1. Importance of Cross-Sectoral Impacts
and Thematic Considerations
to Achieve the MDGs and Future SDGs:
Synthesis of ESCAP Studies
Shiladitya Chatterjee
Siem Reap , 6 March 2015
1
High-Level Asia-Pacific Policy Dialogue on the Implementation of the
Istanbul Programme of Action for the Least Developed Countries
2. Plan of Presentation
1. Implications of
A. Cross-sectoral impacts
B. Thematic considerations
2. Country responses and their problems
A. National level coordination
B. Outcome level coordination
C. Local level coordination
D. External aid coordination
3. Recommendations
2
7. Importance of basic infrastructure
• Importance of roads
– Lao PDR roads
• Improved income earning opportunities in rural areas
• Facilitated irrigation and electrification
• Reduced rural poverty: areas with roads had lower poverty (28%) than those without (41%)
– Nepal: areas with roads had lower MMRs
– Bhutan: roads helped improve school attendance rates
• Importance of electricity
– Nepal: health facilities improved vastly with electricity availability
– Lao PDR: households with electricity had much lower poverty (17%) than those
without (39)%
• Importance of irrigation
– Lao PDR: households without irrigation had much more poverty (78%) than
those with (22%)
7
8. Cross-sectoral impacts: health and education
• Education benefits health
– Nepal districts with higher women’s literacy had much lower maternal mortality
(correlation -0.12; p>0.005)
• School health programs improve student and general health
– Nepal’s School Health and Nutrition program benefited students by
• Reducing anemia and parasite infections
• Improved general knowledge of nutrition and health
– Bhutan’s health education in schools promoted
• Hygiene and nutrition
• Awareness of emerging health issues like STD, HIV/AIDS, and adolescent
reproductive health
• School nutrition and feeding programs improve education
– In Bhutan, improved enrolment and attendance rates particularly of poor families
• Major benefits accrue in combining health, nutrition and
education interventions
– Bhutan has emphasized Early Childhood Education which combines all three for
pre-school children
8
9. Cross-sectoral impacts: water and sanitation on
health, education and environment
• WATSAN has direct impact on health
– Cambodia: in 2005 poor WATSAN caused 9.5 million cases of
diseases; 10,000 deaths; and health costs of US$ 11 million.
– Nepal: improved WATSAN significantly reducing MMR
• WATSAN helps education
– Bhutan: lack of WATSAN hurt children’s ability to learn, increased
absenteeism (particularly girls) and under-nutrition
– Cambodia: clear relationship between female school drop-out
rates and lack of sanitation in schools
• WATSAN impacts severely on environment
– Cambodia: high costs of poor WATSAN caused loss of tourism
revenues ($75 million annually); and
– Improper disposal of wastes severely contaminates ground water
9
12. Gender
• Neglect of gender equity can devalue MDG outcomes
seriously
– MDGs did not stress this enough; SDGs must remedy this
– Cambodia: neglect of gender considerations leads to
higher drop outs
– Nepal: lack of gender empowerment
• affects women’s health which requires broader interventions
involving gender empowerment not just treatment of women
• gender discrimination complicates obstetric care
• Women’s literacy reduces maternal deaths
• Intersection of discriminations need more attention
– Bhutan: women from ethnically deprived groups suffer
more
12
13. Other forms of inequity
• Income inequity and poverty
– Nepal: out-of pocket (OOP) health expenditures of poor
(64% of income) almost double of non-poor (36%)
– Cambodia: WATSAN services for poor neglected
– Bhutan: children from poor households had high drop outs
from school
• Social discriminations; ethic and minority status
– Lao PDR: poverty reduction much slower among
discriminated groups
– Nepal: OOP health expenditures for disadvantaged janajatis
(53% of income) higher than upper castes (32%)
• Geographical inaccessibility: remoteness, mountains
– Nepal: OOP of mountain areas (65% of incomes) higher than
non-mountain
13
14. Lao PDR: poverty reduction slow for mountains
and some ethnic groups
14
15. Participation
• Decentralization mostly incomplete in LDCs
and beset with multiple problems
– Nepal: Health decentralization has coordination,
resources and staffing issues
– Bhutan: individual schools still need to navigate
bureaucratic hurdles for resources and facilities
– Cambodia: WATSAN still centralized
• Civil society insufficiently involved
• Private sector participation still miniscule
15
17. A. National level coordination:
Lao PDR strategic planning and budgetary processes
Resolution of 7th
, 8th
& 9th
Party Congresses
11 National Priority Programs
4 Break Through Guidelines
National Programs
Industrialization and Modernization Strategy2001-
2020
2020 Vision
National Growth and Poverty Eradication Strategy
National Strategy
Development Strategyfor 2010 and 2020
Etc.
