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Understanding and monitoring service delivery in a decentralizing environment in Mongolia : the case of education and health (English)

This study attempts to develop a better understanding of how education and health service delivery in Mongolia has been affected by decentralization and identifies measures to strengthen service delivery going forward. A “decision space” (the amount of choice local officials have over different system functions) analysis was used to provide a general overview of the degree of choice local officials have over different system functions as well as capacities and accountability at different levels of the system. Quantitative and qualitative surveys were developed to gather information on implementation of the The Integrated Budget Law (IBL), as captured by the perspectives of local authorities, service delivery units, and citizens on the delivery of education and health services. Several issues related to service delivery in a decentralizing environment were also examined, namely: education financing, teacher management, and health service provider payment systems. Further information on Mongolia’s public finance system, with a focus on financing of education and health services, is presented in Chapter 1 of this report; a full description of the “decision space” framework for assessing the impact of the IBL on delivery of education and health services is presented in Chapter 2; findings from the six modules of the survey, comparing the perspectives of different actors and stakeholders on education and health services delivery, are presented in Chapter 3; this study also examined several issues pertinent to service delivery in a decentralizing environment, such as the current system of primary and secondary education financing and proposed measures to help strengthen the system as described in Chapter 4; further issues related to teacher management and teachers’ wages are examined in Chapter 5; analysis of health services provider payment systems, for which the implications of the IBL are particularly important in the context of payments to primary care providers is presented in Chapter 6. The main conclusion is that a major overhaul of the payment systems does not seem to be necessary. Mongolia can make substantial progress with a shift in the basis for the payment cap and budget payment from inputs to parameters that reflect population health needs and with some technical refinements to the design of the diagnosis-related group-based payment system and capitation.

Details

  • Document Date

    2015/12/31

  • Document Type

    Working Paper

  • Report Number

    103721

  • Volume No

    1

  • Total Volume(s)

    1

  • Country

    Mongolia,

  • Region

    East Asia and Pacific,

  • Disclosure Date

    2016/03/07

  • Disclosure Status

    Disclosed

  • Doc Name

    Understanding and monitoring service delivery in a decentralizing environment in Mongolia : the case of education and health

  • Keywords

    education and health;health facility;primary health care services;public health facility;private health care facilities;income from user fees;children with special need;provision of health service;access to health service;primary health care facilities;Primary and Secondary Education;human resource management;delivery of education;state budget;quality of care;health service provider;quality of education;Financing of Education;insufficiency of fund;amount of fund;central government transfer;health care facility;degree of autonomy;adequate human resources;health facility level;family group practice;intergovernmental fiscal relation;public sector finance;regulation on price;provision of education;availability of service;local revenue source;line item budget;delegation of authority;local budget;provider payment mechanisms;basic education facility;success of reform;provision of service;education development plan;subnational government finance;expenditure in education;expenditure education;accountability in education;management development;degree of independence;public health service;Public Financial Management;source of revenue;household survey result;service delivery system;public sector reform;education service delivery;public sector financing;public service provision;fiscal decentralization reform;source of financing;types of service;decision on procurement;teacher training program;secondary school level;central government control;Access to Education;achievement of targets;expenditures on wages;quality of teaching;quality of teacher;health service provision;income from fee;cost of delivery;primary health service;public finance system;delivery of health;corporate income tax;survey results;Fiscal Reform;health organization;school financing;service charges;teacher management;financial flow;payment system;intergovernmental transfer;budget constraint;empirical investigation;survey respondent;local capacity;expenditure assignment;own-source revenue;budget allocation;budget proposal;budget category;Salary Scales;accountability mechanism;education organization;organizational level;

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Citation

Understanding and monitoring service delivery in a decentralizing environment in Mongolia : the case of education and health (English). Washington, D.C. : World Bank Group. http://documents.worldbank.org/curated/en/736861468191042111/Understanding-and-monitoring-service-delivery-in-a-decentralizing-environment-in-Mongolia-the-case-of-education-and-health