Philippines - Filipino report card on pro-poor services

Report No. 22181-PH Philippines Filipino Report Card on Pro-Poor Services May 30, 2001 Environment and Social Development Sector Unit East Asia and Pacific Region Document of the World Bank  CURRENCY EQUIVALENTS (As of May 30, 2001) Currency unit = Peso $1.00 = 50.57 Pesos 1.00 Peso - $0.02 FISCAL YEAR January 1 - December 1 Vice-President Jemal-ud-din Kassum, EAP Country Director Vinay Bhargava, EACPF Sector Director Zafer Ecevit, EASES Task Manager Bhuvan Bhatnagar, EASES  ABBREVIATIONS AND ACRONYMS ACSI - American Customer Satisfaction Index ADB - Asian Development Bank AGILE - Accelerating Gross Investment and Liberalization with Equity APIS - Annual Poverty Indicators Survey ARMM - Autonomous Region of Muslim Mindanao ASEAN - Association of Southeast Asian Nations AusAid - Australian Agency for International Development BHS - Barangay Health Station BP - Batasang Pambansa BWSA - Barangay Waterworks and Sanitation Association CDA - Cooperative Development Authority CDF - Congressional Development Fund CENTEX - Center for Excellence in Public Elementary Education CHAPEL - City Housing Acquisition of Private Lots CIDSS - Comprehensive Integrated Delivery of Social Services CMP - Community Mortgage Program COA - Commission on Audit COCA - Certificate of Occupancy COMPAS - Center for Market and Survey Research COPE - Community Organization of the Philippines Enterprise CORE - City-Owned Lots Rehabilitation and Disposition CWS - Clark Water & Sewerage DBM - Department of Budget and Management DBP - Development Bank of the Philippines DECS - Department of Education, Culture and Sports DEDP - Divisional Elementary Education Development Plan DILG - Department of Interior and Local Govemment DOF - Department of Finance DOH - Department of Health DPWH - Department of Public Works and Highways DSWD - Department of Social Welfare and Development EO - Executive Order ERAP - Enhanced Retail Access for the Poor ESC - Education Service Contracting GAO - General Accounting Office GASTPE - Government Assistance to Students for Private Education GDP - Gross Domestic Product GFI - Government Financing Institution GH - Government Hospital GLAD - Group Land Acquisition Development Program GMA - Greater Manila Area GOP - Government of the Philippines GSA - General Services Administration GSIS - Govermment Service Insurance System HDMF - Home Development Mutual Fund (or PAG-IBIG) HH - Household  Filipino Report Card on Pro-Poor Services HHH - Household Head HSRA - Health Sector Reforn Agenda HUDCC - Housing and Urban Development Coordinating Council IBRD - International Bank for Reconstruction and Development ICSI - Institute on Church and Social Issues IMR - Infant Mortality Rate IPC - Institute of Philippine Culture IRA - Internal Revenue Allotment KG - Kilogram LBP - Land Bank of the Philippines LGU - Local Govermment Unit LGUUWSP - Local Government Unit Urban Water and Sanitation Program LWUA - Local Water Utilities Authority MBN - Minimum Basic Needs MCWD - Metro Cebu Water District MFI - Multilateral Financial Institution MSO - Marikina Settlements Office MTWG - Municipal Technical Working Group MWCI - Manila Water Company, Inc. MWLP - Multi-Window Lending Program MWSI - Maynilad Water Services, Inc. MWSS - Metropolitan Waterworks and Sewerage System NAPC - National Anti-Poverty Conmmission NCR - National Capital Region NEDA - National Economic Development Authority NFA - National Food Authority NGA - National Government Agency NGO - Non-Government Organization NRA - National Housing Authority NHMFC - National Home Mortgage Finance Corporation NSCB - National Statistical Coordination Board NSO - National Statistics Office NSP - National Shelter Program NWRB - National Water Resources Board NWRC - National Water Resources Council O&M - Operations and Management OCW - Overseas Contract Worker ODA - Official Development Assistance OECF - Overseas Economic Cooperation Fund PAB - Project Advisory Board PAC - Public Affairs Center PCER - Presidential Commission on Educational Reform PAF - Poverty Alleviation Fund PD - Presidential Decree PHIC - Philippine Health Insurance Corporation PhilHEALTH - Philippine Health Insurance PHILSSA - Philippine Support Service Agencies  Filipino Report Card on Pro-Poor Services PhP - Philippine Peso PIDS - Philippine Institute of Development Studies PNC/H - Private Non-Profit Clinic/Hospital PO - People's Organization PPAS - Public Performance Audit System PPC/H - Private For-Profit Clinic/Hospital PTA - Parent-Teacher Association PTFWRDM - Presidential Task Force on Water Resources Development and Management PWUA - Provincial Water Utilities Act RA - Republic Act RHU/C - Rural Health Unit/Urban Health Center RP - Republic of the Philippines SIDCA - Swedish International Development Cooperation Agency SBWS - Subic Bay Water & Sewerage SRP - Self-Rated Poverty SSS - Social Security System SWS - Social Weather Stations TA - Technical Assistance TEEP - Third Elementary Education Project TFS - Tuition Fee Subsidy TH/A - Traditional Healer/Attendant UHC - Urban Health Center UK - United Kingdom UN - United Nations UNCHBP - United Nations Centre for Housing, Building and Planning UNDP - United Nations Development Programme UNICEF - United Nations Children's Educational Fund UPA - Urban Poor Associates UPAO - Urban Poor Affairs Office URC - Urban Research Consortium WB - World Bank WD - Water District WHO - World Health Organization   TABLE OF CONTENTS SUMMARY ........................................I 1. Introduction .i 2. Summary Findings .vi 3. Institutionalization of the Report Card .xx CHAPTER I: INTRODUCTION ..1 1. What is the Report Card .1 2. Why Prepare a Report Card9 .2 3. What Does the Report Card Present .4 4. How are the Poor Identified? .5 5. How Participatory is the Report Card? 6 6. Structure of the Report .8 7. Last Word .9 CHAPTER II: HEALTH ..10 1. Poverty and Health .10 2. The Survey .1 3. Use and Access .11 4. Services Provided by Health Facilities .14 5. Satisfaction with Heath Facilities .16 6. Health Expenditures .20 7. Key Findings and Recommendations .23 8. The Government Health Sector Reform Agenda .27 CHAPTER III: ELEMENTARY EDUCATION . .30 1. Poverty and Education .30 2. The Survey .31 3. Use and Access .31 4. Drop-Outs .33 5. Satisfaction with Elementary Schools .34 6. Household Expenditure on Schooling .38 7. Parent-Teacher Associations .40 8. Key Findings and Recommendations .42 CHAPTER IV: WATER SUPPLY . .49 1. Poverty and Potable Water .49 2. The Survey .52 3. Access .52 4. Reasons for Not Applying .55 5. Water Consumption .57 6. Household Expenditure on Water .60 7. Satisfaction with Water Supply Services .62 8. Key Findings and Recommendations .63  Filipino Report Card on Pro-Poor Services CHAPTER V: HOUSING .. .................................. 71 1. Poverty and Housing ....................................... 71 2. Structure of the Chapter ....................................... 72 3. The Survey ....................................... 73 4. Client Assessments of Current Housing ....................................... 74 5. Client Assessments of Housing Services ............ ........................... 83 6. Key Findings and Recommendations ....................................... 92 CHAPTER VI: SUBSIDIZED RICE DISTRIBUTION . ............................ 103 1. Poverty and Food Security ....................................... 103 2. NFA's Mandate ....................................... 103 3. The Survey ....................................... 105 4. Rice Consumption ....................................... 105 5. Household Expenditure on Rice ....................................... 107 6. Awareness and Access ....................................... 109 7. Factors Influencing Rice Purchases ....................................... 110 8. Targeting Rice Subsidies to the Poor ........................................111 9. ERAP (Enhanced Retail Access for Poor) Stores ....................................... 113 10. Key Findings and Recommendations ........... ............................ 115 11. Targeted Low-Priced Rice Distribution Pilot Program ...................................... 117 CHAPTER VII: LINGAP PARA SA MAHIHIRAP PROGRAM ................................ 120 1. Poverty Alleviation Funds ................................................. 120 2. Lingap Para sa Mahihirap Program .................. ............................... 122 3. Funding ................................................. 123 4. Progress to Date ................................................. 125 5. The Survey ................................................. 126 6. Awareness ................................................. 126 7. Inclusion of Non-Poor Barangays ................ ................................. 127 8. Inclusion of Non-Poor Households ................................................. 128 9. Role of Elected Representatives ............... .................................. 129 10. Key Findings and Recommendations ................................................. 133 CHAPTER VIII: INSTITUTIONALIZATION OF THE REPORT CARD ..................... 137 1. Why Institutionalize the Report Card? ................................................. 137 2. Global Experience with Report Cards ................................................. 