271062001

The World Bank

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IV~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Environment and Social Development Unit

East Asia and Pacific Region 'J,1~~

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Filipino Report Cardon Pro-Poor Services

SUMMARY

Environment and Social Development UnitEast Asia and Pacific Region

The World Bank

The Filipino Report Card TeamT | ahe Filipino Report Card on Pro-Poor Services was preparedby a team led by Bhuvan Bhatnagar, and comprisingMusunuru Sam Rao, Dennis M. Arroyo, and Adarsh Kumar.

It was prepared under the general direction ofVinay Bhargava, ZaferEcevit, and Robert Vance Pulley.

The client satisfaction survey, on which the Report Card is based,was designed and implemented by the Social Weather Stations,under the direction ofMahar Mangahas and Lindaluz B. Guerrero.

The sector chapters were prepared by Jayshree Balachander,-- Joven Balbosa, Carol V. Figueroa-Geron, Vijay Jagannathan,

Mariles Navarro, Ching Dela Pefia, and Mary Racelis, with inputsfrom the Report Card Team. Ganesan Balachander, Cyprian Fisiy,

inrJ Marita Concepcion C. Guevara, Rana Hasan, Jesko Hentschel,,- }= Angie Ibus, Manny Jimenez, Smita Lahiri, Juri Oka, Samuel Paul,

M_ s Parmesh Shah, and Anna Wetterberg provided valuable suggestions7-1 ~ * and inputs. The Report Card benefited from several hundred_ * reviewers both inside and outside the Bank.

Luisa Sambeli Espafiola provided excellent production support.Brian James J. Lu designed this summary edition. Most photographscame from the collection ofTilak Hettige.

A Note to the Reader

T his booklet contains the summary of the Filipino Report Card. It also inicludes the tableof contents forthe full-length report, which is available at the Public Information Centerof the World Bank Office, Manila. For more information on the Filipino Report Card,

please vtisit the websites at www.worldbank.org/participation or www.worldbank.org.ph.

Thefindings, interpretations, and conclusions are those of the report team and should not beattributed to the WorldBank, its Board ofDirectors, or any ofits member countries.

SUMMARY

I believe in listening to and leaming from those whom / serve. / will ensure that my organizationcreates and respects genuine mechanisms for regular feedback from our citizen-customers, andsubsequently uses this feedback to render better service to them.

President Gloria Macapagal-Arroyo

INTRODUCTION Visayas, and Mindanao. In keeping with globalbest practice, client satisfaction with public ser-

is the Report Card? vices in the Philippines was measured by com-paring it with satisfaction with services pro-

he Report Card is a way for citizens to vided by the private sector.7

provide systematic feedback to publicagencies about their performance. It Why Prepare a Report Card?

elicits information about users' awareness of, There is a growing concern in the Phi-access to, use of, and satisfaction' with public lippines about the performance and account-services. It is an important follow-up to the ability of public agencies that deliver services,World Bank's Philippines 2000 Poverty As- e clly o t poor. Mos aoa bility

2 especially to the poor. Most accountabilitysessment. It complements the expert analyses mechanisms for ublic agencies focus on in-and findings in the Poverty Assessment with a g and findings in the Poverty Assessment with a puts (e.g., number of personnel, facilities, and"bottom-up" assessment of pro-poor services expenditures). They occasionally report onin five key sectors: health care, elementary edu- broad outcome indicators such as literacy andcation, water supply, housing, and subsidized

3 mortality rates. Beyond this arithmetic, little isrice distribution.3 known about the quality of services deliveredThe Report Card identifies the key con- by the State. It is thus difficult to identify spe-

straints that Filipinos face in accessing public cific areas where these services could be im-services, their appraisals of the quality and ade- proved.quacy ofpublic services, and the treatment they Service providers and experts have under-receive from service providers, especially gov- taken a number of evaluations of pro-poor pro-emnment officials. It offers several recommen-

datins n setorpoliies strteges, nd ro- grams in the Philippines that often identify pro-grams to address these constramits and improve gram-specific problems. The studies explore is-sues that do not, however, connect or cut acrossservice delivery, especially to the underserved the various sectors. Moreover, very few of theand the poor. evaluations are done from the perspective of

The Report Card is based on a national client the clients.8 The Report Card initiative wassatisfaction survey undertaken by the World launched so that citizens could rate pro-poorBank in collaboration with the Social Weather public services, based on their experience as re-Stations (SWS), a premier survey organization cipients. The Report Card also helps to pull to-in the Philippines that is independent, nonparti- gether the myriad individual problems facingsan, and credible.4 The survey was carried out the various programs into common sectoral is-between March 26 and April 17, 2000. It cov- sues. It draws attention to the worst problemsered 1,200 households, 5 distributed nationwide and to good practices in the five selected sec-in four broad regions:6 the National Capital Re- tors. By ranking and quantifying issues, itgion (NCR), Luzon excluding the NCR, the brings into the limelight the concerns that trou-

REPORT CARD

ble Filipinos most.9 What is in the Report Card?

To be effective, traditional public account- The Report Card presents people's perspec-

ability systems need to be strengthened through tives on pro-poor services. These are not al-

innovative approaches that involve public par- ways captured in traditional evaluations by ex-

ticipation. Those at the receiving end -- Fili- perts and in the routine reports of agencies pro-

pinos who use the services -- are well placed to viding the services.' 3 The client assessments

provide systematic feedback on government ac- bring forth valuable insights on pro-poor ser-

tions intended to benefit them. Most recipients vices from different service providers (e.g., gov-

cannot comment on complex technical matters. ermient, the private sector, and other sources).

But they are eminently qualified experts on They probe into such critical dimensions as

whether the public services meet their needs awareness, availability, and affordability.

and expectations. They can say with authority These dimensions of service are presented from

whether specific aspects are satisfactory or un- the perspectives ofdifferent population groups.

satisfactory, and whether the concerned agen-cies are responsive, reliable, or accountable. They are differentiated by geographic re-

gion, rural and urban residence, level of house-The Report Card is a timely initiative: it hold expenditure, and by gender. These should

should help demonstrate the renewed commit- be key inputs in the design and improvement of

ment of Filipinos to a democratic, transparent, effective service delivery programs. They

and accountable State responsive to the needs should be seen as complementing the findings

of the people, especially the poor. This commit- of expert evaluations and agency reports. The in-

ment was reiterated by President Gloria Maca- sights derived from the Report Card can shed

pagal-Arroyo, who required her Cabinet mem- light on the degree to which pro-poor services

bers to sign a pledge to be accountable to eleven are reaching the target groups, the extent ofleak-

service standards. The pledge includes respon- ages, and the factors that contribute to such mis-

siveness to client feedback." direction of resources and services. They help

This shift to thinking about Filipinos as cli- identify issues that constrain the poor from ac-ents rather than beneficiaries requires that their cessing and using the services, like physical"voices" count in the design, delivery, and as- availability, quality, and cost. Theyuncoverpos-sessment of public services. Private firms oper- sible ways to rectify the situation. The latter in-

ating in a competitive environment make use of clude suggestions by citizens about the types of

this approach. They utilize the data from client programs that might provide better service de-

surveys to redesign theirproducts to better meet livery,.' 4 Further, the Report Card results helpcustomer needs and enhance customer loyalty, test from the clients' standpoint some ofthe pol-User feedback is especially important for agen- icy conclusions reached in other analytical stud-cies providing government services as they of- ies. 5 Thus, it presents a "bottom-up" perspec-

ten operate as monopolies, i.e., with no compe- tive on the analytical work of the World Banktition. In this situation, people, especially poor andothers.people, may have few viable and affordable al-ternatives.12 Citizen feedback is a much- How Did the Report Cardneeded corrective in this setting. It can be used Identify the Poor?by reform-minded champions in the Govern-ment as a trigger for public pressure to improve The primary measure of poverty in the Re-

performance. port Card is based on household expenditures.' 6

2

SUMMARY

Households with expenditures in the bottom Government.30% are classified as poor. Those with expendi- Initiatives and actions are already underwaytures in the middle 30% are considered middle- to address some of the constraints identified byincome. Those with expenditures in the top 20 Report Card40% are regarded as the rich. 17The incidence teRpr adrsodns40% are regarded as the rich.1 Theincidence. . recommendations are already incorporated inof expenditure poverty in the Philippines is the new Medium Term Development Plan2 andabout 30% according to official estimates, so revised poverty strategy of the Goverment.households with expenditures falling in the bot- Many of them were mentioned in the Presi-tom 30% should cover virtually all, if not all, d 2 22

households that are below the official poverty dings are o be u bthe World Banline. findmgs are also bemg used by the World Bankas key inputs into the design of a new country

