Toward More Efficient and Effective Public Social Spending in Central America.

Front Cover -- Contents -- Foreword -- Acknowledgments -- About the Authors -- Abbreviations -- Executive Summary -- Overview -- Main Findings -- Main Recommendations -- Note -- Chapter 1 Introduction -- Notes -- Chapter 2 Context: Progress and Opportunities for Human Development in Central America -- Notes -- References -- Chapter 3 Recent Trends in Social Spending across the Region and Sectors, 2007-14 -- Notes -- References -- Chapter 4 Coverage and Targeting -- Education Coverage and Targeting -- Health Care Coverage and Targeting -- Social Protection and Labor Coverage and Targeting -- Notes -- References -- Chapter 5 Effectiveness and Efficiency of Public Social Services -- Effectiveness and Efficiency of Education Services -- Effectiveness and Efficiency of Health Services -- Effectiveness and Efficiency of Social Protection and Labor Spending -- Cost-Effectiveness of Public Spending: Relating Spending to Outcome -- Notes -- References -- Chapter 6 Selected Institutional and Governance Arrangements in the Social Sectors -- Education -- Health -- Social Protection and Labor -- Note -- References -- Chapter 7 Policy Recommendations -- Education -- Health -- Social Protection and Labor -- Cross-Sectoral and Cross-Regional Messages -- Notes -- References -- Appendix A Survey Sources, by Country -- Boxes -- Box 4.1 Expanding Health Coverage in Costa Rica, El Salvador, and Panama through Mobile Teams -- Box 5.1 Politics Matter-Strong Teachers' Unions Often Fight Changes -- Box 5.2 Challenges Posed by NCDs to the Costa Rican Health System -- Box 5.3 Impact of Avancemos CCT in Costa Rica -- Box 5.4 The Experience of the Red de Protección Social CCT in Nicaragua -- Box 5.5 The Experience of the PATI in El Salvador -- Box 5.6 Public Sector Performance (PSP) and Public Sector Efficiency (PSE) Indicators -- Figures.

Figure 1.1 Government Revenue Compared with GDP per Capita, 2014 -- Figure 1.2 Changes in Revenue and Fiscal Balance (Deficit or Surplus), 2007-14 -- Figure 2.1 GDP per Capita, 2000-14 -- Figure 2.2 Poverty Rates, 2005-14 -- Figure 2.3 Inequality (Gini Coefficient), 2004-14 -- Figure 2.4 Distribution of Youth, 15-18 Years Old, by Activity (2014 or Most Recent Year) -- Figure 2.5 Distribution of Youth, by Activity and Income Quintile (2012 or Most Recent Year) -- Figure 3.1 Social Expenditure as a Share of GDP, 2007-14 -- Figure 3.2 Per Capita Social Public Expenditure, by Sector, 2012 or Latest Year Available -- Figure 3.3 Budget Execution, by Sector, 2007-14 -- Figure 3.4 Social Spending as a Share of Total Public Spending in the Subregion, 2007-14 -- Figure 3.5 Primary Public Expenditure per Pupil as a Share of GDP per Capita Compared with GDP per Capita -- Figure 3.6 Secondary Public Expenditure per Pupil as a Share of GDP per Capita Compared with GDP per Capita -- Figure 3.7 Public Spending, by Educational Level, as a Share of Education Public Spending in the Subregion, 2014 -- Figure 3.8 Preprimary and Primary Public Education Spending in the Subregion, 2007-14 -- Figure 3.9 Lower Secondary Public Spending, 2007-14 -- Figure 3.10 Upper Secondary Public Spending, 2007-14 -- Figure 3.11 Public Spending on Health as a Share of GDP, 2007-14 -- Figure 3.12 Public Expenditure on Health as a Share of GDP Compared with GDP per Capita, 2013 -- Figure 3.13 Per Capita Public Spending on Health -- Figure 3.14 Share of Hospitals in Public Spending on Health -- Figure 3.15 Share of Public Spending on Health Spent on Salaries -- Figure 3.16 SPL Spending as a Share of GDP, by Country -- Figure 3.17 SPL Spending per Capita, by Country -- Figure 3.18 Social Assistance and Labor Spending as a Share of GDP, 2014.

Figure 4.1 Gross Enrollment Rates across All School Levels in the Subregion, 2007-14 -- Figure 4.2 Net Enrollment Rates across All School Levels in the Subregion, 2007-14 -- Figure 4.3 Costa Rica Daycare and Preschool Attendance, by Income Quintile, 2014 -- Figure 4.4 Preschool Enrollment, by Type, State Compared with Community, Nicaragua, 2009 -- Figure 4.5 Teacher Salaries, by Level (National Currency, 2014) -- Figure 4.6 Lower Enrollment Rates after Primary School, Ages 5-20 -- Figure 4.7 Average Years of Total Schooling (25+) Compared with GNI per Capita -- Figure 4.8 Secondary Completion Rate, Ages 25+ -- Figure 4.9 Enrollment, by Location, Indigenous Regions, and Income Distribution, Ages 5-20, 2013 -- Figure 4.10 Youth Attendance Rates, by Type of School, Location, and Income Quintile, Ages 13-18, Honduras, 2013 -- Figure 4.11 Public and Private Enrollment, by Income Quintile, Guatemala, 2014 -- Figure 4.12 Share of 15-19-Year-Olds Attending Private School, by Income Quintile, Costa Rica, 2014 -- Figure 4.13 Computers per Student in Public and Private Schools, Costa Rica -- Figure 4.14 Reasons for Dropping out of School, by Reason Reported -- Figure 4.15 Reasons for Not Attending Secondary School, by Educational Level, 2014 -- Figure 4.16 Reasons for Not Attending Upper Secondary School, by Gender, 2014 -- Figure 4.17 Reasons for Not Attending Lower Secondary School, by Gender, 2014 -- Figure 4.18 Reasons for Not Attending School, Children Ages 13-18, Nicaragua, 2014 -- Figure 4.19 Average Years of Tertiary Schooling, Ages 25-29, Compared with GDP per Capita, 2012 -- Figure 4.20 Enrollment in Tertiary Education per 100,000 Inhabitants, by Country -- Figure 4.21 Distribution of Total Students in Panama, by Level and Income Quintile, 2013 -- Figure 4.22 Coverage of Health Providers in Central America.