138 3. Institutionalizing the Report Card in the Philippines ......................................... 141 4. Improving the Report Card ................................................. 143  Filipino Report Card on Pro-Poor Services APPENDIX 1: SAMPLE DESIGN AND METHODOLOGY .................................... 145 1. Itroduction .145 2. Sample Size .145 3. Geographic Distribution of the Sample .145 4. Questionnaire .148 5. Survey Execution .151 6 Household Characteristics .152 7. Urban-Rural Distribution of Households .154 8. Poverty Classifications .154 9. Data Analyses .156 BIBLIOGRAPHY . 66 ACKNOWLEDGEMENTS The Filipino Report Card on Pro-Poor Services is prepared by a team led by Bhuvan Bhatnagar, Task Team Leader, and comprising Musunuru Sam. Rao and Adarsh Kumar. The client satisfaction survey, on which the Report Card is based, has been designed and implemented by the Social Weather Stations, under the direction of Mahar Mangahas and Linda B. Guerrero. The sector chapters are prepared by Joven Balbosa, Jayshree Balachander, Carol V Figueroa-Geron, Vijay Jagannathan, Mariles Navarro, Ching Dela Pena, and Mary Racelis, with inputs from the Report Card Team. Ganesan Balachander, Cyprian Fisiy, Marita Concepcion C. Guevara, Angie Ibus, Manny Jimmenez, Smita Lahiri, Juri Oka, Samuel Paul, Parmesh Shah, and Anna Wetterberg provided valuable suggestions and inputs. In addition to direct contributions to its contents, the Report Card has benefitedfrom the comments andfeedback of several hundred reviewers both inside and outside the Bank. Cheloy Tria provided excellent production support.   FILIPINO REPORT CARD ON PRO-POOR SERVICES SUMMARY "I believe in listening to and learning from those whom I serve. I will ensure that my organization creates and respects genuine mechanisms for regularfeedbackfrom our citizen- customers, and subsequently uses this feedback to render better service to them. " President Gloria Macapagal-Arroyo' 1. INTRODUCTION A. What is the Report Card? 1. The Report Card is a means by which citizens can provide credible and collective feedback to public agencies about their performance. It brings forth information on users' awareness, access, use and satisfaction with public services. It is an important follow-up to the World Bank's Philippines Poverty Assessment.2 It complements the expert analyses and findings in the Poverty Assessment with a "bottom-up" assessment of pro-poor services in five key sectors -- health care, elementary education, water supply, housing and subsidized rice distribution.3 2. The Report Card identifies the key constraints that Filipinos face in accessing public services, their appraisals of the quality and adequacy of public services, and the treatment they receive in their interactions with service providers, especially government officials. It offers several recommendations on sector and sub-sector policies, strategies and programs to address the constraints and improve service delivery, especially to the poor and under-served areas and groups. 3. The Report Card is based on a national client satisfaction survey undertaken by the World Bank in collaboration with the Social Weather Stations (SWS), a premier survey research organization in the Philippines that is independent, non-partisan and credible. The survey was implemented from March 26 to April 17, 2000. It covered 1,200 households, distributed nationwide in four broad regions: National Capital Region (NCR), Balance Luzon,4 Visayas, and Mindanao -- in proportion to their population. In keeping with global best practice, client satisfaction with public services in the 1 President Gloria Macapagal-Arroyo required her Cabinet members to undertake a pledge to be accountable to eleven service standards, including responsiveness to Constituency Feedback. 2Philippines Poverty Assessment, The World Bank, Washington, D.C., June 14, 2000. 3 These five sectors are key elements of the government's poverty reduction efforts under the Minimum Basic Needs (MBN) approach, which include the Social Reform Agenda of the Ramos Administration and the flagship Lingap Para sa Mahihirap Program of the Estrada Administration. 4Rest of Luzon excluding NCR.  Filipino Report Card on Pro-Poor Services ii Summary Philippines is assessed using the results for the services provided by the private sector as benchmarks.5 B. Why Prepare a Report Card? 4. There is a growing concern in the Philippines about the performance and accountability of public agencies that deliver services, especially to the poor. Most accountability mechanisms for public agencies focus on inputs (e.g., number of personnel, facilities, and expenditures) and occasionally on broad outcome indicators such as literacy and mortality rates. Beyond this arithmetic, little is known about the QUALITY of services delivered by the State. It is therefore difficult to identify specific areas for improvement to make public services more responsive to and effective in meeting the needs of the users. 