23 ~~~~~~~~~~~~24strategy23 and future lending operations.

is the Report Card? The draft Report Card was finalized basedon feedback from different stakeholders. The

The Report Card began with consultations next step is to stimulate informed dialogue andwith key stakeholder groups in government, the follow-up actions by development partners.private sector, civil society, and academe. Dissemination efforts will focus on three targetTheir inputs were actively solicited and incor- audiences: the service providers, the Congress,porated in the design of the survey question- and the general public. Different versions ofthenaire. After the fieldwork was completed, pre- Report Card will be produced and disseminatedliminary data tables were prepared. The initial to cater to the needs of various target audi-findings drawing upon the tables were pre- ences.25 The follow-up dissemination actions in-sented to stakeholder representatives in re- clude:gional workshops in June 2000.18 The partici-pants helped validate the preliminary results * Individual consultations with concernedand suggested areas for additional tabulations public agencies on the Report Card results;and further analysis. They identified a numberof nuances that were helpful in explaining the 0 Consultations between public agencies onperceived discrepancies between the Report common citizen concerns that cut across sec-Card results and sector level data. '9 tors;

Detailed tabulations, analyses, and interpre- * Consultations between citizens and servicetation ofthe survey responses took place during providers (public, private, and civil societythe succeeding six months. World Bank sector organizations);specialists and national experts prepared thewrite-ups on the five sectors, utilizing the final * Targeted dissemination to the legislativedata tables. They married Report Card findings branch ofthe Government;with other sector-level data to present a com-prehensive picture of the situation in the sec- * Dissemination of the main findings of thetors. The detailed data tables and draft sector Report Card through the media2 and re-write-ups were shared with the Government gional stakeholder workshops; andthrough the National Economic and Develop-ment Authority. This encouraged independent * Distribution of the Report Card data andscrutiny and validation of the analysis by the findings on user-friendly compact discs.

3

REPORT CARD

SUMMARY FINDINGS FIGURE 1Private Facilities are Rated Befter than Public Facilities

T n he Filipino Report Card captures citi-zen assessments of public service pro- Non-medical facilities 7vision in five key sectors: health care, el-

Availability of medicines _ 73ementary education, water supply, housing, 23

subsidized rice distribution, and the Lingap Waiting time 73

para sa Mahihirap (or Caring for the Poor) Pro- Medical facilities 73

gram. The assessments and key implications 15T72for sector findings are summarized below. Treatment received 33

Quality of medicines 70

Health Care Competence of personnel 22 70

The health facilities assessed in the Report Availability of personnel 25 68

Card included barangay (village) health sta- Number of personnel

tions, rural health units/urban health centers, 28government hospitals, private clinics/hos- Attitude of personnel 24

pitals, nonprofit clinics/hospitals, and tradi- Convenience of schedule 63

tional healers.Understanding health needs 22

The nonpoor use health facilities more 52

than the poor. More than three fourths ofthe re- r 18 0

spondents have utilized a health facility in the Convenience of location 56

12 months preceding the survey. Urban re- Flexibility of payment 60sidents visit the facilities more than rural resi- 30

dents. A larger proportion of the better-off visit Cost of medicines 6729

health facilities, compared to the poor, although Cost of treatment 76

poor Filipinos are more likely to suffer from ill 20 40 60 80 10

health. Those who did not go to health facilities Percent of respondents

gave absence of illness, self-medication, andthe high cost of medical care as reasons. Base: Households most often using (private/public) facility

and with access to altemative (public/private) facility

Public facilities are low in cost but in-ferior in quality. Publicly provided health ser-vices are used mainly by those who cannot af- a PRIVATE facilities are better than public facilities in (ASPECT)

ford the widely preferred private services. si PUBLIC facilties are better than private facilities in (ASPECT)

Compared to government facilities, clientsrank private facilities superior in all quality as-pects (care, facilities, personnel, medicines, units/urban health centers) appropriately pro-and convenience). The only advantages of go- vide preventive health services and treatment

vemment facilities over private facilities are for minor illnesses/accidents. However, a siz-their low cost (oftreatment, medicines, and sup- able number of Filipinos bypass them, evenplies), and flexibility ofpayment (Figure 1). when they are highly accessible, in favor of gov-

Primary facilities are frequently by- emient hospitals and private clinics/hospitalspassed. Government primary health facilities (Figure 2). Thus, government hospitals end up(barangay health stations and rural health providing the same services as primary facili-

4

SUMMARY

FIGURE 2Public Primary Health Facilities are Often Bypassed facilities do so because they are dissatisfiedPublic_Primary_Health_Facilities_are_Often_Bypassed with their quality. In fact, satisfaction is lowest

for frontline barangay health stations andgrassroots rural health centers. Diagnosis is

Barangay poor, necessitating repeat visits. Medicines andhealth 68 supplies are inferior and often unavailable.

station Staffmembers are often absent, especially in ru-ral areas, and are perceived to lack medical and

Rural/Urban people skills. Waiting time is long, scheduleshealth 74logcealter ! !are very inconvenient, and facilities are run-

cenr / / down.

65 70 75 Primary facilities are used mostly by thePercent of respondents poor. Private clinics/hospitals are more likelythat bypass facility to be visited in Metro Manila and in other urban

Base: Households within a 15 minute walk areas, and by the nonpoor. On the other hand,residents of Mindanao and rural areas, and thepoor, are more likely to visit government pri-

ties. Only a third of their business consists of mary facilities andtraditional healers.specialty services like care for major illnesses Improving primary facilities is pro-poor.(Figure 3). Since public primary facilities are mostly fre-

Primary facilities arenotedfortheirquented by the poor, improving their quality,Primry aciitie ar noed fr teirlow and stressing services needed by the poor,

quality. Those who bypass the primary health wud make te re poor.would make them more pro-poor. This wouldFIGURE 3 also reduce the inefficient use of public hospi-Public Hospitals Mostly Do the Work of Primary Facilities tals. The Sentrong Sigla program of the Depart-

ment of Health, which issues a seal of approvalto facilities that meet quality standards, shouldbe strengthened. Targeted assistance to upgrade

Specialty care the quality of primary facilities should focus onpoorer, isolated communities.

M ri Government hospitals require quality up-Minor curative i care 30 grading, too. While clients rate governmenthospitals higher than public primary facilities,

Preventive 35 there remains a significant quality deficit in gov-health care 63 ernment hospitals compared to private facili-

ties, especially in the NCR. This is particularly0 20 40 60 80 disconcerting, since a large share ofthe national

Percent of households government budget for health is spent on gov-ernment hospitals in Metro Manila. The prior-

Base: Respondents that sought their services ity is to improve service quality in governmenthospitals through financial autonomy and mar-

| O Primary facility U Hospital ket pressure.