Development MasterPlan
National Development Master Plan
Regional Development Master Plan
Medium Term Development Plan
National 5-Year Socioeconomic Development Plan
Sectoral 5-Year Development Plan
Provincial 5-Year Development Plan
Annual Development Plan
National Annual Socio-Economic Development Plan
SectoralAnnualDevelopment Plan
Provincial Development MasterPlan
Sectoral Development Master Plan
Source:OrabouneS,2011
ine inistriesand
rovinces - lanningand inancial onference
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18. A. National level coordination: problems
• Positive side of Lao PDR and Cambodia examples
– Integrates MDGs within the planning process
– Involves some participatory process
• Provision exists for consultation with stakeholders such as provinces,
external donors and private sector
• Technical working groups (TWGs) important coordination mechanism
• Problems
– Process too rough and inexact; only a rigorous exercise such as
MAMS can resolve this
– Ministries remain silo-based focused on sectors rather than
outcomes
– Little indication that effective coordination (beyond routine
consultation) with civil society and private sector is done
– Insufficient attention to thematic considerations
18
19. Philippines MAMS example
• Uses a core CGE model that captures basic
structure and interactions of the economy
– Involving a Social Accounting Matrix (SAM)
• Services highly disaggregated to capture the MDG services
• An MDG module is built in
– This contains equations that determine the MDG
indicators
• The two interact through
– Household consumption, provision of MDG services,
wages, infrastructure stocks. For example,
• Education demanded = f (quality of education, wage
premium of education, health, infrastructure, per capita
consumption)
19
20. B. Coordination of individual outcomes:
L h
Costing of MDG child nutrition targets for
2014 and 2015 (US Dollars)
Sector Total cost Available
resources
Financial
gap
Agriculture 42,840,000 21,700,000 21,140,000
Education 9,800,000 3,650,000 6,150,000
Health 9,380,000 1,994,000 7,386,000
WASH 18,480,000 3,200,000 15,280,000
Multi-sectoral coordination, external
monitoring and evaluation (1.5% of
total)
1,207,500 25,000 1,182,500
Total 81,707,500 30,569,000 51,138,500
Multi-sector national nutrition strategy
20
21. B. Coordination of individual outcomes:
problems
• The positive side: example Lao PDR nutrition model
– Involves detailed inter-sectoral costing
– Has supporting sector level strategies in concerned sectors
– Developed a high level coordination mechanism for multi-
sectoral and thematic coordination
• Problems however are
– Arrangements focused mainly on public sector and
national government
– Equity (thematic) aspect needs to be better addressed
• E.g. services to poor and traditionally deprived ethnic groups
– Coordination arrangements need better integration with
budgetary process
21
22. C. Local level coordination
Cambodia: Alignment of
national and local level plans Nepal: District level coordination
22
23. Local level coordination: problems
• Local coordination requires both vertical and
horizontal coordination
• Challenges to vertical coordination
– Decentralization has not proceeded adequately
• Insufficient clarification of roles and responsibilities
– Insufficient information on MDGs
• Horizontal coordination at local level generally
weak
– Overemphasis on vertical coordination of national
programs and priorities
– Insufficient devolution of authority
– Weak local capacities
23
24. D. Coordination of external assistance
Cambodia: ODA critical and
supports several sectors Principles of aid effectiveness
Series1,Health,13.5
Series1,Education,9.7
Series1,HIV/AIDS,3.2
Series1,Agriculture,10.0
Series1,RuralDevp,5.0
Series1,Mfg,Tourism,Finance,1.4
Series1,UrbanPlg,0.7
Series1,Transport,28.9
Series1,WATSAN,4.8
Series1,Energy,4.7
Series1,InfoComm,0.2
Series1,Governance,6.7
Series1,SocWelfare,5.3
Series1,Gender,0.6
Series1,Env,1.7
Series1,ClimareChange,0.6
Series1,Culture,0.3