5. There are a number of evaluations of pro-poor programs in the Philippines, undertaken by service providers and experts that often identify program-specific problems and issues with little connection to sectoral and cross-sectoral dimensions. Also, very few of the evaluations and assessments are done from the client perspectives. The Report Card initiative was launched to undertake an assessment of pro-poor services by citizens, based on their experience. In addition, the Report Card helps to pull together the myriad individual problems facing the various programs into common sectoral issues, by drawing attention to the worst problems and good practices in the five selected sectors. By ranking and quantifying issues, it brings into limelight those concerns that trouble the clients most and can trigger public pressure and collective action. 6. To be effective, traditional public accountability systems need to be strengthened and reinforced through adoption of innovative approaches that involve public participation. Those at the receiving end -- clients/users or Filipino citizens -- are well placed to provide systematic feedback to service providers and policy makers on the results of government actions that are intended to benefit them. While most users may not be able to comment on complex technical matters, they are eminently qualified -- EXPERTS -- on whether the public services meet their needs and expectations, whether specific aspects are satisfactory or unsatisfactory, and whether the concerned agencies are responsive, reliable, and accountable. 7. The Report Card is a timely initiative, which should help translate the renewed commitment of Filipinos6 to a democratic, transparent and accountable State that responds to the needs of the people, especially the poor. It builds upon the previous Administration's commitment to "treat each citizen as a customer in much the same way as the best private companies treat their clients." This commitment is reiterated by President Gloria Macapagal-Arroyo, who required her Cabinet members to sign a Pledge 5 For example, see Federal Agencies Government-wide Customer Satisfaction Report for the General Services Administration, December 1999, University of Michigan Business School, American Society for Quality, and Arthur Anderson. 6 After the successful non-violent People Power II revolution in January 2001.  Filipino Report Card on Pro-Poor Services iii Summary to be accountable to eleven service standards, including responsiveness to Constituency (client) Feedback.7 8. This shift to think of Filipinos as customers or clients rather than beneficiaries requires that their "voices" count in the design, delivery and assessment of public services. Private firms operating in a competitive environment make use of this approach and use the information gathered through client surveys to redesign their products to meet customer needs and enhance customer loyalty. User feedback is especially important for government service providing agencies as they often operate as monopolies or oligopolies where people (particularly, poor people) may have few viable and affordable alternatives. For example, aspects such as quality of services, timeliness of service delivery, and responsiveness of agency personnel may leave much to be desired, but market pressures (through, for example, competition in service provision at comparable prices) are missing to rectify the deficiencies. Client feedback is a much-needed corrective in this setting, which can be used either by reform-minded champions in the government and/or as a trigger for public pressure to improve performance. 9. While user report cards and client surveys are new to most governments and their agencies, these are now being used as a way to assess performance of public agencies in several countries including Canada, Denmark, Ghana, India, Sweden, United Kingdom, United States, and Uzbekistan. In these cases, quantifying and grading different dimensions of public services from the perspective of users is helping government agencies measure and benchmark their performance, understand the factors that contribute to it, and respond better to the needs and expectations of the people they serve. C. What Does the Report Card Present? 