The poor pay more, but get less. Median

5

REPORT CARD

annual household expenditure on health is FIGURE 5

PhP1,180 (about $25), and, in absolute Medicines are Expensive

amounts, the rich spend ten times more onhealth care on average than the poor. This islargely due to patronage by the poor of cheaper, Others

lower-quality government services. However, Laboratory

the modest health care spending of the poor ab- Consultation, treatment

sorbs a larger share of their income than does Hospital stay l

the health care spending of the rich (Figure 4). Medicines l __ _ ___

The poor especially need insurance cover- 0 10 20 30 40 50

age. Insurancecoverage couldlightenthemed- Percentage share in total

ical burden of all Filipinos, especially the poor. health expenditures

While one third of the population is protected Base: All households

by health insurance, less than 1% ofthe poor arecovered. Thus, payments for health care by the some drugs by half.poor are almost entirely out of pocket, effec-tively limiting their use of care for catastrophic Implement the Health Sector Reformillnesses or for quality (private) care. Agenda. The Health Sector Reform Agenda

(HSRA) proposes to make the health care sys-

High prices of medicines are a burden. tem in the Philippines more pro-poor by (i) ex-Medicines and supplies account for the largest panding health insurance coverage for the poor;share of household medical expenses, at 49% (ii) improving the quality and accessibility of(Figure 5). This is even larger than the 33% health care for the poor in public primary facili-

share that goes for hospital stay and the 10% ties; (iii) reducing the cost ofmedicines and hos-

share for consultation and treatment. It is urgent pital stays; and (iv) improving quality in gov-

to cut the prices of medicines, which are signifi- emient hospitals by giving them financial au-

cantly higher in the Philippines than in the rest tonomy. If successfully implemented, the

of the Association of Southeast Asian Nations HSRA could respond to the aspirations and con-(ASEAN). Hence, the Government has initi- cems of Filipinos.ated parallel importation of cheaper drugs fromcountries such as India. Competitive bidding Elementary Educationprocedures have also helped cut the prices of

Elementary education in the Philippines isFIGURE 4 provided by public and private (including sec-Health Care is More Costly for the Poor tarian) schools.

Elementary school enrollment is almostRich universal, and mostly in public schools.

. _ l More than nine out of ten school-age childrenPoor are enrolled in elementary schools, and 88% of

(-- )---------r-- -6 ---8----~ them go to public schools. Access to public0 2 4 6 8 schools has improved overtime.Mean health expenditure as a percentage

of total household expenditure Dropouts are mostly from poor families.

Base: Rich and poor households About three fourths of the dropouts belong to

poor households. They are most often located

6

SUMMARY

in rural areas. Two out of five Filipino children FIGURE 7not in school are Mindanao residents (Figure Private Schools are Rated Better than Public Schools6). Boys tend to drop out more often than girls.Of those children who drop out of elementaryschool, 60% do so in grades 4 and 5. Teachers' mastery 7 _

FIGURE 6 Textbooks 91 1Most Children Not in School are from Mindanao Class size 11_84

Facilities in the _ 1 78Metro Manila classroom

Visayas l Teachers' attitude 78Balance of Luzon Other facilities 76

Mindanao 6 b - . 6z < ~~~~~~~~~~~~~Administrators' ability _ 2i1

0 20 40 60 73I Teachers' attendance _ 7Regional distribution of childreniInot in school, in percent Convenience of 7 3

schedule 3Base: All children not in school Classmates of child 7 647

Location I

Children drop out for health and eco- Transport costs 40nomic reasons. Poor health (or disability) is Uniform costs 0 7

the main reason for dropping out, followed by Tuition 8: 6economic reasons, like the high cost of educa- --t

tion, or the need for the child to work. A small 0 20 40 60 80 100proportion drop out due to poor grades. Percent of respondents

Filipinos recommend the following pro- Base: Households with children in (private/public) schoolsand with access to alternative (public/private) schools

grams for helping poor families keep children_________in school: in-school health care; full exemption C Child's PRIVATE school is better than alternative publicfrom miscellaneous fees; and more qualified, school in (ASPECT)and better trained, teachers. Scholarships for rl Child's PUBLIC school is better than alternative privateschool in (ASPECT)poor families, specifically targeted at childrenin rural areas, are also recommended.

Public schools are low in cost, but inferiorin quality. A significant majority of private andpublic school patrons agree that private schools patronized by rich, urban households, and resi-are better in quality than public schools (Figure dents of Metro Manila. Unsurprisingly, these7). On the other hand, public schools are rated schools are more often located where the better-higher by clients on their low cost and conve- off live.nience of location. Those who can afford to pay On the other hand, public elementary edu-send their children to private schools. cation is far from free. Public education is sup-

Tuition fees of private schools are ten posed to be free. In fact,Jfamilies spend abouttimes those of public schools. Because they 2% of their total household expenditures onare out of the reach of poor and most middle- each child enrolled in a public elementaryincome households, private schools are mainly school.

7

REPORT CARD

FIGURE 8Public Elementary Schools: Lowest Ratings for Class Size, Facilities, and Textbooks

Class size 1.02Facilities in the classroom 1.05

Other facilities 1.07Textbooks 1.09

Tuition 1.24Convenience of schedule 1.24

Classmates of child 1.24Teachers' attendance 1.33

Transport costs 1.37Teachers' attitude 1.37

Teachers' mastery 1.39Ability of administrators 1.41

Convenience of location 1.64

0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8Very Satisfied 2, Satisfied 1, Neutral 0,Dissatisfied -1, Very Dissatisfied - 2

Base: Households with children in public elementary schools

One fifth of this amount goes to miscella- lower rating for teachers' performance shouldneous fees and donations for the school's up- be of particular concern to private schools, askeep. These fees are particularly high in the this has been their main comparative advantageVisayas. Transportation accounts for about half over public schools. Unless private schools areof education expenses, and uniforms for about a able to arrest this decline, they are likely to losequarter. more students. This is bad news for public

Class size, textbooks, and facilities are schools, too, as it puts additional pressure on al-

rated poorly in public schools. Public school ready strained resources.

patrons are most satisfied with location, per- Parent-Teacher Associations are wide-haps because of the successful implementation spread. Parent Teacher Associations (PTAs)of the long-standing "one baran gay, one are found in 98% of public schools, and twoschool" policy of the Government. However, thirds ofthe parents are PTA members. Partici-they are least satisfied with class size, availabil- pation ofthe poor is higher than the national av-ity of textbooks, and school facilities (Figure erage -- three fourths of poor households are

8). Average class size in the Philippines (45) is PTA members (Figure 9) -- and has improvedmuch higher than the average teacher-to- over time. Four out of five private schools havestudent ratio (35), largely due to poor deploy- PTAs, and their numbers too have risen overment of teachers. Five students, sometimes timemore, share a single textbook. And the condi-tionofmostpublic schoolbuildings is poor. PTAs are a potent force for reform. Al-

There has been a drop in client satisfac- most all of the poor say they are well repre-tion with private schools. The fall is related to sented in PTAs. Public school PTAs are equallytuition fee increases, slipping teachers' perfor- concerned with education and fundraising, andmance, and deteriorating school facilities. The members feel they have considerable influence

8

SUMMARY

FIGURE 9 while 3% get water from vendors. This meansParent-Teacher Associations are Widespread 3 7% of the consumers devise their own ways to

get water. Self-provisioning is the last resort of100 - poor households. They are forced to collect wa-80 ter from contaminated sources. They store it in60 containers (such as clay pots, plastic cans, or20 - tins) that are not regularly cleaned, and drink ito -- l without treatment.

Poor Middle RichThe poor are excluded from Level III wa-

ter service. Only one quarter ofthe poor get wa-Base: Household with children in elementary school ter piped to their homes (Figure 10). The access

ofthe poor to home-piped water is less than half* Member in PTAs that of the rich. The poor are three times moreCL PTAs represent their views closely likely than the rich to access water from wells,

springs, and communal faucets. Of the poorwith no house connections, more than two

on the teaching programs. thirds want such access. Figure 1 1 shows the dis-tribution ofwater sources for the poor.

Private school PTAs are mostly concernedwith education activities, and members feel Rural communities and Mindanao arethey have considerable influence on the teach- underserved. Urban households are four timesing programs, too. Thus, PTAs represent valu- more likely to be served by Level III systemsable social capital that could help enhance re- than rural households. More than four out ofsponsiveness, accountability, and results orien- five households in the NCR enjoy access totation in elementary schools.

FIGURE 10Only Two out of Five Filipinos Have Piped Water

Water SupplyThe Government provides water through

three formal levels. Level I is a point source Philippines I(without any piped distribution), like a spring Mindanaoor protected well. It serves around 15 house- Visayasholds within 250 meters. Level II is a piped sys- Balance of Luzontem with community faucets, serving four to six Metro Manilahouseholds within 25 meters. Level III is a full Ruralwaterworks system with individual house con- Urbannections. When water is not piped, responsibil- Richity for improving quality is transferred to the Middleconsumer. Level I and II water has to be stored poorfor a longer time, at greater risk of contamina- P 26_0 20 40 60 80 100tion.