Figure 4.23 Insurance Coverage, by Quintile -- Figure 4.24 Insurance Coverage, by Country -- Figure 4.25 Outpatient Visits in Costa Rica, by Income Quintile, 2006 -- Figure 4.26 Prenatal Care Provided by Medical Doctor, Guatemala, 2014/15 -- Figure 4.27 Prenatal Care Provided by Medical Doctor, Honduras, 2011 -- Figure 4.28 Share of the Sick Who Did Not Consult a Provider, and Who Consulted Public or Private Health Providers, by Country and Income Quintile -- Figure 4.29 Main Reasons for Not Consulting, by Income Quintile -- Figure 4.30 Health Care Visits, by Level of Care, El Salvador, 2008-12 -- Figure 4.31 Share of Workers Contributing to Social Security, by Country, circa 2014 -- Figure 4.32 Share of Elderly Covered by Pensions, by Income Quintile -- Figure 4.33 Distribution of Pension Beneficiaries among the Elderly, by Income Quintile and Country -- Figure 4.34 Public Spending and Share of Beneficiaries of Main CCTs, by Country -- Figure 4.35 Distribution of Social Assistance Program Benefits -- Figure 4.36 Coverage of Unemployed, by Income Quintile -- Figure 4.37 Beneficiaries of El Salvador INSAFORP Training Courses, 2009-13 -- Figure 4.38 Distribution of Guatemala INTECAP Beneficiaries, by Age, 2011 -- Figure 5.1 Primary School Out-of-Age Enrollment Rates, 2014 -- Figure 5.2 Third-Grade Reading SERCE 2006 and TERCE 2013 Test Scores -- Figure 5.3 Third-Grade Mathematics SERCE 2006 and TERCE 2013 Test Scores -- Figure 5.4 SERCE/TERCE Comparative Results on Sixth-Grade Mathematics, 2006 and 2013 -- Figure 5.5 TIMSS 2007 Mathematics, Fourth Grade, Compared with GDP per Capita -- Figure 5.6 Relationship between Reading and TERCE Test Scores and Income -- Figure 5.7 Public Spending in Education per Student in Primary School, El Salvador -- Figure 5.8 Average Test Results, Third Grade, El Salvador.

Figure 5.9 Upper Secondary Learning Outcomes Compared with per-Student Spending, El Salvador -- Figure 5.10 Teacher Salaries in Relation to GDP per Capita, LAC, circa 2010 -- Figure 5.11 TIMSS 2011 Mathematics Fourth Grade (Sixth Grade for Honduras) and GDP per Capita -- Figure 5.12 PIRLS 2011 Fourth Grade (Sixth Grade for Honduras) and GDP per Capita -- Figure 5.13 TIMSS 2011 Mathematics Eighth Grade (Sixth Grade for Honduras) and GDP per Capita -- Figure B5.2.1 Demographic Trends in Costa Rica, 1990 Compared with 2005 -- Figure 5.14 Health Worker Ratios per 10,000 Inhabitants -- Figure 5.15 Would You Say You Are Satisfied with the Way the Public Hospitals Work? -- Figure 5.16 Use of Public and Private Health Care Facilities, by Quintile, Guatemala and Panama, 2008 -- Figure 5.17 Use of Public and Private Outpatient Services and Hospitals, by Quintile, El Salvador, 2013 -- Figure 5.18 Patient Visits, by Quintile, Costa Rica, 2006 -- Figure 5.19 Public-Private Spending Shares of Total Health Spending, 2013 -- Figure 5.20 Gross Pension Replacement Rates: Low and High Earners -- Figure 5.21 Social Pension Distribution of Beneficiaries, by Quintile -- Figure 5.22 Social Pensions in Central America: Monthly Payment per Day and Share of Minimum Wage, 2012 -- Figure 5.23 Social Assistance Programs-Important Positive Impact of CCTs on Extreme Poverty among Beneficiaries -- Figure B5.3.1 Enrollment Rates, Ages 5-20, Costa Rica, 2014 (Extreme Poor) -- Figure 5.24 Generosity of CCTs in Honduras, Panama, Costa Rica, and Guatemala -- Figure 5.25 Public Spending on ALMPs as a Share of GDP -- Figure 5.26 Premium to Training Education, Costa Rica, 2009-14 -- Figure B5.5.1 Impact of the PATI on Labor Force Participation and Incomes, El Salvador -- Figure 5.27 PSP and Efficiency in LAC, 2015 -- Figure 6.1 Teachers' Salaries (Hourly Earnings) in Panama and Costa Rica.

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