World Bank Document

manpower, the complementary barriers that separate them from medicine, family planning andactivities of local governments and the poor. Supply lines for text- nutrition education.voluntary agencies, the receptivity books or medicine may be con- Most developing country govofintended beneficiaries to public tinually breaking down, and the ernments are well aware of theservices, and the persistence necessary technical support may need to improve administrativeof effort. be lacking. But these and similar performance, and have under-Unlike many aspects of agricul- difficulties must be overcome to taken some form of public sectortural, industrial and infrastructural reach the poor; that usually means reorganization. A common objecdevelopment,human develop- improving organization at the tive is to decentralize; planningment programs can rarely be put grass roots. units are being created at theout to contract. Improvements can-state or provincial level in thenot be effected by changes in Strengthenin government Philippines and Sudan, for example,policy or legislation alone. Funds, machinery as a first step toward greaterequipment and advanced technol- No matter how resourceful indi- devolution of power (thoughogies can seldom substitute for viduals or local communities premature decentralization, as intrained field personnel or admin- may be, sustained progress in Tanzania, can complicate programistrators. human development inevitably implementation).Administration is a vital ingre- requires national governments With the help of multilateraldient in primary health care: with- to mobilize and apply the much and bilateral agencies, manyout adequate training, supervision greater resources, both domestic countries are trying to improveand supplies, locally recruited and international, attheir disposal. the performance and skills of publicparamedical staff cannot be effec- Reviews of World Bank projects sector employees through training;tive. This is one of the important reveal a number of common insti- through better job classification,lessons of Brazil's early experience tutional problems-among them, which facilitates recruitment, trainwithrural primary health care in weak planning agencies and an ing and evaluation; and throughits poor northeast region, one con- inability (or failure) to relate changes in civil service regulationsfirmed in countries as diverse as annual budgets to long-term -for example, to specify promotionChina, Jamaica and Botswana. development priorities. Some of requirements more clearly and toIn education, too, there are the existing deficiencies are due to tighten discipline. Thailand isobvious administrative difficulties, inappropriate administrative struc- introducing special procurementbecause of the number and geo- tures and procedures, which still procedures to prevent slippage ingraphic spread of primary schools. tend to reflect the metropolitan project implementation. MalaysiaBut most countries have wide models on which they were isimplementingamoresystematicexperience of operating an educa- patterned. They plate undue approach to the preparation andtional system, although major emphasis on central control and appraisal of agricultural projects.changes in curricula or teaching take inadequate account of Several Asian and African counmethodsmay be administratively prevailing cultural or social tries have begun to streamlinedemanding. For nutrition, general attitudes. cumbersome budgetary practices.food subsidies are simpler to or- Other weaknesses arise be- These and other efforts to makeganize than targeted programs- cause the administration is not government machinery more effibutsubsidizing food consumed properly geared to identifying cient will take many years tomainly by poor people (see pages the people to be served, increasing produce discernible results. The62-63) is a form of targeting that their access to services, adapting continuous expansion of publiceases administrative problems. services until they are appro- sector activities in most developingImproving administration at the priate, delivering them efficiently countries has produced its ownperiphery is far more complex and and observing (and reacting set of constraints: many bureaudifficultthan administrative reform to) the public's response. This cracies have become large, powerfulat the center, a task that has itself sequence requires people who can and protective of their own interests.often proved intractable. Many of learn from the intended benefi- Frequent changes of politicalthe poor are hard to reach through ciaries and gain their confidence leadership have insulated someconventional public programs, and (see box). This is critically impor- bureaucracies from pressures forthe end-of-the-line workers may tant when the poor are cautious reform; in other countries radicalnot be motivated to break the (or even hostile)-as they often are attempts to restructure or purgesocial, linguistic and physical in their reactions to preventive public services have greatly76