than double wage outlays

Figure 32. Most budget is non-programmatic

Figure 33. Better-off households spend more on healthcare, 2007

Figure 34. User fees are an important source of funding, 2009

Figure 35. User fees generate substantial incomes

Figure 36. The source of funding for national hospitals varies, 2008-09

Figure 37. Spending on primary care is more pro-poor than hospital spending

Figure 38. Poor people have closer access to health centers than hospitals

Figure 39. Budget allocations are linked to beds but not to hospital outputs

Figure 40. Provincial allocations vary

Figure 41. The distribution of doctors and primary midwives varies considerably

Figure 42. Stockouts persist despite rapid increases in spending for pharmaceuticals

Figure 43. The cognitive ability of very young Cambodian children has declined

Figure 44. Predicted probability of school attendance and enrollment as a function relative-ranking.

...... 54 Figure 45. Government education spending fell relative to GDP, 2003-2009

Figure 46. Payment arrears quickly dropped and fully eliminated in 2007 …

Figure 47. …while end-quarter disbursements improved quickly

Figure 48. Priority spending steadily improved together with high growth of investment spending ….

.. 66 Figure 49. …and overall annual disbursements by expenditure profiles rose markedly.

Figure 50. Economic downturn resulted in a contraction of revenues in 2009 …

Figure 51. …while direct tax growth rate remained volatile

Figure 52. Priority sector spending share of total domestic budget is declining.

Figure 53. TSA’s cash balances have been decreasing since mid-2009

TABLES

Table 1. Cambodia Key Macroeconomic Indicators

Table 2. Cambodia: General Government Fiscal Accounts, 2000-2010

Table 3. Structure of Government Revenues, 2000-2009

Table 4. General government spending surged in 2009 after rising modestly during 2005-08.

................. 16 Table 5. Overall public spending in Cambodia is large

Table 6. The average wage for education has risen but more slowly than the average civil service wage 21 Table 7.

Spending across most functional categories rose

Table 8. Foreign aid finances more than half of government spending in transportation and health.

........ 23 Table 9. Transfers from the central government to sub-national levels are small

Table 10. Communes’ priorities for development are yet to be aligned with domestic donor support.

..... 25 Table 11. The quality of public outcomes is similar to that in countries with similar per-capita income.. 26 Table 12. Growth in agriculture has been strong

Table 13. Strong growth in agriculture, modest government spending

Table 14. Cambodia is on track to meet many health MDGs

Table 15. Access to primary and higher education services

Table 16. Improving the Quality and Efficiency of Education Services

Table 17. Institutional and Capacity Development for Educational Staff for Decentralization.

................ 56 Table 18. Cambodia’s education expenditures are lower than in relevant comparators

Table 19. Education Expenditures, 2009-13

Table 20. Teacher profiles and teacher wage bill, 2001/02 to 2009/10

Table 21. Household education spending varies by quintiles, 2009

Table 22. Total higher education expenditure per source of funding

Table 23. The 3 + 2 proposal: key catalysts for financial accountability

BOXES

Box 1. Scope, Definitions, and Calculation of the Expenditure Data used in this Report

Box 2. Recording Expenditures of Donor-Funded Projects and /Programs

Box 3. What does an Integrated Financial Information System (IFMIS) do?

Box 4. The new classification encourages the use of government public financial systems

Box 5. The World Bank Experience with Treasury and Financial Management Information Systems..... 71 Box 6. Incentive Measures for Implementing the Reform Program

ANNEX DISPLAYS

Annex Display 1. NSDP 2006-2010 targets and the Cambodia Millennium Development Goals............. 78 Annex Display 2. General government financing by functional classification

Annex Display 3. General government by functional classification: treasury executed component.......... 80 Annex Display 4. General government by functional classification: externally financed component....... 81 Annex Display 5. Externally-financed technical assistance and NGOs’ own resources

Annex Display 6. NSDP resource requirements and actual allocations

Annex Display 7. MOH program budget allocation, 2009

Annex Display 8. Government budget allocations for health, 2000-2009

Annex Display 9. Employment at the Ministry of Health

Annex Display 10. CMS invoice prices for ciprofloxacine are higher than international prices................ 84 Annex Display 11. Prices for ciprofloxacine are lower at private pharmacies than abroad

Annex Display 12. Performance indicators, 2004-2010

Annex Display 13. High level traffic light performance Indicator for the Platform Two

Annex Display 14. Regional comparison of PEFA scores



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