fly on to bite the rich as well. InBrazil in 1974, an epidemic of spinal How much would it cost?meningitis aroused public concern- Take an illustrative list of human develop- cost 4 percent of GNP. Eliminating foodin response, 80 million people were ment needs: five years at school; adequate deficits in Brazil-with its much highervaccinated within 10 months, nutrition; primary health care no more income-could cost from I to 2 percentstopping the epidemic. than an hour away; family planningservices; at least 20 liters a day of pureof GNP in 1980, depending on the typeof food provided.are also seen almost everywherewater within 100 yards of home; and apit latrine. How much would it cost a* Health and family planning. Malay-sia's system of public health care coveredas contributing to national unity. government in a developing country to more than 75 percent of the populationUniversal primary education in provide this for everyone? in 1974. It relied heavily on low-costparticular can provide all citizens The answer varies from country to paramedical staff-and its operating costswith a common intellectual heritage country, depending first (and most were nearly 2percent of GNP. Sri Lanka'simportantly) on the standard of service; government spent about 1.7 percent inand help overcome the potentially second on such factors as climate, the mid-1970s. China's central governdivisiveeffects of regionalism, communications and population disper- ment spent less than 1 percent on healthtribalism, race and caste and class sion; and third on the balance between in 1978, but much of the primary caredistinctions. In addition, govern- capital and operating costs (most budgets system was financed locally; Brazil' spentments often see human development do not provide enough for the operating about 2.5 percent of GNP in 1975, butcosts that an effective service would public health insurance was biased towardas helping to build broad-based need). But there are also two general hospitals and urban areas-covering almostpolitical support among potentially rules that affect cost: one, for any given go percent of urIan dwellers but muchantagonistic groups. standard the proportion of GNP required less of the 40 percent of people in ruralThe appeal of and political com- falls as GNP rises, partly because higher- areas.income countries have more educated * Water. A recent <strong>World</strong> <strong>Bank</strong> estimatecut across ideological boundaries:people-whose wages are therefore relativelylower-to implement the programs,suggests that it would cost the Tanzaniangovernment about 1.8 percent of GNPChina, Cuba and North Korea have and partly because nonlabor costs rise a year over a 10-year period to supplyplaced great emphasis on such more slowly than GNP. And two, mar- every village with pure and reliable water,programs, but so have South Korea ginal unit costs usually fall as coverage plus 0.8 percent for operating costs onceand Costa Rica. Their appeal is rises, but only up to a point: the costs of the system is fully established. In Braziland Costa Rica. reaching the last 10-20 percent of the theinvestmentneededtocoverthewholereinforced by international and population may be several times the population by 2000 has been estimatedethical support. The Universal average costs for the first 80-90 percent at less than 0.1 percent a year of a muchDeclaration of Human Rights of because of physical inaccessibility or larger and faster-growing GNP in rural1948 included the rights to food, inadequate demand. areas (allowing for higher costs to reachhealth and education. The United Some examples from different countries: the last 10 percent of the rural population)h Education. The average gross enroll- and perhaps 0.1 to 0.2 percent a year inNations and its specialized agencies mentratiofor primary school in developing urban areas depending on GNP growth.have played an important role in countries in the early 1970s was about Coverage of the rural and urban populafocusinginternational attention 70 percent; central governments were tions was 62 and 14 percent, respectively,on human development and on then spending an average of 1.7 percent in 1976. Operating costs are borne bypopulation issues. All the major of GNP on primary education. Few the users.governments have provided universal * Sanitation. In Brazil, where 37 percentreligions also provide strong back- elementary education for less than 3 of urban houses had sewers or septicing for efforts to improve the health, percent of GNP. Peninsular Malaysia tanks in 1976, extending the sewer networknutrition and education of the poor. spent 2.7 percent in the mid-1970s and to cover them all by 2000 would requirehad a gross enrollment rate of 93 percent. annual investments of about 0.2 to 0.3Easing the financial constraint* Nutrition. In 1979, when subsidized percent of GNP. Providing latrines inrations were restricted to the poorer half rural areas would cost only between 0.01Finance ministers everywhere (withof the population in Sri Lanka, they still and 0.02 percent of GNP.the exception of some mineral-richcountries) find that available fundscannot meet the many competing ture, debt service, defense and so of GNP (and often a good dealdemands placed on them. In the on) commonly exceed 12 percent more) on doing so.poorer countries, public revenue of GNP. Yet governments that have The costs involved depend on(taxes, other domestic revenue and assuredvirtuallyeveryoneprimary many factors (see box), among theforeign assistance) usually is less education, health care, family most important of which are thethan 20 percent of GNP, while planning services, adequate food, range and standard of services.expenditures other than on social pure water and sanitation have Thus governments in some poorprograms (agriculture, infrastruc- generally spent more than 10 percent countries-notably Sri Lanka and72
probably China-have managed Table 6.1 Taxes as a percentage wasteful showcase projects, subtoprovide the essential services of GNP sidizing inefficient enterprises and,(primary education, food supple- Group of Percentage so far as security considerationsments and basic health and family countries 1953-551972-76 increase permit, military spending (whichplannirng facilities) to almost every- 7 low-income on average in East Asia, Southone for less than 10 percent of countries 11.2 16.0 43 Asia and the Middle East exceedsGNP. Typically, though, govern- 17 middle- public outlays on education andments are spending from 3 to 10 income health combined). And withinpercent of GNP for human devel- developing human development programspercent~~~~~~~~~countries12.1 16.4 36 thuman developenromto prelogramsopment programs that are far from Total (24 there is often room to reallocatecomprehensive-and whose effec- developing budget shares away from high-costtiveness is often reduced by lack countries) 11.8 16.3 38 and less-urgent projects (such asof money for operating costs (wages 15 developed urban hospitals and universitiesfor health workers and teachers, countries 26.2 36.2 38 largely serving the relatively wellmaintenanceof