Central America Social Expenditures and Institutional Review

World Bank

Central America Social Expenditures and Institutional Review

Autores

World Bank

Editor

World Bank, Washington, DC

Descripción

The evolution of Costa Rica’s social sectors over the past decade has been dichotomous. On the one hand, economic growth has remained relatively high, however poverty and inequality have not declined (moreover, they have increased), and persistent employment challenges remain. On the other hand, the country has continued experiences advances in many social indicators, such as pre-primary and tertiary enrollment rates, access to improved sanitation, and labor force participation, though not in others (secondary school completion, immunizations, employment). Higher economic growth and (to a lesser extent) revenues seem to have allowed a substantial increase in public social spending. Looking forward, the key challenges Costa Rica faces are related to continuing improving the quality and efficiency in the social sectors, while improving targeting to serve the most in need, in a tight and severe fiscal context. To expand coverage of excluded population, priority will have to be given to reallocations and improvements within the spending envelope for the social sectors to maximize impact. With a fiscal deficit of more than 6 percent of GDP, further expanding public social spending is no longer an option and budget cuts are looming. Improvements in public spending management and budget execution, including the need of institutional reform to consolidate programs and improve coordination among executing agencies is equally important. In a country that has long been the champion in expanding universal welfare state, sustainability concerns will imply that hard fiscal decisions would need to be made to increase the social returns of budget allocation.

Palabras clave

SANITATION, RISKS, WORKFORCE, ECONOMIC GROWTH, BASIC EDUCATION, QUALITY OF SERVICES, NATIONAL DEVELOPMENT PLAN, FORMAL EDUCATION, SOCIALIZATION, PEOPLE, OLD AGE, SKILLED WORKERS, SOCIOECONOMIC STATUS, INFORMATION SYSTEM, HUMAN IMMUNODEFICIENCY VIRUS, PUBLIC EDUCATION, PREVENTION, LAWS, LIVE BIRTHS, COMMUNITY HEALTH, LEVELS OF EDUCATION, RESOURCE ALLOCATION, LABOR FORCE, HEALTH INSURANCE, PUBLIC SERVICES, PRENATAL CARE, NATIONAL DEVELOPMENT, HEALTH CARE, PUBLIC SECTOR EXPENDITURES, HEALTH, DROPOUT, COMPREHENSIVE CARE, INFORMATION TECHNOLOGIES, HYPERTENSION, RURAL POPULATION, FUTURE GENERATIONS, SOCIAL SCIENCES, INFORMATION SYSTEMS, LONGER LIFE, HOSPITAL, PUBLIC HEALTH, LIFE EXPECTANCY, ACCESS TO EDUCATION, MATERNAL MORTALITY, HEALTH SECTOR, KNOWLEDGE, SET OF RECOMMENDATIONS, DIABETES, LABOR MARKET, COMMUNITY DEVELOPMENT, MINISTRY OF HEALTH, MILLENNIUM DEVELOPMENT GOAL, DISEASES, TRAINING, IMMUNIZATION, PATIENTS, PATIENT, SOCIAL EXCLUSION, EDUCATIONAL ATTAINMENT, INTERVENTION, POPULATION DIVISION, HEALTH INDICATORS, FAMILY HEALTH, PUBLIC HOSPITALS, AGING, DEMOGRAPHIC PROJECTIONS, SECONDARY SCHOOL, CHILD DEVELOPMENT, FERTILITY RATE, HEALTH CARE SERVICES, ADOPTION, TETANUS, MARKETING, HOUSEHOLD INCOME, HOUSEHOLD SURVEYS, MORTALITY RATE, SOCIAL SECURITY, TEACHER SALARIES, TUBERCULOSIS, SOCIAL RETURNS, SERVICE DELIVERY, PLACE OF RESIDENCE, SOCIAL EXPENDITURES, GROSS DOMESTIC PRODUCT, MORTALITY, HEALTH CARE SYSTEM, RISK GROUPS, ELDERLY, RESPECT, PROGRESS, UNEMPLOYMENT, CHILDBIRTH, INFANT MORTALITY, POPULATION TRENDS, HUMAN CAPITAL, INFANT, DIPHTHERIA, INVESTMENT IN EDUCATION, WORKERS, WHOOPING COUGH, SURGERY, SOCIAL SECTOR, POLICIES, LABOR CODE, AGED, SOCIAL SERVICES, PATIENT SATISFACTION, CHRONIC DISEASE, HIV, BASIC NEEDS, IMMUNODEFICIENCY, PENSIONS, IMPACT ON HEALTH, PUBLIC HEALTH EXPENDITURE, MEDICAL SERVICES, SOCIAL POLICY, MINISTRY OF EDUCATION, HEALTH OUTCOMES, INTERPERSONAL SKILLS, LONG-TERM CARE, POPULATION DENSITY, URBAN AREAS, STRESS, EARLY CHILDHOOD, IMMUNIZATIONS, MANDATES, DECISION MAKING, CHEMOTHERAPY, NUTRITION, MEASLES, POPULATIONS, POLICY, PRIMARY HEALTH CARE, WORLD HEALTH ORGANIZATION, DEMOGRAPHIC TRENDS, LIFESTYLES, CHILD MORTALITY, HEALTH SYSTEM, SOCIAL SECTORS, SEX, GOVERNMENT POLICIES, COMMUNICABLE DISEASES, PREGNANT WOMEN, WORLD POPULATION PROJECTIONS, TEACHER RATIO, CHILDREN, LEVEL OF EDUCATION, CLINICS, WORLD POPULATION, HEALTH PROVIDERS, RURAL AREAS, POPULATION PROJECTIONS, ISOLATION, ENDOCRINE SYSTEM, DISABILITY, CIRCULATORY SYSTEM, NUMBER OF DEATHS, SCHOOL YOUTH, POPULATION, HOSPITAL BEDS, STUDENTS, INSTITUTIONALIZATION, NOURISHMENT, DIGESTIVE SYSTEM, MATERNAL MORTALITY RATE, STRATEGY, SOCIOECONOMIC DIFFERENCES, PRIMARY EDUCATION, FERTILITY, FAMILIES, WOMEN, MEDICINES, HOSPITALS, MATERNAL MORTALITY RATES, HEALTH INTERVENTIONS, PUBLIC SERVICE, INFANT MORTALITY RATE, SECONDARY EDUCATION, TERTIARY EDUCATION, SOCIAL WORKERS, HEALTH SERVICES, IMPLEMENTATION, PREGNANCY, AT RISK GROUPS, DEMAND FOR SERVICES, NURSING, HUMAN DEVELOPMENT, SANITATION FACILITIES