Percent of respondents with accessTwo out of five Filipinos do not get water to home-piped (Level oll) waterconnections

from formal sources. Only 64% of Filipinosget water from the Level I, Level II, or Level III Base: All householdssystems. One third rely on self-provisioning,

9

REPORT CARD

FIGURE 11 FIGURE 12A Third of the Poor Collect Their Own Water Those with Home Pipes Consume the Most Water

VendedPhilippines

Communal Vendedfaucets

Wells, springs

Home pipes - - Communal faucets

Self-provisioningSelf-

provision Home Pipes _ f._ _ : _

Wells, 0 20 40 60 80 100

springs _ __ E 1 Median water consumed, in litersper capita per day

0 10 20 30 40

Main source of water supply,percent of households Base: All households

Base: Poor families

Level III services. Level III service is least ceptably low. Half of all poor and rural house-

available in Mindanao. A majority there get wa- holds consume less than 41.6 liters per capita

ter from communal faucets (Level II) and point per day. This is a meager amount, given that 30

sources (Level I), and one third rely on self- liters barely meets human water requirements.

provisioning. Among the poor who buy water from vendors,

Level III service is unable to meet con- median consumption is just 20.8 liters. Thepoor and rural households are more vulnerable

sumer demand. Hence, consumers are forced . ..to get water from other sources. Among those to diseases like malaria, gastroenteritis, denguewithout access to home-piped water, two thirds fever and typhoid induced by scarce, contami-

want to get it, but 95% have not applied for such nated water.

service. The main reason cited is absence of the Water supplied by all sources is consid-

service in their area. Water services should be ered unsafe for drinking. Almost all house-

provided based on what the clients want and are holds incur additional expenditures on water

willing to pay for. treatment and bottled water, and such expendi-

Level III service con- tures are often substantially higher than those

Househmold w iterthan others. Median water paid to the water utility. The quality ofwater pro-sum moewtr thnohr.Mda.ae vided in the rural areas appears worse than that

consumption for Level III households is more in areas,aaseseenoin the r trat

than the combined consumption for those withLevel I and Level II access (Figure 12). Higher costs in the countryside.

consumption levels and convenience are indi- Low water quality especially hurts the

cators of greater welfare, and the survey con- poor. Rural residents spend more than twice as

firms that Level III systems are preferred. Even much on treating water as they do on their util-

the poor consume more water from Level III sys- ity bills. Urban households spend an almost

tems, compared to any other source. equal amount on bottled water, a source in need

Water consumption by the poor is unac- of improved regulation. The poor scrimp on wa-

10

SUMMARY

ter treatment because they cannot afford it and largest State investments and subsidies (in capi-because oftheir lack ofhygiene education. tal and operational costs), serve mainly the ur-

The poor pay more, but get less. Outlays ban nonpoor. Therefore, these groups benefiton water vary from 2% to 9% of total household more from goverment subsidies.expenditure. Self-provisioning and vended wa-ter show the highest shares. On average, poor Housinghouseholds allocate proportionally more of The Report Card sought citizen assessmentstheir monthly expenditure to water than do the of their current housing as well as the housingrich. The poor can afford only limited amounts assistance services they received from both pub-of (low-quality) water, and have very little lic and private sources. Information on currentmoney to treat it. They should receive priority housing provides a context for better interpret-in new service provision. ing the experiences ofFilipinos with housing as-

sistance programs.The poor spend the most on low-qualityvended water. Clients give the lowest quality The poor are extremely dissatisfied withand service ratings to vended water. Almost one their housing. Half of the respondents ratetenth ofMetro Manila residents, many ofwhom their housing as inadequate (Figure 14). An-are poor, get their water from vendors. The Fili- other third consider their housing as borderline-pino poor who rely on vended water as their inadequate. In Mindanao and Visayas, wheremain source devote 9% of their household ex- poverty is more widespread than Luzon, nearlypenditure to buying water (Figure 13). This is two out of three households regard their hous-the highest share among all categories and ing as inadequate. Dissatisfaction with housingsources. They should receive top priority fortar- is higher in rural communities, where moregeted interventions. poor Filipinos live, than in urban areas. How-

ever, the urban poor are extremely dissatisfiedThe rich are subsidized more than the FIGURE 14

poor. Level III systems, which often get the Half the People Rate their Housing as PoorFIGURE 13Expenditure on Vended Water is a Burden on the Poor

Philippines I U

Metro Manila101'- I_

8- / l Balance Luzon I .. _ .6- //| 5 -Visayas IEEEEEE

4- ~~~~~~~Mindanao E EE I2- ~~~~~~~~~~~~~~Urban

Poor Rich Rural IE*E* E: Share of vended water as 0 10 0 30 40 50 60 70percent of total householdexpenditure Percent of respondents who

rate their housing as poorBase: Households that rely on vended

water as main source of water Base: All households

REPORT CARD

comparedto theirwealthierurban counterparts. The poor are capable of building their

Location is linked to satisfaction. Urban own shelter. The Report Card finds that al-though residential land ownership iS lowest

residents, especially the poor, are more satis-fied than rural Filipinos with tamong the poor, house ownership is highest,

thedr house relalive i o wit the ocaton of compared to middle-income and rich house-ltchirihouse at h p lace of wok ub- holds. This reflects the capacity of the poor to

lic aciitis, nd ublc srvies.Becusetheur- build their own shelter. To improve housing forban poor value access, distant, out-of-city relo- ,thep r the GoverneTs prort hould be

cation is ill-advised. There is also a need to e otenure and the provsiton of es-

bringjobs, public facilities, and public services sentiao srie leand the ir

closer to rural communities, that give low ownhouses,grades on access. Community upgradingand provision of basic services, like water and Access to housing programs is very lim-

sanitation, will improve their quality of life. ited. Out of the five basic services included in

Land tenure is vital to housing satisfac- the survey, housing assistance offers the lowest

tion. In the Philippines, house ownership (at access. Only one tenth of the respondents have

78%) is more common than residential land ever applied for housing assistance. Of this

ownership, at 58%. Among the expenditure number, one third had to do so because of gov-

groups, the poor have the lowest proportion of emient relocation drives. The three main rea-households owning residential land (Figure sons for not applying for housing assistance are

15). They are also the least satisfied with their lack of awareness about housing programs and

housing. As such, programs that focus on se- ways to access them (50%); lack ofneed (20%);

curity of land tenure, like the Community Mort- and high transaction costs, at 7% (Figure 16).gage Prgrm,arnigdmadansou As a first step, service providers should inform

gage Ptrongram,red in high demand and should the public, particularly non-NCR, rural, andbe strengthened. poor households, about the programs. They

FIGURE 15 should streamline application procedures, setResidential Land Ownership is Lower among the Poor reasonable waiting times, and establish respon-

sive complaint mechanisms.

80 - / The private sector hardly participates.70- Three fourths of those who get housing assis-

60- / 1!|!1 - --- m tance obtain it from the Government. A maj-

50 |- "] ~ -ority of the rest get it from informal sources like

40 / | - * _ relatives, moneylenders, religious institutions,

30 cooperatives, and non-government organiza-

10 l player in housing assistance. An option that

_ l _ _ could raise the flow of private funds into hous-

Philippines Poor Middle- Rich ing is to develop a secondary market for mort-Income gage-backed securities. This would require le-

Percent of respondents gal, regulatory, supervisory, and tax reforms.who own residential lots

Government housing assistance benefitsBase: All households mostly those who need it least. About 95% of

the beneficiaries of government housing as-

12

SUMMARY

FIGURE 16 The poor are excluded from housing asso-Information on Public Housing Assistance is Lacking ciations. The SSS, GSIS, and PAG-IBIG pro-

grams require that participants contribute for at______-- least two years before they qualify for assis-

Not eligible tance. Such requirements discriminate againstthe poor and those employed in the rural and in-

High expenses formal sectors. Since only 3% of poor house-holds are members, most applications come

Not required from the nonpoor. Even the poor who are mem-Don't know how b bers are often unable to access assistance, be-

cause of unrealistic payment requirements andNot aware I _ _ -_ corruption among lending officials. A separate

0 10 20 30 and transparent housing assistance window tar-Top reasons for not applying geted at the poor, with more favorable terms, isfor govemment housing recommended.assistance, in percent

Client rejection of housing assistance isBase: Households that did not apply for assistance Appliantsject o r than alfithe ashigh. Applicants reject more than half the as-sistance offered to them by housing agencies.

sistance have been urban households (the ma- The assistance appears to come too late, as re-jority in the NCR). Most of the assistance has spondents complain of long waiting times. Ru-been captured by rich and middle-income ral Filipinos display a higher rejection rate thanhouseholds, with only 21% of the beneficiaries urban Filipinos. This may be due to the addi-coming from the poor (Figure 17). Ironically, a tional transaction costs of traveling long dis-larger proportion of the NCR, urban, and tances to urban centers to make monthly pay-nonpoor households confirmed that they did ments. Reforms would require the decentral-not require assistance. The Government should ization of housing services and capacity build-give more attention to rural and poor house- ing for local governments.holds.

