Importance of Cross-Sectoral Impacts and Thematic Considerations

to Achieve the MDGs and Future SDGs: Synthesis of ESCAP Studies

Shiladitya Chatterjee

Siem Reap , 6 March 2015

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High-Level Asia-Pacific Policy Dialogue on the Implementation of the Istanbul Programme of Action for the Least Developed Countries

Plan of Presentation

1. Implications of A. Cross-sectoral impacts

B. Thematic considerations

2. Country responses and their problemsA. National level coordination

B. Outcome level coordination

C. Local level coordination

D. External aid coordination

3. Recommendations

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1A: IMPLICATIONS -CROSS-SECTORAL IMPACTS

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Silo-like approaches are sub-optimal

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Example: Child survival benefits of better coordination in health and water and sanitation interventions

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Trade-offs among the Sustainable Development Goals

Source: Human Development Report 20116

Importance of basic infrastructure

• Importance of roads – Lao PDR roads

• Improved income earning opportunities in rural areas• Facilitated irrigation and electrification • Reduced rural poverty: areas with roads had lower poverty (28%) than those without (41%)

– Nepal: areas with roads had lower MMRs – Bhutan: roads helped improve school attendance rates

• Importance of electricity – Nepal: health facilities improved vastly with electricity availability – Lao PDR: households with electricity had much lower poverty (17%) than those

without (39)%

• Importance of irrigation– Lao PDR: households without irrigation had much more poverty (78%) than

those with (22%)

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Cross-sectoral impacts: health and education

• Education benefits health– Nepal districts with higher women’s literacy had much lower maternal mortality

(correlation -0.12; p>0.005)

• School health programs improve student and general health– Nepal’s School Health and Nutrition program benefited students by

• Reducing anemia and parasite infections

• Improved general knowledge of nutrition and health

– Bhutan’s health education in schools promoted• Hygiene and nutrition

• Awareness of emerging health issues like STD, HIV/AIDS, and adolescent reproductive health

• School nutrition and feeding programs improve education – In Bhutan, improved enrolment and attendance rates particularly of poor families

• Major benefits accrue in combining health, nutrition and education interventions– Bhutan has emphasized Early Childhood Education which combines all three for

pre-school children

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Cross-sectoral impacts: water and sanitation on health, education and environment

• WATSAN has direct impact on health – Cambodia: in 2005 poor WATSAN caused 9.5 million cases of

diseases; 10,000 deaths; and health costs of US$ 11 million. – Nepal: improved WATSAN significantly reducing MMR

• WATSAN helps education– Bhutan: lack of WATSAN hurt children’s ability to learn, increased

absenteeism (particularly girls) and under-nutrition– Cambodia: clear relationship between female school drop-out

rates and lack of sanitation in schools

• WATSAN impacts severely on environment– Cambodia: high costs of poor WATSAN caused loss of tourism

revenues ($75 million annually); and – Improper disposal of wastes severely contaminates ground water

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Cambodia- relationship of school sanitation and female school drop-out rates

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1B: IMPLICATIONS -THEMATIC CONSIDERATIONS

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Gender

• Neglect of gender equity can devalue MDG outcomes seriously– MDGs did not stress this enough; SDGs must remedy this

– Cambodia: neglect of gender considerations leads to higher drop outs

– Nepal: lack of gender empowerment • affects women’s health which requires broader interventions

involving gender empowerment not just treatment of women

• gender discrimination complicates obstetric care

• Women’s literacy reduces maternal deaths

• Intersection of discriminations need more attention– Bhutan: women from ethnically deprived groups suffer

more

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Other forms of inequity

• Income inequity and poverty– Nepal: out-of pocket (OOP) health expenditures of poor

(64% of income) almost double of non-poor (36%)– Cambodia: WATSAN services for poor neglected– Bhutan: children from poor households had high drop outs

from school

• Social discriminations; ethic and minority status– Lao PDR: poverty reduction much slower among

discriminated groups– Nepal: OOP health expenditures for disadvantaged janajatis

(53% of income) higher than upper castes (32%)

• Geographical inaccessibility: remoteness, mountains– Nepal: OOP of mountain areas (65% of incomes) higher than

non-mountain

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Lao PDR: poverty reduction slow for mountains and some ethnic groups

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Participation

• Decentralization mostly incomplete in LDCs and beset with multiple problems

– Nepal: Health decentralization has coordination, resources and staffing issues

– Bhutan: individual schools still need to navigate bureaucratic hurdles for resources and facilities

– Cambodia: WATSAN still centralized

• Civil society insufficiently involved

• Private sector participation still miniscule

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2. COUNTRY RESPONSES AND THEIR PROBLEMS

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A. National level coordination: Lao PDR strategic planning and budgetary processes

Resolution of 7th, 8th& 9th

Party Congresses

11 National Priority Programs

4 Break Through Guidelines

National Programs

Industrialization and Modernization Strategy 2001-

2020 2020 Vision

National Growth and Poverty Eradication Strategy

National Strategy

Development Strategy for 2010 and 2020

Etc.