water supply Note: Taxes include social security taxes. off) and toward more basic prosysterms,gasoline for transporta- grams (such as primary health caretion of doctors in rural areas, and education).textbooks in schools). in the distribution of income). OnHow can financial constraints this basis, India's taxable surplus Keeping costs downon hurnan development programs in 1975 was 41 percent of aggregate By modesty in standards and effibeeased? There are four ways: income; the ratio of taxes to taxable cient choice of technology, govemincreasingtaxes, reallocating surplus therefore was 34 percent ments can provide services relativelyrevenues, reducing costs and using -comparable with the tax-to-GNP cheaply-and without precludingresources other than those obtained ratios of industrialized nations. future improvement. (For examfromnational taxes and duties. Earmarking taxes for programs ple, public standpipes can supplywith strong ethical or political safe water at some sacrifice in con-Increas.;ng tax revenues appeal can raise extra money when venience but at less than half theMany developing countries have further general taxation is not cost of individual house connecalreadymade impressive progress feasible. In Colombia a share of tions.) This general approach willin improving their tax-gathering the beer tax is reserved for public often be opposed by teachers,(see Table 6.1). Since 1975, how- hospitals. Many Latin American doctors, architects, engineers andever, tax ratios in developing countries finance their health and other professionals who insist oncountries have not increased; social security budgets by a pay- high standards-and correspondalthoughsome obvious steps can roll tax. (But payroll taxes cover ingly high costs. Not surprisingly,be taken (making taxes more only formal employment, and they the financial constraint is then saidprogressive and reducing evasion tend to reduce growth in jobs by to prevent the extension of serandarrears), the scope for raising raising the cost of labor relative vices to poor rural areas. Politicaltaxation is less now than it was to capital.) Motor fuel taxes are leaders have sometimes felt that20 years ago. good for earmarking, for several it was better to accept unaffordablyThis is especially true of the reasons. They are easy to collect, expensive standards than to riskpoorer countries-even where are progressive, help curb oil con- the charge that they were backingforeign trade is a substantial share sumption, and have high revenue "second rate" projects. But theof output. Their tax administration potential-in some cases exceeding <strong>World</strong> <strong>Bank</strong>'s experience in health,is generally weaker, there is usually 1 percent of GNP. But like all education and urban developmentsubstantial unmarketed output, earmarked taxes, they should be projects suggests that many govemandtheir taxable surplus accounts used only sparingly, because they ments now see political as well asfor a smaller share of their GNP. increase the rigidity of the way economic benefits from being ableEven a tax-to-GNP ratio of 15 per- government revenues are spent. to reach the poor by acceptingcent in such countries implies a lower standards initially.heavy tax burden. Take India as Reallocating existing revenues Chapter 5 discussed a numberan example: its taxable surplus may Public spending on human de- of specific ways of economizingbe defined as all income beyond velopment can be increased by in health, education and nutritionthe poverty line (defined there as reallocating government revenue programs. China's barefoot doctheincome of the fortieth percentile from less productive uses, including tors (see box overleaf) are an excel-73
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t' 8 ~~~~ottoWorld Development Repo
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Oc 1980 by the International Bankfo
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ivThis report was prepared by a tea
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Text tables2.1 Summary of prospects
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DefinitionsCountry groups in the an
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illion people have barely enough fa
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in official aid and other capital a
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production and consumption; in- Tab
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measures can raise efficiency fairl
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adjustment; but the increases pro-
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dustrialized countries' GNP would T
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windfalls, some of their extra cont
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e done to increase the supplies Lat
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exchange-rate depreciation, by perc
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- Page 49 and 50: ably could not have been achieved c
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EnergyEnergyconsumptionAverage annu
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Merchandise tradeAverage annual gro
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Percentage share of merchandise exp
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Percentage share of merchandise imp
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Destination of merchandise exports
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Destination of manufactured exports
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Current accountbalance before Inter
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Public and publicly guaranteed medi
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External public debtoutstanding and
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Amount1981a 1982a 1983a 1984a 1985a
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Average annualHypotheticalgrowth of
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PercentageCrude Crude Percentage Pe
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Percentage ofpopulation ofworking a
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Percentage of urban population Numb
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Life Infant Childexpectancy mortali
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PercentageDaily calorie supplyPopul
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Number Numberenrolled in enrolled i
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Percentage share of household incom
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Average index Tables 4 and 5. Growt
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28 (minerals, crude fertilizers and
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continues to grow after replacement
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posttax income and conceptually tic
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-~~~ S-~~~~~ sEuropean Office:66, a