FIGURE 17Housing Assistance Approvals are Biased Against Poor and Rural Filipinos

Poor

Middle-income I _

Rich I --

Rural

Urban I -

0 10 20 30 40 50 60 70 80 90 100Approved applications, in percent

Base: All who accepted govemment housing assistance

13

REPORT CARD

Low-cost rental housing can benefit the chase as muchNFA rice as stocks allow.poor. The Philippine Constitution calls for ade- NFA rice is low in cost, but inferior in qual-quate shelter for all, not home ownership for all (FAgre is low aing decirior bal-Affordability is a major issue, so alternatives to it (Figure 18). Purchasing decisions are basedownership are necessary. Rental housing can largely on priceandquality. Given the poor qual-improve housing quality and security oftenure, ity of NFA rice, those who can afford to pay awimprhoutsconfeing qualitywandsecrity Te tenu, Chigher price buy better quality non-NFA rice;without conferring ownership. The Rent Con- while the poor, who do not have adequate in-trol Law should be overhauled to make the come resort to lo Not have terental housing market work for the poor. The come, resort to lower-priced NFA rice. The

desttut hoeles ma reuir speialhosels nonpoor appear to buy NFA rice mostly for do-destitute homeless may require special hostels mestic helpers and pets.offering beds and toilet facilities.

The nonpoor benefit more from the rice

Distribution of Subsidized Rice subsidy. While proportionately more poor peo-ple buy NFA rice, the absolute number of the

Rice is important for the welfare of the nonpoor who buy NFA rice is not very differentpoor. The Report Card reconfirmed the lm- from the absolute number of the poor who doportance of rice as a staple food, particularly in so. Because the middle-income and rich house-rural and poor communities. It also showed that holds purchase more NFA rice than the poor,84% of Filipinos bought rice in the market, the nonpoor enjoy a bigger subsidy (Figure 19).while only 13% produced the rice they con- This appears to be a misallocation of scarce re-sumed. Even in the rural areas, approximately sources for a Government concerned with im-71% ofthe respondents bought rice. To this end, proving basic services for the poor. To this end,if the Government is serious about addressing the Government should consider targeting ricethe needs of the poor, it should ensure that af- support to the poor, rather than providing a gen-fordable rice is available and accessible to the eral rice subsidy for all.poor.

FIGURE 18Availability of National Food Authority NFA Rice is Rated Cheap But Low in Quality

rice is limited. The Government, through theNational Food Authority (NFA), has been sub-sidizing rice, not necessarily to tackle food pov-erty, but to ensure stable prices and supplies. Poor in color

The survey found that the majority of respon- P i tat

dents are aware that the NFA sells subsidized Poor in taste

rice. Yet only 15% of the respondents buy NFA Low inrice, which is consistent with the level of NFA quality

participation in the market. Low in price

The poor self-target NFA rice. Despite the Poor in smell

NFA's limited participation in the market, it ap- 0 10 20 30 40

pears to have disproportionately reached the Percent of respondents

poor, with 27% of the poor buying NFA rice, Base: Households that purchased type of rice

compared with 16% among the middle-incomei *NFA Rice o Non-NFA Rice

group and 6% among the rich. However, thisdoes not appear to result from any deliberategovernment targeting, since anyone can pur-

14

SUMMARY

FIGURE 19 The nonpoor patronize Enhanced RetailMore NFA Rice Subsidies Go to the Nonpoor Access for the Poor stores more. Client feed-

back on the Enhanced Retail Access for thePoor (ERAP) stores, which are supposed to be

2,108 1 / = ^ <located in areas where the poor live, is not en-2,106 couraging. The survey found that middle-2,104 income and rich households are more aware2,100 than the poor of the ERAP stores, which are in-2,098 tended to provide the poor with access to basic

oor onpoor commodities at subsidized prices. Moreover,Million pesos/year the survey showed that more middle-income

Base: Consumers of NFA rice and rich households patronize the ERAP stores,than do poor households (Figure 2 1).

Mindanao is excluded. Among all the re-Filipinos recommend geographical tar- gions, Mindanao has the highest proportion of

geting to the poor. Targeting rice subsidies to households for whom no NFA rice is available.the poor, which has been on the government It also has the fewest ERAP stores in the coun-agenda for the past few years, is validated by the try. As a first step, more stores should be locatedsurvey results. A majority of respondents rec- in disadvantaged areas, especially Mindanao,ommend geographic targeting, by locating spe- to enable the poor to avail themselves of low-cial stores selling NFA rice in poor areas, as the pricedbasic commodities, includingNFA rice.most effective targeting mechanism (Figure20). There is less support for the provision of The Government is testing geographicalidentification (ID) cards and food stamps due to targeting plus ID passbooks. Government isconcerns relating to potential corruption, high proposing a Targeted Low-Priced Rice Distri-costs ofradministration,tand impliedtlimits. bution Pilot Program to make available low-priced, good-quality NFA rice to poor families.

This is expected to pave the way for discontinu-FIGURE 20 ing the general rice subsidy. The pilot programPeople Prefer Geographic Targeting uses geographic targeting but further limits ben-

eficiaries and the purchase of rice through theuse ofpassbooks, a form of ID system. Combin-

Give poor people food ing geographic targeting and IDs may reducestamps _ leakage more significantly than the application

Give poor people ID of either one alone.cards

I___ ____ Review the subsidy level. The NFA pilotLocate stores In poor _ , program offers rice at the same price as the gen-

barangays ,/erally available NFA rice. However, a key sur-0 20 40 60 vey finding is that the amount of NFA rice sub-

Preferences for targeting sidy is modest and makes only a marginal dif-percent of respondents ference for the poor. Therefore, NFA may wish

to consider adjusting upwards the price for gen-Base: All households erally accessible stocks. The savings obtained

from adjusting the price of generally accessible

15

REPORT CARD

FIGURE 21 LingapparasaMahihirap ProgramLow Use of ERAP Stores by the Poor

The Lingappara sa Mahihirap (Caring for

the Poor) Program, which aimed to benefit the

11 1 100 poorest families, was launched as the flag-

Public market _ ship poverty reduction program of the Estradastalls Administration. It aimed to reduce the number

of poor Filipinos from 24 million in 1997 to 17

Rolling stores million by 2004. Initially, 16,100 poor families

Rolling stores were identified to receive assistance; these

were selected as the 100 poorest families in

Neighborhood I each of the 78 provinces and 83 cities. Supportstores to poor families was channeled in the form of a

package of assistance with (i) food, nutrition,10 20 30 40 50 and medical assistance; (ii) price supports for

Patronage of ERAP stores rice and cor; (iii) protective services for chil-in percent

Base: All households dren and youth; (iv) rural waterworks; (v) so-cialized housing; and (vi) livelihood develop-

| Poor oi Middle income Rich ment.