Development MasterPlan

National Development Master Plan

Regional Development Master Plan

Medium Term Development Plan

National 5-Year Socioeconomic Development Plan

Sectoral 5-Year Development Plan

Provincial 5-Year Development Plan

Annual Development Plan

National Annual Socio-Economic Development Plan

SectoralAnnualDevelopment Plan

Provincial Development MasterPlan

Sectoral Development Master Plan

Source: Oraboune S, 2011

ine inistries and rovinces

- lanning and inancial onference - eviewing by overnment - onsent and agreement

s and s

- eviews and provides comments from National ssembly N

- overnment’s revision - inal ndorsement N

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A. National level coordination: problems

• Positive side of Lao PDR and Cambodia examples– Integrates MDGs within the planning process– Involves some participatory process

• Provision exists for consultation with stakeholders such as provinces, external donors and private sector

• Technical working groups (TWGs) important coordination mechanism

• Problems– Process too rough and inexact; only a rigorous exercise such as

MAMS can resolve this– Ministries remain silo-based focused on sectors rather than

outcomes– Little indication that effective coordination (beyond routine

consultation) with civil society and private sector is done– Insufficient attention to thematic considerations

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Philippines MAMS example

• Uses a core CGE model that captures basic structure and interactions of the economy– Involving a Social Accounting Matrix (SAM)

• Services highly disaggregated to capture the MDG services

• An MDG module is built in – This contains equations that determine the MDG

indicators

• The two interact through– Household consumption, provision of MDG services,

wages, infrastructure stocks. For example,• Education demanded = f (quality of education, wage

premium of education, health, infrastructure, per capita consumption)

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B. Coordination of individual outcomes:L h

Costing of MDG child nutrition targets for 2014 and 2015 (US Dollars)

Sector Total cost Available

resources

Financial

gap

Agriculture 42,840,000 21,700,000 21,140,000

Education 9,800,000 3,650,000 6,150,000

Health 9,380,000 1,994,000 7,386,000

WASH 18,480,000 3,200,000 15,280,000

Multi-sectoral coordination, external

monitoring and evaluation (1.5% of

total)

1,207,500 25,000 1,182,500

Total 81,707,500 30,569,000 51,138,500

Multi-sector national nutrition strategy

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B. Coordination of individual outcomes: problems

• The positive side: example Lao PDR nutrition model – Involves detailed inter-sectoral costing

– Has supporting sector level strategies in concerned sectors

– Developed a high level coordination mechanism for multi-sectoral and thematic coordination

• Problems however are– Arrangements focused mainly on public sector and

national government

– Equity (thematic) aspect needs to be better addressed• E.g. services to poor and traditionally deprived ethnic groups

– Coordination arrangements need better integration with budgetary process

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C. Local level coordination

Cambodia: Alignment of national and local level plans Nepal: District level coordination

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Local level coordination: problems

• Local coordination requires both vertical and horizontal coordination

• Challenges to vertical coordination– Decentralization has not proceeded adequately

• Insufficient clarification of roles and responsibilities

– Insufficient information on MDGs

• Horizontal coordination at local level generally weak– Overemphasis on vertical coordination of national

programs and priorities– Insufficient devolution of authority– Weak local capacities

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D. Coordination of external assistance

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D. Coordination of external assistance: problems

• Five principles of aid effectiveness not working– Ownership not pursued particularly at local levels– Alignment hurt by donors sticking to own systems

and calendars– Harmonization affected as few donors developed

common arrangements; most focused on funds and not improving systems; set up own PMSs

– MfDR ineffective as each donor following own MfDRsystem

– Accountability weak with divergent donor systems

• Insufficient capacity to coordinate large number of donors

• Functioning of Donor Working Groups has to be improved

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3. RECOMMENDATIONS

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General

• Data improvements essential for better coordination– MDGs have suffered throughout with missing or outdated data – Data also needed on disaggregated basis

• both at national and subnational levels (including spacial categories) • according to thematic needs (gender, poor and non-poor or income

levels, and socially deprived groups)

– Periodical updating of data is also critical– Statistical capacity building is a major need, particularly for LDCs

• Will need considerable external support • Regional partnership between UN, the multilaterals and large

bilaterals such as Ausaid and JICA necessary

• Abandoning sector bias and focusing on outcomes essential– For future SDGs, sector bias has to be modified– Need to integrate thematic considerations in outcomes

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National level coordination

• Comprehensive overall coordination necessary at national level – To best account for cross-sectoral and thematic

influences

– Process best informed by MAMS type exercises• LDC capacity building for this necessary

• Ideally, ministries should be reorganized along development goals– Alternatively, fully empowered superstructures

organized on outcome basis

– Response to thematic objectives also built in

– And effective participation

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Coordination at outcome level• Detailed outcome level coordination necessary to supplement

national level coordination• Enhanced version of Lao PDR coordination of child nutrition can

provide a good model. Desirable features are– Detailed costing of investment needs by all sector ministries

• Helps in planning budget allocations

– Incorporation of strategies and action plans supporting child nutrition outcome in all concerned sector and thematic ministries

– Establishing an outcome superstructure type coordination mechanism • Headed at a suitably high level • Fully empowered, and • With representation of all concerned ministries and stakeholders

– Adding strong participation elements including with LGUs and private sector

– Better responsiveness to equity objectives– Strong linkages to budgetary processes

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Coordination at local level

• Local level coordination essential for success in meeting development goals

• But such coordination may fail if decentralization is not carried out effectively– More authority has to be delegated to LGUs– More information must be disseminated about

development goals at local levels

• Attention needed on both vertical as well as horizontal coordination– Overemphasis on vertical coordination must end

• Major strengthening of capacities of local staff essential

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Coordination of external assistance

• Given importance of development aid, better coordination of external assistance is critical

• Five principles of aid effectiveness must be properly implemented by both government and donors

• LDC governments must improve capacities to coordinate external assistance more effectively

• The coordination process, particularly functioning of donor working groups must be improved– More outcome rather than sector focus– Full participation by government

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Thank You!shilochatterjee@gmail.com

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