Series1,BudgetSupp,1.1
Series1,FoodAid,1.8
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25. D. Coordination of external assistance: problems
• Five principles of aid effectiveness not working
– Ownership not pursued particularly at local levels
– Alignment hurt by donors sticking to own systems
and calendars
– Harmonization affected as few donors developed
common arrangements; most focused on funds and
not improving systems; set up own PMSs
– MfDR ineffective as each donor following own MfDR
system
– Accountability weak with divergent donor systems
• Insufficient capacity to coordinate large number
of donors
• Functioning of Donor Working Groups has to be
improved
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27. General
• Data improvements essential for better coordination
– MDGs have suffered throughout with missing or outdated data
– Data also needed on disaggregated basis
• both at national and subnational levels (including spacial categories)
• according to thematic needs (gender, poor and non-poor or income
levels, and socially deprived groups)
– Periodical updating of data is also critical
– Statistical capacity building is a major need, particularly for LDCs
• Will need considerable external support
• Regional partnership between UN, the multilaterals and large
bilaterals such as Ausaid and JICA necessary
• Abandoning sector bias and focusing on outcomes essential
– For future SDGs, sector bias has to be modified
– Need to integrate thematic considerations in outcomes
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28. National level coordination
• Comprehensive overall coordination necessary at
national level
– To best account for cross-sectoral and thematic
influences
– Process best informed by MAMS type exercises
• LDC capacity building for this necessary
• Ideally, ministries should be reorganized along
development goals
– Alternatively, fully empowered superstructures
organized on outcome basis
– Response to thematic objectives also built in
– And effective participation
28
29. Coordination at outcome level
• Detailed outcome level coordination necessary to supplement
national level coordination
• Enhanced version of Lao PDR coordination of child nutrition can
provide a good model. Desirable features are
– Detailed costing of investment needs by all sector ministries
• Helps in planning budget allocations
– Incorporation of strategies and action plans supporting child nutrition
outcome in all concerned sector and thematic ministries
– Establishing an outcome superstructure type coordination mechanism
• Headed at a suitably high level
• Fully empowered, and
• With representation of all concerned ministries and stakeholders
– Adding strong participation elements including with LGUs and private
sector
– Better responsiveness to equity objectives
– Strong linkages to budgetary processes
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30. Coordination at local level
• Local level coordination essential for success in
meeting development goals
• But such coordination may fail if decentralization
is not carried out effectively
– More authority has to be delegated to LGUs
– More information must be disseminated about
development goals at local levels
• Attention needed on both vertical as well as
horizontal coordination
– Overemphasis on vertical coordination must end
• Major strengthening of capacities of local staff
essential
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31. Coordination of external assistance
• Given importance of development aid, better
coordination of external assistance is critical
• Five principles of aid effectiveness must be
properly implemented by both government and
donors
• LDC governments must improve capacities to
coordinate external assistance more effectively
• The coordination process, particularly functioning
of donor working groups must be improved
– More outcome rather than sector focus
– Full participation by government
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