The poor and rural residents were notvery aware of the Lin gap Program. About

stocks could then be redirected to increase the veya reothLigpPgamAbucoverage and the berdi to increase the two thirds of the respondents had heard of thecrovragemand.the subsidy to the poor in thepilot Lingap Program. This is impressive, given itsprogram. short history. However, rural residents were

Differentiate price and quality. Ac- much less informed about the program than

cording to the survey, respondents were dissat- their urban counterparts. Awareness was low-

isfied with the quality, smell, taste, and color of est among the poor, at 57%, compared with

NFA rice. In the targeted program, NFA should 63% for the middle-income group, and 69% for

take steps to assign different prices to different the rich.qualities of rice sold, improving consistency ofstocks, and eliminating the need to mix stocks Purse strings were controlled by legisla-

of various qualities. tors. About two thirds of the Lingap funds were

Reconsider the entitlement level. The to be disbursed with the approval ofmembers of

lot program limits the entitlement ofrice alloca- the Senate and House of Representatives. Fur-

tion per person. However, respondents are least ther, the legislators were represented in the pro-

supportive of food stamps to buy subsidized gram advisory boards in each ofthe implement-

rice, due to the implied quantity limits on buy- ing agencies. This subjected the Program to the

ing rice. To this end, NFA may wish to review pressures of political patronage. That is why the

the entitlement level, following the pilot phase. Report Card looked into poverty targeting.

16

SUMMARY

The nonpoor barangays benefited more. FIGURE 23

The proportion of households responding that The Poor Have Less Access to Members of Congresstheir barangay was listed for coverage underthe Lingap Program was almost the same for thepoor, middle-income, and rich groups. In fact,the number of poor households that indicated _- - ithat their barangay was included for coverage Rich

was less than halfofthat ofthe nonpoor. MdMiddle-

The nonpoor households benefited more. income

While 16% ofthe poor counted themselves as el-igible to receive benefits from the Lingap Pro- Poor

gram, so did 16% of the middle-income group / _ _ _/

and 11% ofthe rich. This reveals ineffective tar- 15 20 25 30

geting. Worse, the nonpoor listed as eligible to Percent in each expenditurereceive benefits outnumbered the poor by ara- 1group who know a memberreceive benefits outnumbered the poor by a ra- of the House or Senate

tio ofalmost two to one (Figure 22).Base: All households

The poor are less connected to legislators.One quarter of the respondents said that theyknew a Congressman or a Senator who wouldrecommend their household to be included in The Lingap Program should be over-the Lingap Program. The proportion of poor hauled or terminated. At its inception, a ma-households having such connections is lowest jority of Filipinos believed that the Lingap Pro-(19%), compared with the middle-income gram would have no impact on poverty reduc-group (23%) and the rich (27%). This put the tion. After the first year of implementation, thepoor at a disadvantage (Figure 23). bulk ofthe benefits ofthe Lingap Program were

going to the nonpoor. The mechanisms for bene-FIGURE 22 ficiary selection seem to facilitate this leakage.Lingap Program Benefited the Nonpoor More To this end, the program requires a major over-

haul, or termination.27

300,000,

200,000-

150,000,

0 Poor Nonpoor

Number of households coveredby the Lingap Program

Base: All Households

17

REPORT CARD

INSTITUTIONALIZATION ety organization, often a policy research and ad-

OF THE REPORTCA" vocacy institute. A primary example of this isOF THE REPORT CARD the Public Affairs Centre in Bangalore, Karna-

taka State, India.29 The advantage of this mo-Why Institutionalize del is that it is independent of government, so itthe Report Card? enjoys greater credibility. On the other hand, its

he RportCardprovdes lien assss- links with service providers and public coordi-he Report Card provides client assess-batse on lctiens' experienst svicese nating agencies are tenuous. Service providers

based on citizens' experiences It is ex- may resist the results and/or even underminepected that the service providers will consider the findings. Moreover, the report card may notthe Report Card findings in adjusting their pro- be sustainable in the medium and long term: reg-

28 However, many past assessments did ular funding for it is uncertain, and the rigorousgra.ms.. ,. technical requirements may be burdensome for

not have a lasting impact on service delivery, be- tecical reqiets mayi ebresmsocause they were one-shot exercises with no ef-fective follow-through. It is necessary to run Under the second model, the initiative forthe Report Card periodically to gauge improve- the report card comes from a government ser-ments in service delivery from a "bottom-up" vice provider. The agency contracts out the ac-perspective. Service providers may be moti- tual survey and the preparation of the draft re-vated to respond with concrete improvements if port to a private sector group or civil society or-they know they will be tracked again. Hence, ganization. The draft report is vetted by thethe Report Card mechanism should be institu- agency, finalized, and sometimes disseminatedtionalized: it should be repeated periodically, to the public. The focus of the report card maysay, at 12-to 18-month intervals. be confined to a single program or service, or a

facet relevant to a program. Examples of coun-

Global Experience tries using this model include Canada and thewith Report Cards United Kingdom.30 A major strength of this

While citize report cards are newtomost model is the ownership of the exercise by theWhilemmes itizen arepnor cardsnareu to mste public service provider, while preparation of

governments, they are now being used to rate terpr adb notiefr rnssmthe erfonane ofpubic aencis i Canda, the report card by an outside firmn brings some

thenperformance ofIpubic, agenciesraine, Cana degree of independence to the exercise. The pre-Denmark,Ghana, Idia, Swden, Ukrine, th liminary results are available to the agency and

United Kingdom, and the United States. It is in- itiesuandltsv1ws ndfeedback are included in the finalstructive to review their institutional arrange- report.

ments while exploring options to institutional- report.ize the Report Card in the Philippines. The same factors may become weaknesses

in the model when viewed from a different per-The institutional arrangements may be cate-

gorized under three main types or models. Re- spective. The service provider being assessed*cs y p r iy p sponsors the preparation of the report card and

port cards may be prepared (i) by an independ-pppent civil society organization; (ii) by a gover- oversees its implementation. This arrangement

ment service providergency;adiiiyago may lead the public at large, as well as legisla-ernment servceprovide agency; by ° .atg tors and government coordinating agencies, tom indent cin i ageny collaboration. question the objectivity ofthe findings. In addi-

with aidpdncvsoeytion, the information collected is usually tai-Under the first model, the initiative for pre- lored to meet the requirements of the public

paring the report card comes from a civil soci- agency. It may not be packaged for the con-

18

SUMMARY

sumption of citizen groups and the public. This The consultation process with public servicemakes the report card less subject to public ac- providers was appropriate, but not dominant.countability. Most important, the findings were fed back not

U r tdm conly to the agencies and the public, but also toUnder the third model, a government coordi- the budget allocation process.nating agency engages an independent organi-zation to design and prepare the report card.This work is done in consultation with -- but in- Institutionalizing the Report Carddependent of-- the public service agencies. The in the Philippinesexperience in the United States (US) is instruc- Discussions with key stakeholders indicatetive in this context. The Government Perfor- that the third model would be the most desirablemance and Results Act of 1993 requires the ex- for adoption in the Philippines, with appropri-ecutive branch to report to Congress on the per- ate modifications. In fact, the pilot round of theformance of government agencies. The Gen- Filipino Report Card incorporated many of theeral Services Administration (GSA), a govern- positive attributes of the third model.3 2 It isment coordination agency, is charged with as- highly advantageous to institutionalize thesessing the performance of federal agencies. Report Card tool in a government oversight

The American Customer Satisfaction Index agency that feeds the results directly into the(ACSI), developed jointly by the University of budget allocation process.Michigan Business School, the American Soci- In recent years, the Department of Budgetety for Quality, and Arthur Andersen Consult- and Management (DBM) ofthe Government ofing was selected as the tool for assessing per- the Philippines has started a program to developformance. 31 The GSA engaged the three-party performance-based indicators for public agen-consortium to undertake the 1999 Customer Sat- cies to assess their effectiveness and guide fu-isfaction Survey of Federal Agencies in the ture budget allocations. Three key areas are pro-United States. The survey focused on 29 federal posed for measuring performance: (i) outputs,agencies, which covered 90% of the govern- (ii) processes, and (iii) citizen feedback. To thisment's customers. The survey assessed service end, the DBM has expressed a strong interest inprovision by public agencies using the private institutionalizing the Report Card as a way ofsector as a benchmark. The results ofthe survey obtaining regular user feedback on key publicwere presented to Congress during budget nego- services. It is expectedthatthe incentive for ser-tiations, thus linking citizen feedback with re- vice providers to respond to client feedbacksource allocations. will be enhanced if they know they are being

Among the three models discussed above, monitored regularly by the DBM, using the re-the third model is the most comprehensive in port card tool as one of the three mechanisms to

assess performance and allocate resources.terms of product and process. Legislation setthe mandate for the report card and resources The DBM has agreed to contract out the cli-were allocated for it. An independent and credi- ent survey, the analysis of findings, and the prep-ble consortium of institutions was recruited to aration of the report to a credible and independ-prepare it. A well-established methodology ent civil society organization with substantialwas used to assess the performance of federal expertise in such activities.3 3 An advisoryagencies. Client satisfaction with public ser- panel will be convened to guide the Report Cardvices was assessed using the results of services exercise and its integration into the budgetaryprovided by the private sector for comparison. process. It will comprise representatives ofser-

19

REPORT CARD

vice providers, key government oversight agen- households modified to cover those groups thatcies, the private sector, and civil society organi- have been left out in the first round.36 Finally,zations. the main focus of the questionnaire should be

tailored to the selected principal performance

Improving the Report Card indicators used for monitoring outputs and pro-cesses by the DBM.