10. The Report Card presents people's perspectives on pro-poor services that are not always captured in traditional evaluations by experts and in the routine reports of agencies providing the services.8 The client assessments bring forth valuable insights into such critical dimensions as awareness, availability, and affordability of pro-poor services from different service providers (e.g., government, private sector and other sources). These service dimensions are presented from the perspectives of different population groups, differentiated by geographic region, rural and urban residence, and level of household expenditure. These should be key inputs in the design and improvement of effective service delivery programs. They should be seen as complementing the findings of expert evaluations and agency reports. 11. The insights derived from the Report Card should be helpful in understanding the degree to which the pro-poor services are reaching the target groups, the extent of leakages, and factors that contribute to such misdirection of resources and services. They help identify the physical availability, quality and cost factors that constrain the access to 7 See quote from President Gloria Macapagal-Arroyo at the beginning of this Summary. 8 For example, some of the new insights emerging from the Report Card that have not been captured by traditional surveys to-date, include health/disability-related reasons for dropping out of elementary school and the high dissatisfaction of rural households with their housing. These findings deserve further scrutiny and follow-up.  Filipino Report Card on Pro-Poor Services iv Summary and use of the services by the poor and possible means to rectify the situation. The latter includes suggestions by the respondents (citizens) on the types of programs that might enhance service delivery to and use by the poor. Also, the Report Card results help test some of the policy conclusions in other analytical studies9 from the clients' standpoint. Thus, it complements the analytical work of the World Bank and others from a "bottom- up" perspective. The client appraisals from the Report Card survey need to be augmented with expert assessments and agency reports to obtain a comprehensive picture of the strengths and weaknesses of service provision to various groups. To this end, secondary data have been used to complement and crosscheck, wherever available. D. How are the Poor Identified? 12. The primary poverty measure in the Report Card is based on household expenditures. Households with expenditures in the bottom three expenditure deciles (bottom 30%) are classified as poor;'0 those with expenditures in the fourth to sixth deciles (middle 30%) as middle-income; and those with expenditures falling in the top four expenditure deciles (top 40%) as rich. This helps link the quantitative poverty information from the expenditure module of the Annual Poverty Indicators Survey (APIS) with client feedback on pro-poor services in the Report Card. E. How Participatory is the Report Card? 13. Planning the Report Card survey began with consultations with key stakeholder groups in government, private sector, civil society, and selected academic institutions in the Philippines. The inputs of different stakeholders were actively solicited and incorporated in the design of the survey questionnaire. After completion of the fieldwork, preliminary data tables were prepared and the initial findings drawing upon the tables were presented to stakeholder representatives in regional workshops in Manila, Clark and Cebu during June 2000. The participants identified a number of nuances that were helpful in explaining the apparent discrepancies between the Report Card results and sector level data." Altogether, the feedback from the participants in the workshops helped in validating the preliminary results from the Report Card survey. Also, the stakeholder representatives suggested areas for further analysis and additional tabulations in the Report Card, which have been taken on board and implemented. The strong stakeholder participation in the preliminary workshops suggests that there is interest in the Report Card findings, and positive expectations regarding the follow-up actions. 14. Detailed tabulations of the Report Card survey responses, analyses and interpretation of the results were carried out during the succeeding six-months. A number of World Bank sector specialists and national experts prepared the write-ups on 9 For example, the reconmmendations in the Philippines Poverty Assessment such as abolishment of a general rice subsidy and weak performance of the Lingap Para sa Mahihirap Program. '