A New Social Contract in Peru

This book examines the issues of accountability in the delivery of public services. Each chapter of the book incorporates, in addition to technical, economic, and statistical analysis, an analysis of the institutional context for service delivery. A common theme that cuts across this book is the issue of accountability as developed by the World Bank in its 'World Development Report: Making Services Work for Poor People' (2004).The main conclusion of the book is that, while Peru has made significant progress in both education and health care, there remain significant challenges to achieving greater equity and better quality of services, particularly for the poor. The book finds that Peru has achieved high levels of coverage in all levels of education and in some programs of basic health care and of social assistance. Still, the average quality of most of these programs is low, and health and education outcomes are extremely inequitable.The book recommends three types of interventions:a. quality standards and quantitative goals need to be set,b. accountability chains need to be established so that providers take responsibility for their services; andc. investments are needed to create and sustain the capacity to reach these goals.

Foreword	p. xi
Acknowledgments	p. xiii
Author Biographies	p. xvii
Acronyms and Abbreviations	p. xix
Improving Education, Health Care, and Social Assistance for the Poor	p. 1
Executive Summary and Introduction	p. 1
Coverage, Outcomes, and Equity	p. 4
Public Expenditures in Education, Health, and Social Assistance	p. 9
Teachers and Health Workers: A Low-level Equilibrium	p. 18
The Accountability Framework	p. 20
Attempts to Break the Low-level Equilibrium	p. 24
The Need for Standards of Service	p. 35
Conclusions and Recommendations	p. 37
Public Expenditure in the Social Sectors	p. 43
Main Policy Recommendations	p. 45
Main Diagnostics	p. 47
Review of Research-based Peruvian Literature	p. 61
Policy Recommendations	p. 69
Education Sector: Standards, Accountability, and Support	p. 71
Main Policy Recommendations	p. 71
The Accountability Triangle Approach in Education	p. 73
Issues and Analysis	p. 75
Good Sets of Recommendations and Research-based Diagnostics Already Exist	p. 94
Recommendations in Greater Detail	p. 101
Pro-poor Policies in the Peruvian Public Health Sector	p. 107
Summary of Recommendations	p. 108
Focus of the Accountability Triangle	p. 110
Principal Findings	p. 112
Innovations and Challenges in the Management and Financing of Health Care	p. 123
Review of the Peruvian Literature on the Health System	p. 144
Recommendations	p. 144
Annex-Services Covered by SIS	p. 152
The Social Safety Net	p. 153
Main Policy Recommendations	p. 154
The Accountability Triangle Approach	p. 156
Key Issues of the Social Safety Net Sector	p. 159
Review of Research-based Peruvian Literature	p. 179
Policy Recommendations	p. 186
Human Resources in Public Health and Education in Peru	p. 191
Conclusions and Policy Implications	p. 192
Background	p. 197
Low-level Equilibrium	p. 201
Anti-poor Bias	p. 238
Voice in the Accountability of Social Policy	p. 245
Main Policy Recommendations	p. 245
Conceptual Framework: The Accountability Triangle Approach	p. 247
Issues and Analysis	p. 251
Many Diagnostics and Recommendations Already Exist in Peru	p. 284
Specific Recommendations to Improve Voice in the Social Sectors	p. 284
References	p. 291
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A New Social Contract in Peru

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