Continued assessments of the concepts andmeasures used in the pilot Report Card should Revision and refinement of the question-be undertaken to further improve the tool.3 4 naire should bring about considerable savings,For example, the sampling frame and phrasing as the cost of the survey depends critically onof some questions will require refinement dur- the number of questions. This should make iting the next round. Further, the Report Card cov- more cost-effective and sustainable. Also, lim-erage should be expanded gradually to encom- iting the scope to a few principal and commonpass a larger array of public services. Eventu- performance indicators should focus the atten-ally, the customer services provided by all gov- tion of service providers and key policymakers,emmnent agencies should be covered, along the and result in concrete actions. Above all, itlines ofthe US model described above. should further focus attention on improved ser-

vice delivery to the poor.37

The first (pilot) round of the Report Cardspread the net wide and tried to cover as manyfacets of service delivery as possible within its Last Wordbudget. On the basis of the lessons learned, it is It is recognized that no single sample ofrecommended that the scope of future Report 1,200 households, no matter how carefully se-Cards be limited to a few principal performance lected, can fully represent a country as large andindicators. Ideally, the performance indicators diverse as the Philippines. Nevertheless, the Re-selected for the Report Card should have a sig- port Card does provide valuable feedback fromnificant overlap with those used by the DBM in a wide spectrum of Filipinos on pro-poor ser-monitoring outputs and processes. This would vices.facilitate the triangulation of the results ob- The client assessments have been collectedtained from the three perspectives (i.e., outputs, by m ent andss entste bey ted

processes, an cletfebc)'n rvd by means of sound and well-tested survey tech-processes, and client feedback) and provide a niushtetneainltnad. .T.hecompehesivepicureof agency perfor- niques that meet iternational standards.3 The

comprehensive picture results are subjected to rigorous standard erroranalysis, which shows the findings to be statis-

The need for revision of the questionnaire is tically significant.3 9 Admittedly, the Reportanother important lesson emerging from the Cardtool is notperfect at entry. Many ofthe con-first round of the Report Card. First, there are cepts and measures used in this pilot phase willsome overlaps in the survey questions that undergoiterativerefinementsasthesurveyisin-should be minimized or eliminated. Second, stitutionalized. But what matters most is thatsome of the questions need to be phrased differ- the Report Card provides a channel for citizensently to be clearer to the respondents. Third, tovoicetheirconcernsandpriorities.other questions should be eliminated, as they donot seem to elicit useful/important findings.35 Much can be learned already from this pilotFourth, the questionnaire should be augmented Report Card about its potential to improve pub-in some areas and the process of selection of lic service delivery and accountability to citi-

20

SUMMARY

zens. Recognizing this, similar Report Card ini-tiatives are being launched in the Philippines.These include the preparation of a Report Cardon municipal services in the 17 municipalitiesof Metro Manila, thus localizing the instru-ment.40 Other countries, like Albania, Argen-tina, Ethiopia, and Vietnam, are also showingconsiderable interest in preparing report cardsbased on the Philippine model, to capture citi-

41zen feedback on public services.

21

REPORT CARD

NOTES

1. The responses on satisfaction are captured 6. Further disaggregation of the four regionson a five-point structured scale, in which (e.g., into provinces) would considerably re-"very satisfied" is accorded a score of plus two duce the number of sample households per(+2); "somewhat satisfied" is accorded a score disaggregated unit (province), given the over-of plus one (+ 1); "undecided whether satisfied all sample size of 1,200 households.or dissatisfied" is accorded a score of zero(0); "somewhat dissatisfied" is accorded a 7. For example, see Federal Agencies Go-score of minus one (-1); and, "very dissatisfied" vernment-wide Customer Satisfaction Reportis accorded a score of minus two (-2). The for the General Services Administration, Uni-weighting helps distinguish the variations in versity of Michigan Business School, Ameri-the degree of satisfaction and dissatisfaction. can Society for Quality, and Arthur Andersen,

December 1999.2. Philippines Poverty Assessment, The WorldBank, Washington, D.C., June 14,2000. 8. The following quote from a service provider

representative is a good illustration: "We have3. These five sectors were selected because they always been evaluated by outside consultantswere the focus of the flagship Lingap para sa and experts. It is high time that our clients eval-Mahihirap (Caring for the Poor) Program ofthe uated us. After all, who knows us better?" Com-Estrada Administration. Thus, the five sectors ment from a government representative at anot only ensured breadth of pro-poor services stakeholder workshop arranged to discuss theprovided by the Government, but also rele- preliminary findings of the Report Card, Mani-vance. la, June 13, 2001.

4. If service providers or program implement- 9. Ranking and quantification used in the Re-ers had undertaken the client survey them- port Card are arguably superior to anecdotes inselves, the independence of the results could focusing the attention of policymakers, servicebe questioned by oversight agencies, legisla- providers, and the public at large.tors, and civil society. On the other hand, if advo-cacy NGOs were engaged to conduct the sur- 10. After the successful nonviolent People Po-vey, service providers could question their wer II revolution in January 2001."agenda." In contrast, the SWS is recognizedand respected by many as an independent and 11. See quote from President Gloria Macapa-credible nonpartisan organization. The local re- gal-Arroyo at the beginning of this Summary.spect accorded to their work was a critical fac- Former President Joseph Estrada had also madetor in the selection of the SWS to undertake the a similar commitment to "treat each citizen as asurvey. customer in much the same way as the best pri-

vate companies treat their clients." SeeIntouch,5. The household (family) was selected as the aNewsletteroftheWorldBankCountryOffice,unit of analysis because it is the basic unit of fo- Manila, Volume 5, Number 2, March 2000.cus of most development interventions by theGovernment, the private sector, and civil soci- 12. For example, quality of services, timelinessety organizations. It was also the intended re- of service delivery, and responsiveness ofcipient of pro-poor public services covered un- agency personnel may leave much to be de-der the Lingap para sa Mahihirap program of sired. However, market pressure (through, forthe Estrada Administration. example, competition in service provision at

22

SUMMARY

comparable prices) is missing to rectify the defi- vate sector providers, and civil society organi-ciencies. zations.

13. For example, some of the new insights 19.Forexample, accordingtoofficialdata, theemerging from the Report Card include high teacher-pupil ratio is lowest in Mindanao,participation ofthe poor in Parent TeacherAsso- while the Report Card results show that largeciations and the high dissatisfaction of rural class size is a problem in Mindanao. The Reporthouseholds with their housing. These findings Card findings were confirmed and explained bydeserve further scrutiny and follow-up. participants from Mindanao as being the result

of the poor deployment of public school teach-14. Each of the sector modules in the Report ers in Mindanao by the Government.Card includes questions seeking clientviews on alternative pro-poor programs that 20. For example, the implementation of thewere under consideration by the Government at Health Sector Reform Agenda, which ad-the time of the survey (for example, the pro- dresses several constraints identified by the cli-posed Low-Priced Rice Distribution Pilot Pro- ents, has begun, albeit on a modest scale. Simi-gram ofthe National Food Authority). larly, the implementation of the targeted Low-

Priced Rice Distribution Pilot Program has be-15. For example, the recommendation in the gun, incorporating the Report Card findings.Philippines Poverty Assessment to abolish ageneral rice subsidy and criticism of the weak 21. Medium Term Philippine Developmentperformance oftheLingap Program. Plan 2001-2004, July 24,2001.

16. In addition, two other poverty measures are 22. President Gloria Macapagal-Arroyo's firstused in the Report Card. The first is based on State of the Nation Address was delivered onself-rating of the status of households as poor, July 23,2001, to a joint session of the House ofborderline, and not poor. This is a bottom-up as- Representatives and the Philippine Senate.sessment of the household by the respon- 23. Philippines Country Assistance Strategydent(s). The self-rated poverty measure has Upstream Review: Discussion Draft, Octoberbeen used by the SWS for the last 15 years in its 12,2001.quarterly social surveys. The second povertymeasure classifies households into A, B, C, D, 24. SocialExpenditure ManagementProjectII:and E groups, based on the enumerator's obser- Project ConceptDocument, June 8, 2001.vation and assessment of their housing and liv-ing conditions. This has been a useful poverty 25. For example, busy policymakers may re-measure for market research in the Philippines. quire a short note summarizing the key find-

ings, along with selected data tables and graphs.17. The Report Card obtained information on On the other hand, sector specialists may re-household expenditures by including the ex- quire more in-depth analysis as presented in thependiture module of the Annual Poverty Indi- sector chapters in the main report. Ordinary citi-cators Survey (APIS). This helps link the quan- zens may value yet another form of the Reporttitative poverty information from the expendi- Card, perhaps a "folksy" version, in local lan-ture module of the APIS with client feedback guages, which demystifies service provisiononpro-poor services. and provides information in a simple form.

18. The participants represented central gov- 26. The Report Card findings have been cov-ernment officials, local government units, pri- ered extensively in the local press, with more

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REPORT CARD

than fifty front-page articles and editorials in na- adopted in designing the survey, involving ational newspapers. wide spectrum of stakeholders, including gov-

ernment service providers. Service provision27. The Lingap para sa Mahihirap pro gram has by public agencies was assessed using the pri-already been terminated by the new Adminis- vate sector as a benchmark. The Report Cardtration, based partly on results of the Report findings are being shared with the service pro-

Card. viding agencies, the Congress, and the public,

28. A number of dissemination and advocacy as well as fed into the budget allocation process

actions are proposed to facilitate responses throughtheDBM.from the service providers. 33. A number of independent organizations

29. The work by the Public Affairs Centre is ex- competent to undertake the survey exist in theceptional. The Centre is a nonprofit and pro- Philippines. These include the SWS, Pulse

fessionally competent organization that is well Asia, and others.recognized both within the country and outside. 34. For example, the expenditure poverty mea-Its credibility with the Government and the pub- sure could be refined by constructing regionallic is high. The report card findings are taken se- poverty lines to tabulate poverty-related infor-riously by a wide range of stakeholders. This is mation for the four regions. In addition, clienta testimony to the stature ofthe Chairman, and a satisfaction measures developed in other coun-result of his vision and dynamism. The limita- tries, such as the ACSI, couldbe drawn upon.tions of this model relate to the difficulties inreplicating this unique situation. 35. For example, some ofthe questions on qual-

ity in the subsidized (NFA) rice module seem to30. For example, see Income Security Pro- overlap. Some questions inthe housing modulegrams Client Service Study. Report to Human may require clarification. The sets of questionsResources Development Canada, Center for on corruption did not bring forth significantMarket and Survey Research, Canada, August findings and could be revised in subsequent1998; and see Department of Social Security, rounds.Research Reports, United Kingdom, February15,2001. 36. For example, the design ofthe housing mo-

dule and the selection of households from31. The independent consortium developed the among permanent structures seemed to have re-ACSI in 1994 as an economic indicator of satis- sulted in under representation of the informalfaction with quality, which has since been used settler population, including squatters, in thefor assessing client satisfaction with the ser- sample. Similarly, access to health insurance byvices providedbymajorprivate companies. different groups could be better covered in the

32. For example, obtaining client feedback on health module. To this end, the questionnairepublic services, which is at the core of the Fili- and the household selection process will bepino Report Card, has strong support from the modified/adjusted for the next round.highest levels of the Government of the Philip- 37. The budget deficit in the Philippines is pro-pines. The SWS, an independent and credible in- j ected to be as high as PhP200 billion. Thus, lim-stitution, was engaged to undertake the ited resources allocated for basic servicesdesign and execution of the Report Card survey should be used judiciously. In particular, thisinstrument. A consultative process was means ensuring that scarce public resources are

24

SUMMARY

directed toward providing for the priority needsofthe poor.

38. The national sample size of 1,200 is stan-dard in the survey industry. It is larger than thatused in Austria, Belgium, Denmark, Finland,France, Germany, Great Britain, Greece, Ire-land, Italy, Luxembourg, the Netherlands,Northern Ireland, Portugal, Spain, and Sweden.

3 9. The maj or sector tables with the standard er-rors can be obtained from the Report Card teamby interested users. Please contactbbhatnagar(&worldbank.org .

40. The preparation of the Report Card on mu-nicipal services in Metro Manila is being un-dertaken by the Development Academy ofthePhilippines, with assistance from the Asian De-velopment Bank.

41. During the World Bank-organized inter-national workshop on Voices and Choices at theMacro Level: Participation in Country-OwnedPoverty Reduction Strategies, Washington,D.C., April 3-5, 2001, senior government rep-resentatives from 12 developing countries indi-cated considerable interest in preparing clientreport cards, based on the Philippine experi-ence.

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REPORT CARD

CONTENTS OF THE FULL REPORT

ABBREVIATIONS AND ACRONYMS

SUMMARYIntroductionSummary FindingsInstitutionalization of the Report Card

INTRODUCTIONWhat is the Report Card?Why Prepare a Report Card?What Does the Report Card Present?How are the Poor Identified?How Participatory is the Report Card?Structure of the ReportLast Word

HEALTHPoverty and HealthThe SurveyUse and AccessServices Provided by Health FacilitiesSatisfaction with Health FacilitiesHealth ExpendituresKey Findings and RecommendationsThe Government Health Sector Reform Agenda

ELEMENTARY EDUCATIONPoverty and EducationThe SurveyUse and AccessDropoutsSatisfaction with Elementary SchoolsHousehold Expenditure on SchoolingParent-Teacher AssociationsKey Findings and Recommendations

WATER SUPPLYPoverty and Potable WaterThe SurveyAccessReasons for Not ApplyingWater ConsumptionHousehold Expenditure on WaterSatisfaction with Water Supply ServicesKey Findings and Recommendations

26

SUMMARY

HOUSINGPoverty and HousingStructure of the ChapterThe SurveyClient Assessment of Current HousingClient Assessment of Housing ServicesKey Findings and Recommendations

SUBSIDIZED RICE DISTRIBUTIONPoverty and Food SecurityNFA's MandateThe SurveyRice ConsumptionHousehold Expenditure on RiceAwareness and AccessFactors Influencing Rice PurchasesTargeting Rice Subsidies to the PoorERAP (Enhanced Retail Access for the Poor) StoresKey Findings and RecommendationsTargeted Low-Priced Rice Distribution Pilot Program

LINGAP PARA SA MAHIHIRAP PROGRAMPoverty Alleviation FundsLingap para sa Mahihirap ProgramFundingProgress to DateThe SurveyAwarenessInclusion of Nonpoor BarangaysInclusion of Nonpoor HouseholdsRole of Elected RepresentativesKey Findings and Recommendations

INSTITUTIONALIZATION OF THE REPORT CARDWhy Institutionalize the Report Card?Global Experience with Report CardsInstitutionalizing the Report Card in the PhilippinesImproving the Report Card

APPENDIX: SAMPLE DESIGN AND METHODOLOGYIntroductionSample SizeGeographic Distribution of the SampleQuestionnaireSurvey ExecutionHousehold CharacteristicsUrban-Rural Distribution of HouseholdsPoverty ClassificationsData Analysis

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